While renewing my driver’s license this past weekend, I was again faced with a simple question that we all encounter on DMV forms—would you like the Organ Donor designation to appear on your driver license? These 13 simple words will never impact me directly during my lifetime, but what the state fails to offer with this choice is an explanation of what it truly means to be an organ donor.

The consequences of my answer—which was yes, by the way—will impact my loved ones, and also the lives of at least 18 others who might receive my organs and tissues.

The United States currently uses a system of “encouraged voluntarism” to sustain its organ supply.  Under this system, the method for obtaining organ donors is to educate the public about the social benefits of becoming an organ donor, and facilitating the process so those who wish to be donors volunteer to do so.  There are obviously problems with this current method.

For example, many do not feel moved to check that crucial box on their form; however, alternative methods have their flaws as well.

According to the organizations that coordinate and control transplantation in the United States, UNOS and OPTN, there are nearly 120,000 people in this country who are waiting for the life-saving call that tells them that an organ has become available.

Unfortunately, there are two equally saddening factors that contribute to this statistic.  Every day, 18 people die while waiting for a transplant and the many people who will receive organs do so with the loss of another life, the life of the donor.

Now, on the bright side, over 14,000 transplants took place this year between January and June, with organs coming from almost 7,000 donors.  Begin to consider the number of people who require multiple organs in their transplant, however, and you begin to see that 14,000 transplants does not necessarily mean 14,000 recipients. Next, consider the rates of rejection and number of people who are too sick to even be considered for the waiting list, and the status of the organ supply in this country becomes startlingly bleak.

There are many in the world of medicine and bioethics who point to the “failure” of encouraged voluntarism as a major contributor to the low number of transplantable organs.

Others, like the parents of 12-year-old Newtown Square resident Sarah Murnaghan point to the bureaucracy of the organizations involved in organ procurement and allocation.  Murnaghan first entered the public eye this summer when her parents sought relief from a federal judge to help their child, who suffers from end-stage cystic fibrosis, to gain access to the life-saving transplant of adult lungs.

With current rules of organ allocation, Sarah was at the end of the adult transplant list, but with her worsening condition and the scarcity of pediatric organs, her parents were taking every avenue available to help her survive.  With the intervention of the judge, who argued organ allocation in children should be based on size rather than age, Murnaghan received a pair of adult lungs in early June.

These organs were rejected by her body and she received another pair three days later.  She has recovered well and returned home.

Despite the victory won by the Murnaghans, the picture for people waiting for organs is not much brighter.  Some would consider what they did to be “gaming the system.”

Such accusations are not uncommon, as many would argue that Steve Jobs did the same thing while he was waiting to receive a liver transplant in 2009.  Jobs used his considerable resources to be registered on waiting lists at multiple transplant centers.

While not illegal, many consider actions such as these to be unethical. Dick Cheney has also faced similar charges in his hunt for a healthy heart. Many view this improved access to potential organs as an unfair advantage of the wealthy, which leads to inequitable allocation of the few organs that can be harvested from donors.

One method is to alter the system of donor registration.  Several European countries, including Spain, Portugal, Norway,  Belgium and, most recently,  Wales,  have moved to a system of “presumed consent.”

Under such a system, the default position is that every person wishes to be an organ donor, and those who prefer not to have their organs donated to others must register with the government as non-donors.  Such a system has also been proposed by a New York lawmaker in 2010, although the measure was defeated.  A benefit of this system is the guaranteed knowledge of someone’s status.

The current system allows for some ambiguity, as some would-be donors do not indicate their wishes.  To alleviate this confusion, New Jersey passed a law stating that the organ donor registry contact the deceased’s family to check medical records and to ask for their consent in harvesting the organs of the deceased.

Another way to change the system for organ procurement would be to alter it from a system of donation to a market system.  Under such a model, organs would be sold to the government which could then allocate them where they were needed.

This would certainly increase the donor pool, by adding a financial incentive for donation, but can also lead to other, darker consequences.  There is currently a “black market” in organs which operates across the globe, and many of you have doubtlessly heard the urban legend of the guy who went to Las Vegas and woke up in a bathtub full of ice, missing a kidney.

The issue in a market system of organ procurement is that you may incentivize people to do the right thing for the wrong reason.  Several notable bioethicists, including the University’s Rev. Jim McCartney, O.S.A., argue that the use of an open market for organs could lead to the exploitation of the poor.

“Without appropriate regulation, allowing sale of organs, especially kidneys, on the open market could easily lead to exploitation of the poor and marginalized,” said McCartney. “We have seen this happen with gestational surrogacy, and there’s no reason to believe that it wouldn’t happen with the sale of organs as well.”

So, it seems as though there is only one way left to boost the number of available organs—to increase the organ source pool and promote awareness of living donation.  There are a number of ways to increase the organ source pool: allowing the use of alternative organ sources, changing the dead donor rule or altering the rules that define when and whether a person is dead.

Many see organ donation as something that only occurs after death, but in the past few years, bone marrow transplants and altruistic/paired kidney donation chains have become much more popular.  Although living donation is not ideal for all organs, kidneys, bone marrow and some tissues can be donated with limited risk to the donor.  Lung and partial liver donations increase the risk to a living donor, and something like a heart donation would obviously guarantee death.

The only remaining viable option under the current system, it seems, is to increase the organ source pool by having more people check “yes” in that little box on driver’s license applications.  The current attitude toward donation in this country is that organ donation is an altruistic act of charity, giving the gift of life.  Try to look at organ donation as a duty you have to fellow human beings—if by the transplantation of your organs, you could save the lives of others, why wouldn’t you?



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