Should Organ "Donors" Be Put at Front of Organ Transplant Line?
I received an e-mail from David Undis, the executive director of LifeSharers, alerting me to a column he wrote promoting the creation of an organ transplant priority list that would put those who signed donor cards at the front of the organ transplantation line. Thus, Undis writes:
At first blush this sounds fair. But is it? After all, there are plenty people whose organs are donated who have not signed donor cards, while there are also certainly people who signed donor cards whose organs are not donated due to family objections or for other reasons. More importantly, creating a VIP system for organ transplantation that would explicitly circumvent the organ triage system that matches the first available organs with the sickest people, could cause tremendous turmoil in that it would allow a less sick person who signed a donor card to cut in front of a more seriously ill person who had not signed a donor card.[R]egistered organ donors who need transplants are treated no better than people who have declined to donate their organs when they die. As a result, every year, thousands of registered organ donors die waiting for transplants when the organs that could have saved their lives are given to nondonors. LifeSharers is an organization that seeks to rectify the situation by giving preference to organ donors. Not only would this make the system fairer, but the effect of moving donors to the front of the line would be to increase the number of donated organs available for everyone.
Here's another aspect of Lifesharer's that I find disturbing:
LifeSharers members agree to donate their organs when they die. They also agree to offer them first to other members, if any member needs them, before offering them to others. This is done through directed donation, which is legal under federal law and in all 50 states. There is no age limit, and parents can enroll their minor children. LifeSharers has more than 9,200 members and has doubled its membership in the last year.That might be fine for live donations, but I am not sure it is right for cadaver donations.
While the idea of LifeSharers is certainly well-meaning, and I applaud Undis' commitment to increasing the donor pool, in the end, I don't think that its approach is wise. First, I don't think most people would really respond to the carrot of being placed on the priority list, until that is, they became ill and needed an organ transplant. So it wouldn't really serve the purposes for which it is intended because most members would be recipients and not donors. Second, it sets up a private barter system that interferes with the triage process. If the idea took off, it seems to me that the entire organ distribution system could be well on the way to collapse. Moreover, there would soon be other categories of do-gooders (which I mean literally and not as a pejorative) who could also claim that they deserve special consideration for organ transplantation.
There is no doubt that we need more organ donations--although with greater auto safety standards and motorcycle/bicycle helmet laws, it is likely that the number of people with catastrophic head injuries--the prime organ donors--will continue to decline. No, rather than turn organ procurement into a quid pro quo system, I think it best to increase public confidence in the system by maintaining rigorous ethical parameters for organ transplants, setting national standards to which every transplant center and hospital must adhere, and educate, educate, educate.
Thanks to Dave Undis for alerting me to LifeSavers and for his commitment to saving human lives.
posted by Wesley J. Smith @ 10:20 AM
9 Comments
9 Comments:
As much as I love the idea of organ-donation, and recognise that it saves lives, I can't bring myself to sign a donor card. I'm afraid of being declared brain dead or being less aggressively treated for the sake of my organs. I'd rather leave that decision in the hands of my husband, who I am confident will wait until all treatment options are exhausted before signing my organs over to someone else.
Kate: Thanks for dropping by. This is the real problem, it seems to me. A lot of people would sign organ donor cards if the Hippocratic values of medicine were not under assault. As it is, people worry--and not unreasonably--that their organs will be viewed as more valuable than their lives.
Mr. Smith:
Thank you for your kind words and for your very thoughtful comments about LifeSharers.
Americans bury or cremate 20,000 transplantable organs every year. LifeSharers is an attempt to stop this terrible waste. We offer a compelling trade – you agree to donate your organs after you die, and in return you’ll increase your chances of getting a transplant should you ever need one to live.
You implied that giving organs first to registered organ donors might not be fair because “there are plenty people whose organs are donated who have not signed donor cards, while there are also certainly people who signed donor cards whose organs are not donated due to family objections or for other reasons.”
It still makes sense to reward the act of registering as an organ donor, which is what LifeSharers does. When a deceased person’s family knows he was a registered organ donor or is given evidence that he registered, they approve of organ donation about 90% of the time. When the family doesn’t know if he wanted to donate and there is no evidence that he registered, they approve only about 50% of the time. So registering as an organ donor makes it more likely that a person’s organs will actually be donated.
You said “creating a VIP system for organ transplantation that would explicitly circumvent the organ triage system that matches the first available organs with the sickest people, could cause tremendous turmoil in that it would allow a less sick person who signed a donor card to cut in front of a more seriously ill person who had not signed a donor card.”
In the first place, under the present system the first available organ doesn’t necessarily go to the sickest person. The sickest person can take a back seat to someone who is closer to the organ, someone who is younger, or someone who has been waiting longer. More importantly, giving organs first to registered organ donors increases the supply of organs, so even the sickest people are better off.
You said “I don't think most people would really respond to the carrot of being placed on the priority list, until that is, they became ill and needed an organ transplant. So it wouldn't really serve the purposes for which it is intended because most members would be recipients and not donors.”
This hasn’t proven to be the case so far. LifeSharers has almost 9,300 members, but only about 0.5% of them need transplants. Of course it remains to be seen how many people will respond to the “carrot” offered by LifeSharers, but the incentive to join LifeSharers keeps getting stronger as our membership expands. Joining is the only way to get preferred access to an expanding pool of organs.
You said that if LifeSharers took off “it seems to me that the entire organ distribution system could be well on the way to collapse.” It seems to me that the exact opposite would be true. If LifeSharers takes off, there will be more organs to distribute.
You said that if LifeSharers took off “there would soon be other categories of do-gooders…who could also claim that they deserve special consideration for organ transplantation.”
Perhaps this is true. But if LifeSharers takes off it has the potential to almost double the supply of organs from deceased donors. This would save literally thousands of lives every year. We should not forgo the opportunity to save these lives because others might ask for special consideration in the future.
You said “rather than turn organ procurement into a quid pro quo system, I think it best to increase public confidence in the system by maintaining rigorous ethical parameters for organ transplants, setting national standards to which every transplant center and hospital must adhere, and educate, educate, educate.”
Increasing public confidence in the system is important. But how can we increase public confidence? We already have rigorous ethical parameters for organ transplants, we already have national standards, and we already have lots of education. Yet UNOS reports that a 2005 survey showed 80% of Americans question the fairness of the current allocation system.
I think Americans would have more confidence in the system if they knew their organs would be offered first to other organ donors. Another 2005 survey showed that 53% of Americans believed that people who have previously agreed to donate their organs after death should be granted priority to receive cadaveric organ transplants over those who have not agreed to donate.
I hope you and all your readers will join LifeSharers. Membership is free at www.lifesharers.org or by calling 1-888-ORGAN88. There is no age limit, parents can enroll their minor children, and no one is excluded due to any pre-existing medical condition.
Thanks,
Dave Undis
LifeSharers
Thanks for your reply, and please call me Wesley. I think it is a good basis for a discussion. I did not go into detail about all of the ins and outs of the triage system, because of space. But your point that sometimes nearer people get the organs and etc., I think, further demonstrates my point. To add the new element of a VIP list would make a difficult system even more onerous and would likely distort a fair distribution of this scarce resource.
Thanks again.
I should admit to being anti-donation anyway, at least for vital organs, so perhaps my opinion on the method thereof should not be counted. But it seems to me that Wesley is right and that as a matter of ethical concerns it is not a good idea to have organ donation agreement thought of in terms of "what can I get out of it." We already have some ethical problems on the procurement side, in terms of pressuring patients and even sometimes not following proper protocols in procurement. What we don't need is to develop ethical problems on the donation side as well, so that donors think of themselves as being in any degree or sense "paid" for their organs. It seems to me that this sort of quid pro quo is not sufficiently distinguishable from payment, which has enormous ethical problems.
LifeSharers members agree to donate their organs when they die.
Ah, yes- but dead people can't donate their organs because organs cease to function at natural death. You must alive to donate.
Hence all these new definitions of death: brain death, PVS, etc. (None of which are death, but states of ability/disability). When I die- when my heart stops beating and I turn cold, people may help themselves to my factory-installed parts. Only they won't want them then...
By the way, this reminds me of a episode of an episode of LIFETALK, Life Dynamics' talk show where Mark Crutcher suggested that pro-choicers be denied access to infant adoptions. There's a similar premise of justice here:
1. Prochoicers' ideologies and support lower the number of available infants therefore they should be denied access to the available infants.
2. Non-organ donors ideologies and support lower the number of available organs therefore they should be denied access to the available organs.
I disagree with both instances, but I see the rationale behind them.
Thanks for a good post. First of all, brain death is death. Even after your heart stops, you are not really dead until oxygen stops reaching your brain. That is why your heart can be restarted with CPR and shocks, but your brain, once it is dead, cannot. This is science, not ideaology.
Dave Undis makes a compelling argument. He has also emailed me after reading my blog. My problem with Life Sharers and Matching Donors is this:it is not accessible to all, or even most, people. He says why should someone who is against organ donation receive an organ. However, when you look at the lists, it's usually a case of people whose wishes are unknown receiving organs.
For example, I sign up for LifeSharers and I become brain dead (statistical probability is very small, less than 1% of all deaths are brain deaths). My heart would go to John Smith on the Life Sharers list. Except that John Smith is #52 on the UNOS list. At the top of the list is a status 1A-a person who will die within hours or days if they don't receive a heart. But suppose that status 1A never heard of LifeSharers? Why should they die because they aren't registered with his website? What if it's a person who doesn't have access to a computer? As he says, many people waiting for organs are underprivileged. Matching Donors is even worse, they have a $600 fee to sign up. I have yet to hear his answer to this.
The current system is not working, too many people are refusing to be organ donors, and people are dying because of it. We have to find new ways to inspire the masses to give of themselves in this most basic and invaluable way! If LifeSharers takes off and hundreds of thousands (millions?) of people join, there will be so many organs available for transplant that no-one dies on a waiting list. The ultimate point of LifeSharers is NOT to create a VIP list, but to solve the problem of the shortage of organs for sick people who desperately need them.
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