Thursday, July 12, 2007

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:

[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.

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.

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.