Andrew Siegel, MD Blog #84
This past Monday marked the death of Dr. Joseph E Murray at the age 93, the surgeon who performed the first successful human organ transplant. In 1954, he removed a healthy kidney from a 23-year-old man and implanted it into the man’s identical twin. This heralded the beginning of the transplant era that has saved the lives of thousands of patients who have received new kidneys, heart, lungs, livers and other organs after their own had failed. In 1990, Dr. Murray was awarded the Nobel Prize in medicine.
Currently, there are over 100,000 Americans on the waiting list for organ transplantation, 75% of whom are awaiting a kidney. The situation is literally at a crisis level insofar as there are only about 30,000 transplants performed annually. Twenty or so Americans die EVERY day for want of an organ donor. The bottom line is that people are literally dying while on the wait list for organs; this is a huge public health issue that becomes a very private one if it becomes you, a family member or friend who is the one in need of that organ. What makes this particularly tragic is that this is a readily remediable problem!
I am signed up to be an organ donor. This was a decision that I opted in for when I received my New Jersey driver’s license. I figured that this is the least I can do for my fellow man. If I get hit by a bus or suffer an injury that renders me in a permanent vegetative state, why not recycle my organs for the benefit of the living? I will happily donate my corneas, kidneys, heart, liver, lungs, pancreas or any other organ that will help improve the quality and quantity of the life of my fellow man or woman, particularly as these organs will do me no good at all where I am going.
Charitable acts that are of benefit to another living human being are essential, particularly insofar as in the USA we have a tremendous shortage of available organs, as demand far exceeds supply. With advances in dialysis, patients with kidney disease are surviving longer than ever. This, coupled with the rise in prevalence of kidney failure due to greater longevity, as well as an increase in the prevalence of hypertension and diabetes related primarily to the growing obesity epidemic, has resulted in a major demand for kidneys.
In the USA, consent for organ donation is an opt-in system, usually authorized by the person designated as medical power of attorney. So those persons who give explicit consent become potential donors. However, alternatively, a number of European countries, including Spain, Austria and Belgium, have laws that provide an opt-out system. In these countries, one must petition to be excluded from being an organ donor after death, presumptive consent existing in the absence of specifying a preference.
In general, the opt-out system will dramatically increase consent rates for organ donation. For example, Germany, a country that utilizes an opt-in system, has an organ donation consent rate of 12%; this is as opposed to Austria, a nation that utilizes an opt-out system, which has a consent rate nearing 100%. It would seem that in general, people do not like having to make a decision and check off a box, and if a system is set up such that the default mode results in an action, then meaningful change can result.
Israel has developed an interesting alternative to the aforementioned opt in or opt out approaches. They have enacted a system that prioritizes organ allocation based upon willingness to be a donor. A donor card is issued to willing donors and a registry of donors is maintained. Highest priority (3.5 points) for organ allocation goes to donors and first-degree relatives of those individuals who are non-directed donors (those not donating to a specific individual). Whereas a donor of a live, non-directed organ gets 3.5 points, a directed living donor (those donating to a specific individual) gets no prioritized organ allocation. Anybody with a donor card gets 2 points. If a family member has a donor card, 1 point is given to any first-degree relative of that individual. Even though this approach seems somewhat arbitrary, consent rates for donation have increased, resulting in a significant increase in the number of organ transplants since this system was enacted.
In the late 1980s, Iran adopted a system of paying kidney donors and within a decade or so became the only country in the world to have no waitlists for transplants. Now, by no means am I suggesting that people “sell” their organs for transplantation; however, how sad that monetary incentive compels individuals to act to save lives.
Thanksgiving, the day that we give thanks for the bounty of fortune that we have, has recently passed. The holiday season fast approaches, the time of giving gifts to our loved ones. I’m not certain if the United States will ever develop an opt-out system for organ donors, but in the meantime, the simple act of opting in can provide the ultimate gift to a person in dire need. The DMV has made opting in extremely easy: one need not wait to renew one’s license to check the little opt-in box—simply log onto www.dmv.org to learn how to acquire a form to change your donor status to “yes.” Many states have downloadable forms that, once completed, are mailed or faxed in. And some more progressive states, like California and Pennsylvania, actually allow you to register as a donor on-line.
It was less than 60 years ago that Dr. Murray performed the first transplant—a courageous and heroic moment that many at the time deemed ludicrous—ushering in an era such that transplants have become commonplace. Let us celebrate the holiday season and commemorate the death of Dr. Murray by trying to increase the ranks of organ donors by simply checking the little opt-in box, a painless and altruistic act that, instead of wasting valuable organs, will recycle them, and in so doing, recycle someone’s life. That someone, some day, might just be you, your loved one or your friend.
Andrew Siegel, M.D.
Author of Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food: www.promiscuouseating.com
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