John Oliver on organ donation system: ‘Nowhere near where it should be’
John Oliver looked into the complicated and dysfunctional system of organ and whole body donations on Last Week Tonight, starting with organ transplants. The decision to donate one’s organs after death is widely popular in the US, with surveys finding 90% or more of Americans supporting it; over 42,000 organ transplants were performed in the US last year.
“But the system that handles our donations has considerable flaws,” Oliver noted on Sunday evening. The organ transplant waitlist is over 100,000 people long, with 17 people dying each day waiting for an organ transplant. Meanwhile, over 20,000 people donate their bodies each year, presumably to science but often to more dubious ends.
“The fact is, our donated organs, while being incredibly important to saving lives, are not getting to enough people, and our donated bodies, incredibly important to advancing knowledge, aren’t always treated with the care they deserve,” Oliver explained.
Oliver first dug into the history of organ transplants in the US, which is “only one Oprah old”. In 1984, the National Organ Transplant Act banned the sale of human organs and opened up access by national registry to be run by a private non-profit, United Network for Organ Sharing (UNOS), under government contract.
In theory, the UNOS donation list is a dynamic system based on what organs are available and which patients most need them. But there are multiple problems, starting with UNOS’s computer system, which suffers from aged software, periodic system failures, mistakes in programming and an over-reliance on the manual input of data.
There are also issues with how patients are ranked for need, especially for kidneys. For years, UNOS used a socalled “Black race coefficient”, “which is just as bad as it sounds”, said
Oliver. Basically doctors, using racist junk science saying that Black people had more muscle mass, over-estimated their kidney function and pushed them lower down the list. The governing board of UNOS voted to eliminate racebased calculations for transplant listings last year and have given hospitals until January 2024 to update their waiting lists, “which feels like too long, considering that the correct time to fix that problem was fucking ages ago”, Oliver fumed.
Additionally, rich people can essentially cut the line by registering at multiple transplant hospitals in different states, and flying immediately to one when an organ is available. Moreover, the delivery system for organ donations relies on a primitive system of phone calls and paper manifests with no GPS or other tracking equipment. That, combined with other mistakes an airline issues, led to 170 organs unable to be transplanted over a fiveyear period after transportation problems.
As Dr Stuart Knechtle, an organ transplant doctor, said, comparing the process unfavorably to ordering a toothbrush on Amazon: “They can tell you minute to minute where that toothbrush is. Well, that’s not possible for organ transplantation.”
“Look, we should obviously be able to track organs as easily as we track Amazon packages,” Oliver noted. “Do you realize how shitty your organization has to be for me to say ‘be more like Amazon?’ Things have to be pretty dicey for me to look into a camera and say with my actual mouth, ‘Please