USA TODAY International Edition
Experts debate ways to encourage organ donors
Some say counting on choice may not be enough
The case of the 10- year- old girl in Philadelphia who needed a transplant with adult lungs to survive tugged at the nation’s heartstrings.
But in the wake of the emotional, legal and ethical wrangling around her story, many wonder if there isn’t another way to improve the supply of hearts, kidneys, livers, lungs and other lifesaving organs. Getting more people to register as donors is one obvious avenue, but some say it’s easier said than done, and other ideas are controversial.
“The one thing that the American public can do to help people like Sarah ( Murnaghan) is to register to be a donor,” says David Fleming, president and CEO of Donate Life America, a national non- profit advocate for organ, eye and tissue donation.
“We rely on voluntary choice and altruism,” says Art Caplan, head of the division of medical ethics at New York University Langone Medical Center.
Most polls show that more than 90% of people say being an organ donor is the right thing to do, Fleming says, but only about 109 million Americans — about 45% of adults over 18 — are registered as organ, eye and tissue donors in their states. In the absence of a person being a registered donor, families are asked at the time a loved one dies to consent to organ dona- tion. Consent rates are significantly lower in such situations.
There aren’t nearly enough donors to meet transplant needs. Nearly 120,000 men, women and children await organ transplants in the USA.
“We have 18 people dying every day just waiting for an organ to save their lives,” Fleming says.
Most people volunteer to be a donor when getting a driver’s license at their state’s Department of Motor Vehicles, and people can go online ( donatelife. net/ register- now/) 24/ 7 to sign up, Fleming says. After they volunteer, their name is added to an electronic registry.
Even if people register, chances are they’ll never be a donor because they died from an illness or an accident that left their organs too damaged for anyone else to use, Fleming says. An organ donor is typically brain dead and on a ventilator, which occurs in about 1% of deaths, he says.
Organ donors are usually people who have head injuries resulting from such events as car accidents, gunshot wounds, swimming pool accidents or child abuse, and they’re on life support, Caplan says.
Donors can’t have infectious diseases, cancer or be over 90 years old, and they need to be on life support so the blood and oxygen is still getting to their organs, he says. “It’s relatively hard to be an organ donor because most people don’t die on life support, and even when they do die on life support, they are usually too sick to have healthy organs to donate.”
Some experts such as Caplan suggest rethinking all this. Instead of asking people to “opt into” the system by indicating willingness to be a donor, these experts say the assumption be that everyone should be considered a donor unless they “opt out.”
Caplan says countries such as Spain have had success with getting more organs with an opt- out system.
Fleming doesn’t like the idea. “We would be moving from a system where we honor your wishes to be a donor to a system where it’s the government’s right to procure your organs unless you opt out.
“I truly believe it would be a disaster if it happened here. I think we’d have millions and millions of people register not to be donors,” he says.