Medical marijuana and organ transplants

According to an Associated Press story, Timothy Garon of Seattle needs a liver transplant:

His liver, ravaged by hepatitis C, is failing. Without a new one, his doctors tell him, he will be dead in days.

But Garon isn't getting a new liver. He's been refused a spot on the transplant list, largely because he has used marijuana, even though it was legally approved for medical reasons.

Many people think organs are given to the people who need them the most, and that organ allocation is based only on objective medical criteria. Mr. Garon's story shows that's not how it really works:

Because of the scarcity of donated organs, transplant committees such as the one at the University of Washington Medical Center have tough standards for deciding who should get them. Does a candidate have other serious health problems? Will he religiously take anti-rejection medicines? Is there good family support? Is the candidate likely to drink or do drugs?

This is the case nationwide, not just in Seattle:

The Virginia-based United Network for Organ Sharing, which oversees the nation's transplant system, leaves it to individual hospitals to develop criteria for transplant candidates. At some, people who use "illicit substances" — including medical marijuana, even in states that allow it — are automatically rejected. At others, such as the UCLA Medical Center, patients are given a chance to reapply if they stay clean for six months.

It's a myth that organs are allocated to the people who need them the most. It's a myth that only objective medical criteria are considered when allocating organs. Under the University of Washington Medical Center's standards, the person who needs an organ the most won't get one if he doesn't have good family support. Under UCLA Medical Center's standards, the person who needs an organ most won't get one if he's used marijuana in the last six months.

Critics of LifeSharers, which allocates organs first to registered organ donors, say LifeSharers doesn't give organs to the people who need them the most. That's a straw man. The national organ allocation system doesn't give organs to the people who need them the most. Critics also say LifeSharers introduces non-medical criteria into organ allocation. That's another straw man.

It's easy to see why it might not always make sense to allocate organs based only on need and objective medical criteria, given that there is a severe shortage of transplantable organs. Should an organ be given to someone who won't benefit from it because he has other serious health problems? Should an organ be given to someone who won't take the anti-rejection medicines needed to maintain the organ after surgery? Should an organ be given to someone likely to damage it by drinking or doing drugs?

Organs are allocated with questions like these in mind in order to maximize the benefit from transplanted organs. LifeSharers suggests adding one more question to the list: Is the person who needs the organ a registered organ donor? Adding this question to the list will increase the number of organs donated. That will save more lives. The overriding goal of our transplant system should be to save as many lives as possible.

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Should need govern who gets transplants?

An editorial about LifeSharers in today's Greensboro News & Record is titled: "Need should govern who gets transplants".

It's a nice theory, but that's not how it works in the real world. Organs are allocated based on value judgments that often override need. When the next organ becomes available in the United States, it won't be given to the person who needs it most. Instead, it will be given to the person on the waiting list who scores highest on a complex formula that includes things like age, location, race, and time spent waiting, as well as need. People who can't afford to pay for a transplant never even get on the waiting list. So it's not fair to criticize LifeSharers members for not giving their organs to the people who need them the most.

If you give organs first to registered organ donors, you get more registered organ donors. That saves more lives. Shouldn't saving the maximum number of lives be the goal of our transplant system? Anyone who wants to help achieve this goal by donating their organs to fellow organ donors is welcome to join LifeSharers at http://www.lifesharers.org/ or by calling 1-888-ORGAN88.

The editorial also suggests that LifeSharers members not receive organs from non-members. Let's apply this logic to the group I call LifeHoarders. Members of this group, which includes half of the adult population in the United States, haven't agreed to donate their organs when they die. Why not say that LifeHoarders can get organs only from other LifeHoarders? In other words, why not say that people who haven't agreed to donate can only get organs from other people who haven't agreed to donate? It's actually a great idea. If it was the law of the land, everyone would agree to donate, thousands of lives would be saved every year, and there would be no need for LifeSharers.

The editorial also draws an analogy between blood donation and organ donation, saying that it's a good thing blood isn't given only to blood donors. It's a bad analogy. There is no national blood waiting list or blood allocation system, and there aren't thousands of people dying every year because of blood shortages. In any event, LifeSharers has never suggested blood be handled the same way as organs.

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Organ transplants for illegal immigrants

A Los Angeles Times story highlights a controversial issue: should illegal immigrants receive organ transplants in the U.S. and should taxpayers pick up the cost?

The story presents arguments from both sides of this issue:

"All transplants are about rationing," said Roy Beck, executive director of NumbersUSA, which favors stricter controls on immigration. "I just don't think the public ought to be funding any kind of benefits for people who are breaking the law."

But Dr. Michael Shapiro, vice chairman of the ethics committee for the organ network, said illegal immigrants have just as much right to organ transplants as U.S. citizens. He said it is likely that more illegal immigrants donate organs than receive them. "People are people, and when you make an incision in an organ donor, you don't find little American flags planted on their organs," Shapiro said.

If there were more organ donors, this issue wouldn't be so controversial.

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Organ donor registrations are up in the United States

According to a press release from Donate Life America and Discovery Health, the number of registered organ donors in the United States is up 10% over the last 18 months.

Here are a couple of interesting facts from the press release:
- Only 35% of licensed drivers and ID card holders have committed themselves to donation by registering to be donors through their state registry or motor vehicle department.
- In 2007, only four states had a designation rate of at least 50%: Iowa (67%), Colorado (60%), Ohio (52%) and Utah (50%).

Clearly there's a whole lot of work left to be done in convincing people to register as organ donors.

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Organs for Organ Donors in Israel

According to an article on Ynetnews, a new organ donation law in Israel "includes an innovative clause giving preference to people who sign the donor card should they be in need of an organ transplant in the future."

This is the idea behind LifeSharers. I expect that someday a similar law will be passed in the United States, or that UNOS will change its organ allocation rules to make such a law unneccesary.

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