Organ allocation is not based on need

A common criticism of LifeSharers is that we might prevent an organ from going to the person who needs it the most. But organs are not given to the people who need them the most. We've written about this before here and here. More evidence of this is provided in an ABC News story about Jonathan Simchen, who was turned down by two transplant centers because he uses medical marijuana.

Virginia Mason Hospital in Seattle is one of the transplant centers that turned down Mr. Simchen:

Alisha Mark, a spokeswoman for Virginia Mason, would not discuss details of Simchen's case because of medical privacy regulations, but said that "any patient who smokes any product -- tobacco, cloves, medical marijuana -- would be precluded from receiving a transplant here."

At Virginia Mason, even tobacco use disqualifies you from getting a transplant, no matter how bad you need one.

Why does this kind of thing happen? Here's one possible explanation from ABC's story:

Transplant centers tend to be very careful because they survive financially based on the number of successful transplants they do, explains Maxwell J. Mehlman, director of the Law-Medicine Center at Case Western Reserve University. "They use a screening process to avoid people who might be failures and they look at several factors from drug use to having a support system," he said. "It has actually been a source of bioethical controversy because it allows them to reject homeless people and people who live alone. In some cases, it's a backdoor way of rationing based on social worth and lifestyles."

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In defense of LifeSharers

In a column in the Jackson Sun urging everyone to sign up to become an organ donor, Peter Watson discusses LifeSharers.

Mr. Watson disagrees with the LifeSharers approach. He writes that LifeSharers “totally discounts a person's reason for not donating. Maybe their religion forbids it. Maybe they are medically unable to donate.” Every major religion supports and encourages organ donation. No one is medically unable to offer to donate, because no one can say if your organs will be transplantable when you die. Surgeons keep changing the definition of what is transplantable as the transplant waiting list continues to grow. They are now transplanting lots of organs they would have rejected just a few years ago. The bottom line is that you can either offer to donate your organs to save your neighbors’ lives, or you can refuse. There are no good reasons for not donating.

Mr. Watson asks: “should people be denied life-saving treatment just because they have decided not to become a donor?” Of course not, and LifeSharers does not advocate denying medical treatment to anyone. But there aren’t enough organs for everyone, so giving an organ to one person means someone else won’t get it. It makes perfect sense to give organs first to organ donors, as a way to encourage more people to donate.

Mr. Watson writes: “Organs should be allocated based on who needs them most, not on whether that person is a donor.” This is a nice theory, but that’s not how it works in the real world. Organs are allocated based on several factors that often override need. Organ donor status should be included in organ allocation because doing so increases the number of organs that can be allocated.

Nothing could be fairer than giving organs first to registered organ donors. If you’re not willing to donate, why should you be at the front of the waiting list if you ever need a transplant? Giving an organ to someone who refuses to be an organ donor is like giving the Powerball jackpot to someone who didn’t buy a ticket.

Mr. Watson writes: “Deciding whether to donate one's organs is an extremely personal decision.” So is the decision about who will get your organs if you donate them. If you defend someone’s decision to not donate, you must also defend someone else’s decision to donate to other organ donors.

Every year over 8,000 Americans die waiting for organ transplants. These deaths are not the result of an organ shortage. They are the result of an organ donor shortage. Only about 50% of adult Americans have agreed to donate their organs when they die. Every year 20,000 organs that could have saved their lives are buried or cremated instead.

That’s why LifeSharers advocates giving organs first to registered organ donors. Giving organs first to organ donors will convince more people to donate, and that will save more lives. It will also make the organ transplant system fairer.

The national transplant waiting list will soon reach 100,000 people. Most of those people will die waiting. If you are a registered organ donor you are part of the solution. If you are not a registered organ donor you are part of the problem.

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Advice columnist Carolyn Hax on organ donation

Washington Post advice columnist Carolyn Hax posts the follow letter from a reader in today's column:

Carolyn:

Just found out my boyfriend, whom I am thinking of a future with, is not an organ donor. He doesn't have any religious beliefs to speak of but said he would like to be buried whole.

I lost my lifelong best friend as she waited for an organ donation that never came. Do I have the right to broach such an intensely personal decision with my boyfriend? How do I approach it without putting him on the defensive? I feel that I can talk with him about a lot of things, but I don't want to be unreasonable because I am so emotionally invested in the issue.

This isn't a deal-breaker for me, I don't think. But it is something I want to discuss with him.

Here is Carolyn's answer:

Absolutely you can raise this issue, and I hope you do. It is intensely personal, and you can start by acknowledging that -- but it's also a public health issue. Not to mention, you're close to the point of pondering marriage, so personal questions aren't just permissible, they're necessary.

Explain that your experience gives you a different perspective, and ask him if he has considered the possibility that someone close to him might one day need an organ that never materializes. Or that he himself might.

And if he did need one, and one became available, would he accept it? What about a bone graft? Is it okay by him that other people aren't buried whole? Does he think it's morally consistent to live knowing that the medical safety net of donated organs is there for him, and that he's willing to avail himself of it, but not contribute to it himself?

Does he want his tonsils back?

Then he can revisit his stance, while you revisit your deal-breakers.

Carolyn asks a great question: "Does he think it's morally consistent to live knowing that the medical safety net of donated organs is there for him, and that he's willing to avail himself of it, but not contribute to it himself?" If more people were asked this question, fewer people would die waiting for organ transplants.

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LifeSharers in New Zealand

LifeSharers now has an affiliate in New Zealand. You can see a press release announcing the launch of LifeShaers New Zealand here. It’s great to see the LifeSharers idea take root internationally.

Andy Tookey is director of LifeSharers New Zealand. Andy is founder of GiveLife New Zealand and is New Zealand’s foremost organ donation advocate. The LifeSharers New Zealand web site is here . If you’d like to make a financial contribution to support LifeSharers New Zealand, you can do so here.

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