Tuesday, January 27, 2009

Who is punishing who?

A story aired on ABC TV in our nation's capitol says:

Professionals in the medical community are discussing a controversial proposal that would change the way people are placed on the national organ donor waiting list.

An organ donor network called LifeSharers wants the list to give preference to patients who signed up to be organ donors before they became sick.

According to the story:
The United Network for Organ Sharing, the non-profit organization that maintains the national waiting list, does not agree with the proposal. They believe it punishes transplant candidates who haven't made the personal decision to donate themselves.
Who is punishing who here? If I "haven't made the personal decision to donate", I have made the personal decision to bury or cremate organs that could save several lives. I have made the personal decision to punish my neighbors.

On the other hand, giving a preference to patients who signed up to be organ donors before they became sick will increase the number of organ donors. This helps everyone, even non-donors.

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Rewarding donors will produce more donors

LifeSharers released a proposal last year calling for the United Nework for Organ Sharing to create two transplant waiting lists in the United States -- the 'A' list for registered organ donors, and the 'B' list for everybody.

Under this proposal, all organs would be allocated to people on the 'A' list, with non-donors on the 'B' list only getting organs not needed by registered organ donors. If UNOS did this, just about everyone would register as an organ donor. Very few people would refuse to donate if refusing meant they'd probably never get an organ transplant if they ever needed one.

USA Today published a story about some reactions to this proposal, including this:

Mark Fox, associate director of the Oklahoma Bioethics Center at the University of Oklahoma-Tulsa, says fixes such as the LifeSharers plan have "inherent logic" to them.

Perhaps prior willingness to donate could factor in as a "tiebreaker" in awarding organs, but he says there is no evidence such a plan would increase donation.

Since the LifeSharers plan hasn't been implemented, there is of course no "evidence" that it would increase donations. But there is every reason to think it would do exactly that. It's basic human nature. When you reward a behavior, you get more of it.

More from Dr. Fox:
"We are an age- and death-defying society," he says. Most people do not sign up to donate because they do not think about their own medical frailties, he says.
The LifeSharers plan gives people a good reason to think about their medical frailties. If you think about the possibility you might someday need a transplant, and if you know you probably wouldn't get one if you didn't sign up to be a donor, you will probably sign up to donate.

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Rearranging the deck chairs on the Titanic

The St. Louis Post-Dispatch reports that the Kidney Transplantation Committee of the United Network for Organ Sharing is considering changing the way kidneys from deceased donors are distributed:

The committee discussed three concepts that could be used in a new system to determine who gets kidneys:

— A formula that determines how long a patient can expect to live after receiving a new kidney.

— The amount of time a patient has been receiving dialysis treatments.

— A measure of the quality of the donated organ in relation to the candidate's age and health.

This is like rearranging the deck chairs on the Titanic. None of these changes will do anything to increase the supply of kidneys.

UNOS continues to treat organ allocation as a zero-sum game. It doesn't have to be that way. UNOS can increase the supply of organs by allocating donated organs first to people who have agreed to donate their own organs when they die.

If UNOS did this, just about everyone would sign up to be an organ donor. It would also make the organ allocation system fairer. People who aren't willing to share the gift of life should go to the back of the transplant waiting list.

America doesn't have an organ shortage. We have an organ donor shortage. Americans bury or cremate 20,000 transplantable organs every year. About 8,000 Americans die every year waiting for organ transplants. UNOS should do the math.

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