Free driver's licenses for registered organ donors

A bill introduced in the Vermont legislature would waive the $10 annual driver's license fee for anyone who registered to donate their organs when they die, according to an article in the Burlington Free Press.

This is a great idea. The state of Georgia used to offer discounted driver's licenses to registered organ donors, and it had a significant positive impact in donor registration rates. The discount program was ended after a few years, supposedly for budgetary reasons. See our previous post on this.

Click here to subscribe to this blog

Taking and giving organs

Only 38% of licensed drivers in Delaware are registered organ donors, according to an editorial in the Wilmington News Journal. I bet just about every single one of the other 62% would accept an organ transplant if they needed one to live. Where do you suppose these people think the live-saving organs they may need are going to come from?

It's just not right to be willing to take organs if you're not willing to give them.

About 50% of the organs transplanted in America go to people who haven't agreed to donate their own organs when they die. As long as we let non-donors jump to the front of the waiting list if they need a transplant we'll always have an organ shortage. People who aren't willing to share the gift of life should go to the back of the waiting list as long as there is a shortage of organs.

Anyone who wants to donate their organs to others who have agreed to donate theirs can join LifeSharers. Membership is free at http://www.lifesharers.org/ or by calling 1-888-ORGAN88. There is no age limit, parents can enroll their minor children, and no one is excluded due to any pre-existing medical condition.

Click here to subscribe to this blog

Rationing organ transplants

Nataline Sarkisyan died last month after her health insurance company refused to pay for a liver transplant but then changed its decision after a lot of negative publicity.

According to a story in the Philadelphia Inquirer, "Nataline Sarkisyan's case raises complex questions about how we ration resources - money and, in this case, transplantable livers - and how we make medical decisions in what one ethicist called 'last-chance' situations."

There aren't enough livers available to give one to every person who needs a liver transplant. Deciding to give a liver to one person means someone else won't get one. These are undoubtedly difficult decisions to make.

Deciding whether or not to donate your organs when you die seems very simple in comparision. But only about 50% of adult Americans have registered as organ donors. About half of the livers that could be donated are buried or cremated instead. The people who blow the easy decision about donating force the difficult decisions about rationing.

Under the organ allocation rules used by the United Network for Organ Sharing, people who won't donate pay no price for their decision. They remain eligible to receive a transplant if they ever need one. It's no wonder there is such a large shortage of livers.




Click here to subscribe to this blog

Mandated choice in New Jersey?

According to a story in the Courier-Post, proposed legislation in New Jersey would require people applying for driver's licenses and identification cards to state whether they want to be an organ donor.

The bill "would require applicants to answer whether they want to become an organ donor. If they decide to do so, their donor status would appear on their license and be maintained in a state registry. If they're not ready to make a decision or uncomfortable sharing it, they would designate someone to make that decision on their behalf when the time comes. If someone doesn't want to be a donor, they would check off a box acknowledging that."

If someone doesn't want to be a donor, they should also check off a box acknowledging that their decision means they'll be put at the end of the the waiting list if they ever need a transplant. Almost nobody would refuse to register as an organ donor if they knew it would affect their future chances of getting a life-saving transplant.

Every year Americans bury or cremate 20,000 transplantable organs, and every year about 8,000 Americans die because there aren't enough organs donated. Do the math.





Click here to subscribe to this blog

Help LifeSharers win $50,000

America's Giving Challenge will award $50,000 to 4 U.S. charities that get donations from the most people by January 31, 2008. They'll also award $1,000 to 100 U.S. charities.

Please help LifeSharers by making a tax-deductible donation of $10 or more. Just click on the donation badge to the right.

You can also help by spreading the word about this effort. Our donation badge is at http://www.networkforgood.org/pca/Badge.aspx?BadgeId=106227. If you'd like to show our badge on your web site or blog, please email us at info@lifesharers.org and we'll send you the information you need.

Thanks very much.

Click here to subscribe to this blog

LifeSharers Recruits 10,000th Organ Donor

Organ Donors Get Preferred Access to Organs through Innovative Network

NASHVILLE, Tenn. – November 8, 2007 – LifeSharers, the innovative organ donation network that helps people donate their organs to other organ donors, has attracted its 10,000th member. Membership in LifeSharers has grown by more than 53% in the last twelve months.

LIFESHARERS PUTS ORGAN DONORS FIRST

LifeSharers offers registered organ donors preferred access to donated organs.

LifeSharers members agree to donate their organs upon their death. They also agree to offer their organs first to other LifeSharers members, if any member is a suitable match, before offering them to non-members. In exchange, they get preferred access to the organs of other LifeSharers members. So, people who join LifeSharers increase their chances of getting a transplant should they ever need one.

"LifeSharers membership is a compelling investment in your future. It's free, and it could literally save your life,” says Bill Staton, Chairman of Staton Financial Advisors. “By joining LifeSharers you reduce the chance you'll die waiting if you ever need an organ transplant."

There are over 98,000 people on the transplant waiting list in the United States. More than half of them will die before they get a transplant.

LIFESHARERS MAKES ORGAN ALLOCATION FAIRER

LifeSharers helps correct an inequity in the organ allocation system, which gives about half of all organs to people who are not registered organ donors.

Katrina A. Bramstedt, Clinical Ethicist at California Pacific Medical Center, says "Signing up for organ donation is a social contract. In the case of organ scarcity it is appropriate to favor fellow organ donors over free riders. When it is time to allocate a scarce resource, it is fair to assign priority to people who are willing to both give and receive."

Only about 50% of adult Americans have agreed to donate their organs when they die, but just about 100% would agree to accept an organ transplant if they needed one to live. This is one of the biggest reasons there is such a large shortage of transplantable organs.

The organ shortage grows larger every year. Last year over 48,000 people were added to the national transplant waiting list every year, but only 29,000 people received transplants.

THE ORGAN SHORTAGE IS REALLY AN ORGAN DONOR SHORTAGE

Every year about 8,000 Americans die because they couldn’t get an organ transplant, and every year Americans bury or cremate about 20,000 transplantable organs.

Professor Steve Calandrillo of the University of Washington Law School notes that “Thousands of people are dying needlessly every year -- not because life-saving organs don't exist, but because we don't incent people properly to make them available in the first place. LifeSharers is helping to fix that."

LIFESHARERS CREATES AN INCENTIVE TO DONATE

By giving registered organ donors preferred access to their organs, LifeSharers members create an incentive for non-donors to become donors.

“We offer people a great trade – if you’ll agree to donate your organs through LifeSharers after you die, we’ll increase your chances of getting a transplant should you ever need one to live,” says David Undis, Executive Director of LifeSharers. “This could literally save your life, since most people who need an organ transplant die before they get one.”

"Those who are willing to give should be the first to receive,” says Alexander Tabarrok, Associate Professor of Economics at George Mason University. “LifeSharers makes this idea a reality. If enough people join LifeSharers, we could even have a surplus of organs."

HOW LIFESHARERS WORKS

LifeSharers members use a process called directed donation to offer their organs first to other members. Directed donation as practiced by LifeSharers members is legal in all 50 states and under federal law.

LifeSharers membership is free and open to all at http://www.lifesharers.org/ or by calling 1-888-ORGAN88. There is no age limit, and parents can enroll their minor children. No one is excluded due to any pre-existing medical condition.

LifeSharers members receive an organ donor card, letters to share with family members and doctors, and language to attach to their durable power of attorney for healthcare. Professor Gerry Beyer of Texas Tech University School of Law, an expert in wills and estate planning, helped design these materials.

About LifeSharers

LifeSharers is a 501(c)(3) non-profit network of organ donors. Membership in LifeSharers is free and open to all. LifeSharers does not discriminate on the basis of race, color, religion, sex, sexual orientation, national origin, age, physical handicap, health status, marital status, or economic status.

LifeSharers members include doctors, nurses, bioethicists, teachers, students, members of the clergy, and members of our armed forces.

About 10% of LifeSharers members are minor children enrolled by their parents.

Click here to subscribe to this blog

"Legally binding" organ donation?

North Carolina will soon become the 45th state to make signing up to be an organ donor legally binding, according to a story in the Charlotte Observer:

"A new law, which takes effect Oct. 1, makes a driver's decision to be an organ donor, designated by a red heart on a driver's license, legally binding. Gov. Mike Easley signed the bill Friday. In the past, the red heart indicated the driver's intention to be a donor, but it could be overturned by the owner's family. Under the new law, a family member's permission will not be needed to carry out wishes conveyed on driver's licenses."

It will be interesting to see if North Carolina enforces its new law. None of the other 44 states with similar laws enforce them. Families are routinely asked for permission to transplant organs from deceased relatives. These families refuse permission about 50% of the time.

In the United States you can stop a relative's organs from being donated, and you can refuse to donate your own organs, but still remain eligible for an organ transplant should you ever need one. This is not fair, and it's one of the biggest reasons there is such a large organ shortage in the United States.

Click here to subscribe to this blog

Who shall be saved?

Dr. Sally Satel has a very thoughtful piece in the August-September 2007 issue of the Hoover Institution's Policy Review.

Dr. Satel attended a forum on proposed revisions to UNOS kidney allocation rules. The proposed new rules are an attempt to maximize "Life Years from Transplant", which would mean older patients would get fewer kidneys. This prompted one attendee to say "That’s playing God and people aren’t going to like it.”

Dr. Satel writes: "That is not playing God; that is playing man — the all-too-human affair of people deliberating strenuously and in good faith to determine what is right." She goes on to describe the dilemma caused by the shortage of transplantable organs: "It is the eternal tradeoff that comes with medical rationing: individual versus societal benefit. Who will be saved?"

If there was no shortage of organs, everyone would be saved. There would be no need to decide who to save. Until then, we should decide to save registered organ donors first. Why? Because that will cause more people to register as organ donors, which will increase the supply of organs and save more lives. It will also mean we will face fewer decisions about who to save.

Click here to subscribe to this blog

Ending the black market for human organs

Jeff Stier of the American Council on Science and Health has an excellent piece in the New York Post on August 6th. He points out that the shortage of human organs for transplant operations has led to a macabre black market, and argues that a regulated system of incentives for donors would save lives and reduce the shortage that promotes the black market.

One of the incentives he mentions is Alex Tabarrok's "no give, no take" rule. LifeSharers is a variation of this idea. Alex Tabarrok is an Associate Professor of Economics at George Mason University, Research Director at The Independent Institute, co-author of the Marginal Revolution blog, and an advisor to LifeSharers.

Mr. Stier also writes: "Unless you're lucky enough to have a relative or some other highly motivated and altruistic donor, there is no legal way to improve your chances in the painfully slow race against death." This was true before LifeSharers came along, but it isn't any more. By joining LifeSharers you get preferred access to the organs of other members, so you improve your chances of getting a transplant should you ever need one.

Click here to subscribe to this blog

Kidney donation chain

The Arizona Republic highlighted America's first kidney donation chain in a July 22 story:

A chain of small miracles started in Phoenix last week.

It began when a Michigan man decided to donate one of his kidneys to a person he had never met.

His decision means a Phoenix woman will be able to watch her grandchildren grow up. But it does not stop there. Now the Phoenix woman's husband will donate one of his kidneys to a perfect stranger. That woman's best friend will then do the same. And so on and so on.

Eventually eight people, and possibly far more, will be saved because of the marriage of good will and medical technology.

This kidney chain - the first of its kind - is possible because of a new type of organ donation called a paired donation.

It happens when someone who needs a kidney has a person who is willing to donate one, but their body chemistry prevents a good match.

In a paired donation, those two people will be connected with two other people in the same situation.

Each healthy person then donates a kidney to someone who needs it.

The only unusual thing is that the donors are helping strangers directly in order to indirectly help the person they love.

Some people have been concerned that paired donations violate the National Organ Transplant Act's prohibition against donation for "valuable consideration" because they involve donation of a kidney in exchange for another kidney. President Bush is expected to soon sign legislation clarifying that these types of organ donations are legal.

The existence of paired donations provides further proof that altruism is not the only reason people donate organs. Some people say altruism should be the only reason people donate. If this attitude was turned into law it would kill people.

If you needed an organ transplant, would you care why your donor donated? Or would you just be glad they did?


Click here to subscribe to this blog

Presumed consent

In England, the Chief Medical Officer has recommended implementing an "opt-out" organ donation system. This is also known as presumed consent. Under this system, everybody is presumed to consent to the donation of their organs when they die. Anyone can fill out a form saying they don't want to donate.

If this system was implemented in the United States, the supply of organs for transplant operations would increase significantly. According to polls, about 90% of Americans support organ donation but only about 50% have bothered to register. If everybody was automatically registered, few people would bother to un-register.

Presumed consent can only be implemented in the United States through legislative action -- Congress would have to pass a law. The chances of this happening in the foreseeable future are somewhere between very slim and none, because there is wide-spread opposition to the idea of presumed consent.

This underlines the importance of the grass-roots approach of LifeSharers. You don't need Congressional action to join LifeSharers and donate your organs to other organ donors. When you donate your organs to other organ donors you create an incentive for non-donors to become donors, you make the transplant system fairer, and you increase your own chances of getting a transplant should you ever need one.

Click here to subscribe to this blog

LifeSharers in TIME Magazine

TIME Magazine has a story about LifeSharers in its current issue.

The story says Dr. David Landry, a nephrologist at Columbia University, "points out there are people who consciously don't register for organ donation for religious and other reasons, and it would be unfair to press them on their beliefs." If we are supposed to respect these people's reasons for not donating to us, shouldn't those people respect our reasons for donating to people who will return the favor? Are we supposed to respect their beliefs while they object to ours?

The story also quotes Elisa Gordon, a bioethics professor at Albany Medical College in New York State. "No other patients seeking medical treatment are required to give back anything beyond money for the costs of treatment," Gordon says. But organ transplants are a unique medical treatment -- it's illegal to pay people for their organs so there are no organ transplants without organ donations. As long as we have to rely on donated organs, it makes sense to give organs first to organ donors.

The story also incorrectly says LifeSharers members pledge to donate their organs "only to other members". This is not true. We pledge to donate first to other members. The last thing we want is for our organs to go to waste, so if no member needs an organ from a LifeSharers member, the organ is offered to non-members.

Click here to subscribe to this blog

How many Americans are registered organ donors?

Reuters reports that according to a recent poll by Harris Interactive, half of the adults in the United States say they have registered as an organ donor.

Humphrey Taylor, chairman of Harris Interactive, said he is not totally convinced by the poll's figures: "We know that when we do surveys like this, more people claim to have done the right thing than do the right thing. I think if half of all U.S adults really had registered, we would be in much better shape than we are, so I am skeptical on those numbers."

It's too bad the poll didn't ask those who said they had not registered as organ donors two more questions: "Would you be willing to accept an organ transplant should you ever need one?" and "Why on earth should anyone donate an organ to you if you're not willing to return the favor?"

Click here to subscribe to this blog

Should age determine who gets a kidney transplant?

Should age determine who gets a kidney transplant? That's the question asked by the Chicago Tribune in a story about the United Network for Organ Sharing's proposed changes to the rules it uses to allocate kidneys recovered from deceased donors.

UNOS has proposed allocating kidneys in a way that would maximize the number of extra years lived by kidney transplant recipients.

Does it make sense to give a kidney to a 75-year-old person with a limited life expectancy when you could give it to a 35-year-old person who is likely to live a whole lot longer? Reasonable people will disagree on this question.

UNOS' proposal is controversial. But any change to UNOS' rules will be controversial, because any change will mean more transplants for some groups and fewer transplants for others.

So why not change organ allocation rules in a way that will increase the number of organs donated? Allocating fewer organs to old people won't increase the number of organ donors. Allocating fewer organs to non-donors will.

Click here to subscribe to this blog

Organs for Organ Donors in Israel?

The transplant law in Israel may be changed to put registered organ donors first on the transplant waiting list. Dr. Yaakov Lavi tells the story at Haaretz.com

Click here to subscribe to this blog

LifeSharers on The Adam Carolla Show

I was a guest on The Adam Carolla Show this morning. Click here to listen.

Adam Carolla is a comedian, and his show may seem to be an unlikely forum for talking about organ donation. But LifeSharers got more new members today than we've gotten from all of the other radio shows I've appeared on in five years.

Thanks very much to Adam and his crew.

Click here to subscribe to this blog

LifeSharers on ABC

ABC aired a story about LifeSharers on December 9, 2006, on their "ABC World News Saturday" program. Click on the video to watch it:



You can also watch the video here.

Click here to subscribe to this blog

The most heart-warming organ donation story ever?

If there is a more heart-warming story about organ donation than this one, I haven't read it:

"Love works in mysterious and wonderful ways.

Cheryl Cottle was devastated when she lost her husband, Terry, who died in 1995 at age 33.

But Terry's heart was donated for an organ transplant, and so his death saved another man's life.

And the mysterious ways of love?

Terry's heart still beats inside Sonny Graham, the man Cheryl ended up marrying nine years later."

You can read the whole story here in the Hilton Head Island Packet, or here in The State.

Click here to subscribe to this blog

Why be an organ donor?

In a North Shore Sunday column, Daniel B. Kline writes: "What I can't understand is the millions of people who support organ donation, but aren't donors. Maybe they forget, maybe they just can't be bothered..."

I think he's right about the reasons. The vast majority of people don't have any good reason for not signing up as organ donors. On the other hand, there's no down side to delaying or forgetting.

The biggest reason to sign up as an organ donor is the chance to help others. Sadly, that's not enough of a motivator for a whole lot of people. So every year, thousands of organs that could have saved lives are buried or cremated instead.

With LifeSharers, there's another reason to sign up as an organ donor -- the chance to help yourself. You give up your organs after you're dead, and you get a better chance of receiving an organ if you ever need one to live.

Click here to subscribe to this blog

A federal organ grab without consent?

Sigfrid Fry-Revere of the Cato Institute writes in the New York Post on November 2nd:

...the Department of Health and Human Services Advisory Committee on Organ Transplantation is expected to recommend that states adopt policies of "presumed consent" for organ donation.

In other words, authorities could harvest organs from your dead body without prior permission from you or your family.

If the government is really concerned with getting donor organs, it shouldn't rationalize stealing them, it should amend the National Organ Transplant Act to give people incentives for donating them.

The situation is dire. Some 93,000 Americans are now on the list to receive donated organs; last year, fewer than half got them. Twenty Americans die every day waiting for an organ that never comes.

No one seems to doubt that paying people to donate their organs after they die would dramatically increase the number of organs available - but government bodies hesitate to allow it.

Presumed consent would increase the number of organs available for transplantation. So would paying people for their organs. But neither of these is legal, and it's extremely unlikely that either will be legalized in the forseeable future. Both are total non-starters from a political standpoint because both face substantial nationwide opposition.

The LifeSharers incentive is already legal. It is also less controversial than paying for organs or taking them without consent.

Click here to subscribe to this blog

Rationing life

Today's Los Angeles Times has a story about the agonizing decisions surgeons and hospitals have to make in allocating kidneys for transplant operations. These decisions can mean life or death for patients -- life for the patient who gets the kidney, and death for the one who doesn't.

Many of these decisions would be unnecessary if Americans weren't burying or cremating 10,000 transplantable kidneys every year. What can be done about this? The United Network for Organ Sharing, which sets national organ allocation rules, has the power to make a simple policy change that would eliminate most of this horrific waste of life-saving organs.

UNOS should announce that it will move registered organ donors to the front of the transplant waiting list, and that it will move those who are not registered to the back.

This announcement would cause millions of Americans to register as organ donors. Given that most people on the transplant waiting list die waiting, the vast majority of Americans would decide that registering is a good idea. Almost everyone in the United States supports organ donation, but most people haven't registered. UNOS can provide the kick in the pants that many Americans apparently need.

According to the Los Angeles Times, over the last decade the number of people waiting for kidneys nationwide has more than doubled to about 68,500 and could reach 100,000 by 2010. If UNOS put registered organ donors first on the waiting list it could save thousands of lives every year. How many more people will die needlessly before UNOS makes this simple policy change?

In the mean time, LifeSharers offers Americans the opportunity to donate their organs to other registered organ donors. Please tell your family, friends, neighbors, and colleagues about LifeSharers. You could save someone's life, and the life you save could be your own or someone very dear to you.

Click here to subscribe to this blog

More Hawaii families are saying 'no' to organ donation

A story by Honolulu TV station KHNL reports a very disturbing trend: organ donation rates are dropping in Hawaii because families are refusing to allow transplantation of organs from registered organ donors.

According to the story, last year "only 55% of the potential donors actually became donors because family members agreed to allow their loved ones organs to be donated." But it gets even worse: "So far this year only 40% of potential organ donations actually went through because 25 families decided not to give consent even though the donor intended to."

The decisions these families made prevented about 75 transplants, since the average deceased organ donor contributes about 3 organs. So about 75 people will die or suffer needlessly.

It's outrageous to stop a relative's organs from being donated when you know that your relative wanted to be a donor. It's also outrageous that transplant and law enforcement professionals allow this to happen. Under Hawaii's anatomical gift law, "an anatomical gift that is not revoked by the donor before death is irrevocable and does not require the consent or concurrence of any person after the donor's death." (See Hawaii Revised Statutes chapter 327-2(h).) Just about every other state has a similar provision in its anatomical gift statute.

By the way, if you prevent a relative's organs from being transplanted you will remain eligible for a transplant if you ever need one. That's perhaps the most outrageous thing of all.

Click here to subscribe to this blog

L.A. Times criticizes transplant system oversight

An investigative report published by the Los Angeles Times on October 22nd criticizes the United Network for Organ Sharing. UNOS operates the national organ allocation system in the United States. According to the report, UNOS "often fails to detect or decisively fix problems at derelict hospitals — even when patients are dying at excessive rates." The report describes what it calls a "national pattern of uneven and often weak oversight" and says that at times UNOS "appears more intent on protecting hospitals than patients."

We can expect calls for improved oversight of compliance with UNOS policies. But those policies themselves also need improvement. Specifically, UNOS should allocate organs first to registered organ donors. This simple policy change would cause a large increase in the number of organs available for transplantation in the United States, and thousands of lives would be saved every year.

Problems at transplant hospitals would also be easier to spot if there were more organs to transplant.

Click here to subscribe to this blog

Washington Post editorial endorses idea behind LifeSharers

In an editorial today, the Washington Post says it's time to consider extra incentives to encourage more people to donate their organs when they die. One of the incentives it suggests sounds a lot like LifeSharers.

Among other incentives, the editorial suggests this: "The decision to pledge organs could be linked to the chance of receiving one: People who check the box on the driver's-license application when they are healthy would, if they later fell sick, get extra points in the system used to assign their position on the transplant waiting list."

This is the idea behind LifeSharers, although the details are different. The Washington Post says their suggested incentives "don't raise significant ethical issues" and "would save money and relieve suffering."

Click here to subscribe to this blog

LifeSharers on CNN

CNN aired a story about LifeSharers on September 17, 2006. Click on the video to watch it:



Bryan Stewart of OneLegacy, the organ procurement organization in southern California, said a couple of interesting things in the story.

First, Mr. Stewart said "any time you work outside of the established allocation process, you're not necessarily giving the organs to people that are most in need." This statement is true, but it is misleading. It implies that the established allocation process gives organs to people that are most in need. But that process often bypasses the person most in need. That process takes several factors into account when allocating organs, and need is only one of them.

Next, Mr. Stewart said "the likelihood that someone in LifeSharers is going to benefit from a donor that is part of LifeSharers is extremely low." Is this statement true? It depends on what you mean by "extremely low." At our current membership level, there is about a 25% chance that one or more LifeSharers members will die and become an organ donor within the next 12 months. Will any of the organs donated be a suitable match for any LifeSharers member who needs a transplant? That's impossible to know, but there are currently over 30 LifeSharers members on the national transplant waiting list so it seems likely that at least one suitable match will be found.

Whatever the odds are, it's important to keep in mind that the odds keep growing as the number of LifeSharers members increases. Statistically speaking, it's a virtual certainty that sooner or later a LifeSharers member will recieve an organ donated by another LifeSharers member. It's just a matter of time. When it happens, we expect lots of publicity and a huge number of new members.

Click here to subscribe to this blog

LifeSharers is not discriminatory

A story about LifeSharers in today's Fort Worth Star-Telegram is titled "Organ donation club called discriminatory".

Anyone can join LifeSharers. Membership is free. We welcome everyone, and we turn no one away. Can someone please tell me what is discriminatory about that?

Click here to subscribe to this blog

A good idea from Canada

Here is an excerpt from Peter Duffy's column today in the Chronicle Herald in Halifax:

"A reader named Jeff Whitman has a suggestion to increase organ donations.

He has a very simple idea. Essentially, Jeff feels those who think of others by signing a donor card should get priority if, heaven forbid, they ever need a transplant while they’re alive.

Why, he wondered, should those who refuse to be donors be allowed to be recipients?

That’s not fair, he argued. 'Those of us who sign cards should be first in line if we need a transplant.'

I told Jeff I thought it was an outrageous, unthinkable, mad idea and that it just might work."

Click here to subscribe to this blog

More education won't reduce the organ shortage

In an editorial yesterday, the Mankato Free Press mentions "giving organ donors priority status on the national waiting list" as a way to entice people to donate organs.

The editorial continued by saying that "it would make more sense to educate people about the benefits [of organ donation] and hope they can make an informed decision." Actually, education would not make more sense. Millions and millions of dollars have been spent on educational efforts designed to increase organ donation rates, but the organ shortage continues to get bigger every year.

Bioethics Arthur Caplan puts it really well. In his bioethics column for MSNBC, he wrote: "Americans are well aware of organ donation. Public education campaigns have been letting people know about the 'Gift of Life' for 30 years. One more pamphlet at the office or a few more minutes in drivers ed is not going to boost the percentage of people who sign donor cards beyond what has already been achieved through concerted public education efforts."

More of the same is not the answer. For the sake of the 91,000 Americans now waiting for transplants, we should try something new. How about giving organ donors priority status on the national waiting list? That's what LifeSharers does.

Click here to subscribe to this blog

Do Americans think the organ allocation system is fair?

The Coalition on Donation surveyed 4,500 Americans on organ donation issues in 2005. According to an article about the survey in the January-February issue of UNOS Update, "80% of respondents question the fairness of the organ allocation system."

This is a staggering figure, and it may help explain why organ donation rates remain as low as they are. The article on the survey didn't explain why people question the fairness of the system. It would be interesting to find out why. I know a lot of people think celebrities (Mickey Mantle, for example) get special treatment, and that may have something to do with it.

Would more people trust the organ allocation system if organs were given first to registered organ donors? I think they would.

Click here to subscribe to this blog

Organs from death row inmates?

In an article published by the Philadelphia Inquirer on March 15th, Claude Lewis suggests that an inmate facing a death sentence be allowed to donate a major organ in exchange for a life sentence without the possibility of parole.

Mr. Lewis says his plan could yield hundreds of organs. He's probably right. But it's extremely unlikely his plan will ever be implemented. The legal hurdles are just too high.

As Mr. Lewis eloquently writes, "it is no small irony that while thousands of Americans die needlessly each year because they lack the requisite organs, others go to their deaths carrying off healthy organs needed to sustain life." This situation is not, of course, confined to prisons. Americans bury or cremate about 20,000 transplantable organs every year.

LifeSharers is trying to stop this waste, by giving people a good reason to donate their organs when they die -- a better chance of getting a transplant if they ever need one to live. If the United Network for Organ Sharing, which runs the national organ allocation system, adopted the LifeSharers approach it could yield about 20,000 organs every year.

Click here to subscribe to this blog

To ensure everyone can receive a transplant?

On March 15, WCCO TV in Minneapolis/St. Paul aired a story about LifeSharers.

A spokesperson for LifeSource (the local organ procurement organization) said LifeSharers "could create a class of people that would have priority for transplants." That's the whole point of LifeSharers! Can anyone name the "class" LifeSharers creates? If you said "registered organ donors" give yourself a big pat on the back. Registered organ donors should have priority for transplants. And by the way, everyone can join the class LifeSharers creates. Membership is free.

The LifeSource spokesperson went on to say that the organ allocation system "as it is now, is founded on principles of equity to ensure everyone in need can receive a life-saving transplant." This is just too much. One of the system's "principles of equity" is that when deciding who gets the next organ, registered organ donors should be treated no better than people who refuse to donate their organs. That is one strange principle of equity.

It's even stranger to say the system ensures that everyone in need can receive a life-saving transplant. It does exactly the opposite. More than half of the people who need transplants in the United States will die before they get one. Three years ago, the President-Elect of UNOS (the organization that runs the allocation system) called the transplant waiting list "the waiting to die list."

If "the system" allocated organs first to registered organ donors it would produce more registered organ donors -- and save thousands of lives every year. If you want your organs to go to other registered organ donors, please join LifeSharers. Membership is free and open to all at www.lifesharers.org or by calling 1-888-ORGAN88.

Click here to subscribe to this blog

MatchingDonors.com -- a wonderful success story

Rob Smitty donated a kidney to Bob Hickey on October 20, 2004. Mr. Smitty met Mr. Hickey through at web site called MatchingDonors.com.

This was the first transplant arranged by MatchingDonors.com. In the year since that operation, 16 people have received transplants through the MatchingDonors.com web site. What a wonderful success story!

A few days ago, the national transplant waiting list exceeded 90,000 people for the first time. The list would be much larger if not for the tremendous generosity of live organ donors.

Just as MatchingDonors.com is using the internet to increase the number of live organ donors, LifeSharers is using the internet to increase the number of people who agree to donate their organs when they die.

Click here to subscribe to this blog

Directed donation is not unfair

Today's Philadelphia Inquirer has an excellent opinion piece about organ donation. The author is Jason Lott of the University of Pennsylvania Medical School.

Mr. Lott mentions that critics of directed donation say it is harmful because individuals could unfairly "break in line" ahead of others to receive their organs.

This criticism assumes that organs belong to the people who need them. But organs belong to donors. Federal law allows directed donation. So do the laws of all fifty states.

LifeSharers members want their organs to go to others who have agreed to donate their own organs when they die. Nothing could be fairer. Allocating organs this way also encourages more people to register as organ donors, and that saves lives.

People who won't donate their own organs have no business complaining about directed donation. They have no legitimate moral claim to a place in the transplant waiting list.

Click here to subscribe to this blog

A bad argument against directed donation

Some bioethicists want to take away your right to decide who gets your organs when you die. They say experts should decide who gets your organs.

Arthur Caplan contributes the worst argument against directed donation that I've seen. He is chairman of the Department of Medical Ethics and director of the Center for Bioethics at the University of Pennsylvania. In a speech printed in Science & Theology News, he says: "I don’t think donation is just a matter of individual liberty and choosing what you want to do with your parts, alive or dead. Part of what goes on with a directed donation is that we all wind up paying, to some extent, for the cost of that transplant. The public pays for the training of the people, reimbursing out of Medicare or Medicaid for much of the cost."

Professor Caplan thinks you shouldn't be able to decide who gets your organs because the public pays for some of the costs of transplant operations. But the public pays for some of the cost of just about everything. Under Professor Caplan's logic, experts would control over just about everyhing.

The public pays for some of the costs of treating obese patients. Does this mean experts should be able to decide what you eat? The public pays for some of the costs of treating people hurt in motor vehicle accidents. Does this mean experts should be able to decide what car you drive? The public pays for some of the costs of treating children injured playing sports. Does this mean experts should be able to decide what sports children play?

Professor Caplan's argument can be used to justify just about anything. An argument like that is no argument at all.

Click here to subscribe to this blog

AMA suggests studying presumed consent and mandated choice

The American Medical Association has adopted a new policy that "calls for physicians to encourage and support pilot studies that investigate the effectiveness of presumed consent and mandated choice for organ donation." (You can see the AMA's press release here.)

In presumed consent, a willingness to donate is assumed unless an individual specifically opts out by withdrawing consent. In mandated choice, individuals are required to express a preference for or against organ donation.

It's good to see the AMA trying to do something to help increase organ donation rates. Presumed consent and mandated choice would both probably help reduce the organ shortage -- if they were legal. But they're not, and it's extremely unlikely they will become legal in the forseeable future. Both of these policies are controversial. Neither of these policies enjoys broad-based support. So there's no reason to think Congress or state legislatures will legalize them.

Rather than support policies that are not legal and will not become legal, the AMA should throw its weight behind an already-legal policy that can quickly reduce the organ shortage. The AMA should urge the United Network for Organ Sharing to start allocating organs first to registered organ donors.

Imagine UNOS announced that, until the organ shortage was eliminated, it was going to stop giving organs to people who weren't registered organ donors. Millions and millions of people would register. Thousands of lives would be saved every year.

LifeSharers is implementing this policy from the ground up, and we will eventually put a big dent in the organ shortage in the United States. UNOS can accomplish the same thing much faster by implementing the LifeSharers approach from the top down. UNOS has the power. It should use it.

Click here to subscribe to this blog

Whose organs are they, anyway?

Dr. Douglas Hanto, a transplant surgeon in Boston, wants to stop you from deciding who gets your organs when you die. Unless, of course, you decide to give them to the kind of people he approves.

At a meeting in Chicago earlier this month, Dr. Hanto suggested limiting directed donation. "Directed donation, except in the context of relatives or emotionally related friends, unfairly directs organs away from the neediest patients on the waiting list, and in the case of deceased donor organs, bypasses approved allocation policies and should not be permitted," said Hanto, who represented the American Society of Transplant Surgeons at the meeting. (See this article in the St. Louis Post-Dispatch for more.)

If Dr. Hanto tried to stop people from deciding who got their charitable contributions (or who got their property when they died) most people would be outraged. It's even more outrageous to tell people they can't decide who will get their organs when they die.

Stopping people from deciding who will get their organs would also cause fewer people to donate their organs. That would mean more people would die waiting for transplants.

I want my organs to go to other organ donors. So do over 3,100 people who have joined LifeSharers. They're our organs, Dr. Hanto, and we'll decide who gets them.

Click here to subscribe to this blog

Is your life worth $7? How about your neighbor's life?

In Georgia, you get a $7 discount on your drivers license fee if you register as an organ donor. The state legislature has passed a bill, backed by the governor, to end this discount.

According to a story in Monday's Savannah Morning News, data from the Georgia Department of Motor Vehicle Safety shows that drivers who are eligible for the discount are up to 40% more likely to sign up as donors than those who don't qualify for the discount, such as veterans who get their licenses for free.

That's a whole lot of people who would rather bury their organs than save several lives if they don't get $7. This is more proof that altruism will not solve the organ shortage. There just aren't enough people who are generous enough to share the gift of life with their fellow man.

To get more organs, we need to provide people with an incentive. That's what LifeSharers does. We give people a better chance of getting an organ if they ever need one to live, in exchange for a promise to donate their organs when they die.

There's another benefit to joining LifeSharers -- your organs are less likely to go to someone who thinks your life is worth less than $7.

Click here to subscribe to this blog

The good news and the bad news about organ donation

The number of organ transplants in the United States increased 6% in 2004. That's over 27,000 lives saved. Organs from deceased donors were up 11%, and organs from live donors were up 2%. That's the good news.

Here's the bad news:
- Last year 43,128 people were added to the national transplant waiting list.
- Last year 6,228 people were removed from the waiting list because they had died. Another 1,594 were removed from the list because they had become too sick to undergo transplant surgery.
- At the end of 2004, over 87,300 people were on the national transplant waiting list. That's up from about 83,900 at the end of 2003.

Here's more bad news. While 90% of Americans support organ and tissue donation:
- only 62% say they would be willing to donate some or all of their organs and tissue when they die, and
- only 55% of Americans agree to donate the organs of a deceased relatives when asked for their consent.

The organ shortage continues to get worse because Americans bury or cremate about 20,000 transplantable organs every year. That means thousands of Americans are buried every year next to the organs that could have saved their lives.

Most people don't have any good reason not to donate their organs when they die. But they don't have any good reason to donate them either. LifeSharers gives people a good reason - a better chance of getting a transplant if they ever need one.

Data sources:
Fox News
UNOS
Coalition on Donation

Click here to subscribe to this blog

Change Organ Allocation to Increase Organ Supply

(The following is the text of a speech, as prepared for delivery, at a DePaul Law Review and Health Law Institute Symposium: “Precious Commodities – The Supply and Demand of Body Parts” in Chicago on March 4, 2005)

CHANGE ORGAN ALLOCATION TO INCREASE ORGAN SUPPLY
by
David J. Undis

If we change how we allocate organs we will get more organs to allocate.

We should allocate organs first to people who have agreed to donate their own organs when they die. This will cause many more people to register as organ donors, and save thousands of lives every year. Increasing the supply of organs this way is fair and simple, and it can be implemented without legislative action. It is already legal.

Would changing the organ allocation system really increase the supply of organs?

Imagine that the United Network for Organ Sharing made the following announcement tomorrow: “Beginning January 1 of next year, we will make no human organ available for transplantation into any person who is not a registered organ donor. The only exceptions will be directed donations and cases where no registered organ donor matches an organ that is available.”

Following the announcement of this policy change, millions and millions of people would register themselves and their children as organ donors. Wouldn’t you?

Registering as an organ donor would give you a better chance of getting an organ if you ever needed one. Deciding not to register would reduce your chance. When you consider that more than half of the people who need a transplant in the United States die before they get one , improving your odds could literally mean the difference between life and death. Agreeing to donate your organs after you die is a small price to pay for a better chance to get an organ if you ever need one to live. Almost everyone would decide to pay that price. The supply of organs would go way up, and thousands of lives would be saved every year.

Last year, there were about 7,000 deceased organ donors in the United States, and they provided the organs for about 20,000 transplants. But organs are transplanted from less than half of the eligible deceased donors. That means we could get up to 20,000 additional organs every year by changing the organ allocation system. To put that number in perspective, keep in mind that last year about 6,000 people were removed from the national transplant waiting list because they died and 1,500 more were removed because they became too sick to undergo surgery. So with an additional 20,000 organs per year, we could eliminate most of those deaths, reduce the size of the waiting list, and shorten waiting times for people still on the list.

We don’t need medical breakthroughs to achieve these results. All we need is behavior change. Only about 30% of Americans have signed up to donate their organs when they die. And Americans donate only about 50% of the organs that could be transplanted. They bury or cremate the rest. All we need to do is convince people to stop throwing away organs that could save their neighbors’ lives. Changing how we allocate organs will produce that behavior change.

The idea of giving registered organ donors an allocation preference is not new. It has been around for at least 15 years. Everyone who has suggested it has predicted that it would significantly increase the supply of organs. Some have said it would completely eliminate the waiting list. Even opponents of the idea generally concede it would increase supply. They say it isn’t fair.

So, is it fair to allocate organs first to registered organ donors?

Yes, in fact it makes the organ allocation system fairer.

What isn’t fair is giving an organ to someone who won’t donate their own, when there is a registered organ donor who needs it. It’s like awarding the lottery jackpot to someone who didn’t buy a ticket.

When you die, you can bury your organs, cremate them, or donate them and save lives. When those are your only choices, deciding not to donate is a spectacularly selfish thing to do. People who make that decision have no moral claim to an organ transplant.

Without organ donors there can be no organ transplants. Giving organs first to organ donors produces more organ donors, and that saves more lives.

The primary goal of the organ allocation system should be to save as many lives as possible. Other goals should be secondary.

It would be simple for UNOS to change its allocation system to put registered organ donors first. UNOS could simply add a field to its waiting list database. That field would show whether or not a potential organ recipient is a registered organ donor. Then when an organ becomes available, instead of offering it first to the highest-ranked person on its match run, UNOS could offer it first to the highest-ranked registered donor.

Putting organ donors first has an important advantage over most other suggestions for increasing the supply of organs. No legislative action is needed to implement it. UNOS already has the authority to give registered organ donors an allocation preference. The UNOS Ethics Committee acknowledged this fact in its 1993 white paper titled “Preferred Status For Organ Donors.” They wrote: “a trial could be implemented without requiring any alteration in existing legislation.”

In fact, UNOS already moves live donors up the waiting list if they later need a transplant. UNOS can, and should, do the same for people who agree to donate when they die.

Congress has never made tackling the organ shortage a priority, and there is no reason to think they will do so in the foreseeable future. Anyone who cares about the more than 87,000 people now on the national transplant waiting list should an approach to increasing the organ supply that does not depend on legislative action.

To review, changing the national organ allocation system could save thousands of lives a year and improve the system’s fairness. And UNOS has the power to implement this simple change. So, what is UNOS’ position on this? It hasn’t really taken one.

The closest it came to doing so was in 1993. But its white paper on the subject ultimately stopped short. It only recommended “wider societal discussion before considering concrete plans for implementation” of any system.

UNOS has not led the discussion it recommended. It has been largely silent on the subject since the publication of its white paper almost 12 years ago. That is unfortunate. Over 55,000 people on the UNOS waiting list have died over the last 10 years. Most of those deaths could have been prevented.

Fortunately, as individuals we don’t need to wait on UNOS to increase the organ supply from the top down. We can attack the problem from the ground up.

You can allocate your own organs. You can offer them first to registered organ donors who will do the same for you. That is the premise behind LifeSharers.

LifeSharers is a grass-roots organ donation network. Members agree to donate their organs when they die. Furthermore, they agree to offer their organs first to fellow members, if any member is a suitable match, before offering them to others. Membership is free and open to all at www.lifesharers.com. LifeSharers does not discriminate on the basis of race, color, religion, sex, sexual orientation, national origin, age, physical handicap, health status, marital status, or economic status. We welcome everyone, and we turn no one away. LifeSharers has over 2900 members, including members in all 50 states and the District of Columbia. Over 300 LifeSharers members are minor children enrolled by their parents. LifeSharers is organized as a 501(c)(3) non-profit organization and is staffed by unpaid volunteers. Our operations are funded by tax-deductible contributions.

The first question most people ask when they hear about LifeSharers is: “Is it legal?” The answer is yes. LifeSharers is a form of directed donation, which is legal in all 50 states, in the District of Columbia, and under federal law.

The law here in Illinois is typical. It allows donation of body parts to “any specified individual for therapy or transplantation needed by him or her.”

That is exactly what LifeSharers members do. We carefully follow the law. We donate each of our organs to a specified individual. Specifically, every LifeSharers member says: “for each part of my body donated, I designate as donee that LifeSharers member who is the most suitable match as defined by the criteria in general use at the time of my death.” That means, for example, that I would want my liver to go to the highest-ranked LifeSharers member on UNOS’ match run.

At the federal level, the Organ Procurement and Transplantation Network’s “Final Rule” governs organ allocation policy. It explicitly permits directed donation. The section that lays out how organs are to be allocated concludes by saying: “Nothing in this section shall prohibit the allocation of an organ to a recipient named by those authorized to make the donation.”

Again, LifeSharers carefully follows the law. When a member dies in circumstances that permit recovery of their organs, we provide their family with the names of individual LifeSharers members, if there are any, who need their organs. The member’s family then directs donation to these named individuals.

So, LifeSharers is legal. But can a grass-roots effort really reduce the organ shortage in America? Again, the answer is yes.

LifeSharers gives Americans an incentive to donate their organs when they die, and it is a powerful one. That incentive is preferred access to the organs of all our members. Simply put, joining LifeSharers gives you a better chance of getting an organ if you ever need one.

As the number of LifeSharers members grows, so does the incentive to join if you are not already a member. Consider, for example, what it will be like when LifeSharers has a million members. You’d be crazy not to join. If you didn’t, you’d give up preferred access to a pool of a million livers, two million kidneys, a million hearts, two million lungs, and more. That’s a powerful incentive to join LifeSharers. And that incentive can give a big boost to the supply of organs in America.

No LifeSharers member has yet died in circumstances that would have permitted recovery of their organs, but it’s just a matter of time. At our current membership level, there is about a 14% chance that organs will be recovered from one or more of our members in the next twelve months. When LifeSharers members start getting organs from other members, we expect a whole lot of publicity and a very large jump in our membership.

LifeSharers can’t increase the organ supply as fast as UNOS could if they implemented our approach. But I predict LifeSharers will put a big dent in the organ shortage before any effective legislative action is taken to reduce it.

So, LifeSharers is legal, and it will work. But is it fair? Again, the answer is yes.

I’ve already covered this issue from the demand side – that is, from the standpoint of the people who need organs. It’s also important to look at this issue from the supply side – that is, from the standpoint of the people who donate organs.

If you want to give your organs to other organ donors, is it ethical to override your wishes and give them to someone else? No, clearly it is not. But efforts are under way to do exactly that. Some bioethicists have suggested making it illegal for you to direct the donation of your organs to someone who doesn’t have a relationship with you that fits their criteria.

Imagine you wanted to give some groceries to a poor person. Then imagine some “experts” tried to force you to give them instead to the United Network for Grocery Sharing, so it could decide who gets them. I expect you would find that offensive. It is even more offensive when “experts” say they should decide who gets your organs when you die.

So, what does UNOS have to say about LifeSharers?

UNOS says “Our formal position is that UNOS does not endorse LifeSharers' approach. However, UNOS does not intervene in directed donation if it is allowed by state law.”

But UNOS has also said it doesn’t believe LifeSharers has made an “appropriate interpretation of the intent of directed donation” since “the only connection between donor and recipient is that they share membership” in LifeSharers. LifeSharers has made no interpretation of any sort. State and federal laws regarding directed donation are clear and they are plainly written, and we carefully follow them as written. UNOS is the one doing the interpreting, not LifeSharers.

LifeSharers deserves UNOS’ support, not its opposition. Will more Americans donate their organs if UNOS says they can’t donate them to other organ donors, or will fewer donate? The question answers itself.

Beyond just supporting LifeSharers, UNOS should implement the LifeSharers approach as its own. By doing so, UNOS would increase the supply of organs a whole lot faster than LifeSharers will.

Allocating organs first to organ donors can save thousands of lives a year. Nothing could be simpler, nothing could be fairer, and nothing in the law says we can’t make it happen.

Click here to subscribe to this blog

Netherlands may give transplant priority to registered donors

In the Netherlands, Health Minister Johannes Hoogervorst wants to give priority on transplantation waiting lists to people who are registered as donors. It's nice to see that the idea that organs should go first to organ donors is catching on outside of the United States.

Here is an article from Expatic News:

Plan to give organ donors transplant priority

4 March 2005

AMSTERDAM — Health Minister Hoogervorst wants to give priority on transplantation waiting lists to people who are registered as donors, but MPs slammed the proposal on claims it will introduce discrimination in healthcare.

The Liberal VVD minister defended his proposal by pointing out that Muslims often refuse to donate organs based on religious beliefs. This is despite the fact they are willing to receive an organ if they are ill. "That creates a bad feeling," he said.

"If you say: 'I refuse to donate an organ because of my religion, but I don't want to receive one either', than I will respect it. But I won't respect a one-sided attitude of receiving and not giving. I find that problematic," Hoogervorst said.

After the parliamentary debate on organ donation, the minister said it is not just a few Muslims who refuse to give and whom are willing to receive an organ donation. It is instead a substantial group.

Hoogervorst said immigrants often have poorer health and will require a transplant more often than native Dutch. Due to the shortage of organ donors — especially kidneys — some 200 people die every year in the Netherlands, newspaper De Volkskrant reported.

The minister came to his conclusion in recent months during talks with medical specialists. At the request of Parliament, he will now draw up a detailed proposal.

Hoogervorst is considering a system in which registered donors receive extra points on organ transplant waiting lists, meaning they will get an organ sooner. The Cabinet has not yet determined its stance on the issue.

The Christian Democrat CDA and Labour PvdA led parliamentary opposition to the plan, but nearly all political parties expressed fears that Hoogervorst was introducing discrimination in healthcare. They are concerned that smokers and overweight people will also receive help later than other people.

But Hoogervorst rejected proposals to automatically register the entire population as potential donors, despite the fact that most of the opposition parties and government coalition partner Democrat D66 think that the system will yield more donors.

MPs will vote on automatic organ donation next week, but the proposal is not assured of a majority due to a difference in opinion between Labour PvdA and the Socialist SP party over the type of system to be introduced.

[Copyright Expatica News 2005]

Click here to subscribe to this blog

Transplant denied!

Patrick Garrity wants to donate one of his kidneys to his friend Alex Crionas. Because Mr. Crionas had created a web site to recruit a donor, the LifeLink transplant center in Tampa is refusing to test Mr. Garrity to see if he is a suitable match, according to a story in today's Tampa Tribune.

LifeLink's behavior is outrageous.

If you agree, please send an email to Dr. Victor Bowers, the Medical Director at LifeLink. His email address is Bowers@lifelinkfound.org. Please also send a letter to the editor of the Tampa Tribune. You can access their online form at
http://feedback.tbo.com/

There is nothing illegal about using the internet to try to improve your chances of getting an organ transplant.

Click here to subscribe to this blog

Not all slopes are slippery

The Dallas Morning News published a story yesterday about LifeSharers.

The story quotes Pam Silvestri, a persistent critic of LifeSharers. She works for the Southwest Transplant Alliance, the organ procurement organization that services the Dallas area. She says LifeSharers is a "slippery slope" because if LifeSharers succeeds, "what's to stop dozens of lists from being created that allow special access based on other agendas ... race, religion, etc.?"

Some slopes aren't slippery, and this is one of them. Giving organs first to Hispanics doesn't produce more Hispanics, and giving organs first to Catholics doesn't produce more Catholics. But giving organs first to organ donors produces more organ donors, and that saves lives. That's the whole idea behind LifeSharers.

Besides, is it necessarily a bad thing for organ donors to give special access to members of their own race or religion? If it produces more organ donors and saves more lives, I say it's a good thing.

Ms. Silvestri also says LifeSharers won't work. She says it isn't practical for a LifeSharers member to offer their organs to a fellow member "because the organs might not match anyone in the LifeSharers group...and the small number of people in that group likely won't ever be in a position to donate. And even if they were, it is unlikely that the others in the group will be on the wait list for an organ."

Ms. Silvestri misses the point. It is possible that a member's organs won't be a good match for any other member, but the odds of that go down every time we get a new member. She is also misinformed. We already have 21 members "on the wait list for an organ" and statistically it's a virtual certainty that sooner or later a LifeSharers member will "be in a position to donate."

Ms. Silvestri and her colleagues at the OPOs around the country should be helping LifeSharers, not criticizing us. We recruit organ donors. That helps the OPOs. It also helps save lives. Isn't that what the OPOs are in business to do?

Click here to subscribe to this blog

Avoiding "chaos" vs. saving lives

In an article in today's Houston Chronicle, medicial ethicist Arthur Caplan calls for Congress or the United Network for Organ Sharing to disallow directed organ donations except among family members.

Professor Caplan wants to disallow directed organ donations because if they take off they'll cause "chaos". But he also acknowledges that appeals for directed donation may ease the organ shortage.

Easing the organ shortage means saving lives. How can avoiding "chaos" be more important than saving lives? That's an argument only an expert can love.

LifeSharers uses directed donation to reduce the organ shortage. As practiced by LifeSharers, directed donation is legal under federal law and under the laws of all 50 states and the District of Columbia. If Dr. Caplan has his way, you won't be able to direct your organ donation gift to fellow organ donors, friends, or neighbors. That may avoid "chaos", but it will kill people.

Click here to subscribe to this blog

Researchers want to stop life-saving organ donations

Through a process called list-paired exchange, a person waiting for a kidney transplant gets a higher priority on the waiting list for an organ from a deceased donor when a relative makes a living donation to the waiting list. The living donor is not able to donate to his relative, usually because of blood type incompatibilities, so the willing donor gives his kidney to an unknown person on the waiting list.

List-paired exchanges save lives. Someone on the waiting gets a kidney. The donor's relative gets higher priority on the next matching kidney.

But some "researchers" don't think this is fair! Why? Because list-paired exchanges help people with certain blood types more than people with other blood types. Fewer people die overall, but more people with blood type O die. (For details go here.)

These "researchers" want to prohibit people from donating kidneys that they can't donate to relatives, if their relatives have blood type O. So if you wanted to help your brother get a kidney by giving one of your kidneys to a stranger, they would stop you if your brother's blood type is O.

This is arrogance on the grandest scale. Their proposal stop people from saving lives if their blood types weren't the right ones. And it would kill people in the name of fairness.

The goal of our organ donation system should be to save lives, not to spread deaths equally among groups. LifeSharers helps save lives by increasing the number of organ donors.

Click here to subscribe to this blog

Distrust of the organ donation system

According to an Associated Press report distrust of doctors is one of the reasons for low organ donation rates among blacks. The report cites statistics from the Organ Procurement and Transplantation Network, which say that blacks make up 27% of the waiting list for organ donations but only 12% of organ donors.

One way to increase trust in the organ donation system is to give donors more control over who gets their organs. LifeSharers does that, by helping people direct their organs to fellow organ donors.

Click here to subscribe to this blog

Who deserves an organ transplant?

According to an article in today's Chicago Sun-Times, "From May 2002 to April 2004, 48 Illinois families refused to let organs be taken from the bodies of family members, even though their loved ones had registered as organ donors before they died. Each donor supplies an average of four organs, so these 48 vetoes meant nearly 200 fewer organs were available for transplants."

These vetoes also killed nearly 200 people.

Do the people who prevented their relatives' organs from being transplanted deserve to get an organ transplant if they ever need one? No, they don't. Not as long as there aren't enough organs to go around.

If one of those people got an organ that you or a loved one needed you'd be justifiably outraged.

Click here to subscribe to this blog

Reaction to Houston man's ad campaign for a liver

Following the success of Todd Krampitz's advertising campaign for a liver, the Associated Press quoted the United Network for Organ Sharing as saying that efforts like his "can create an uneven playing field for individuals on the national waiting list for organs." But the allocation system UNOS runs is already unfair. It gives about 70% of all organs to people who haven't agreed to donate their own organs when they die.

As long as people who refuse to sign a donor card can jump to the front of the waiting list if they need a transplant we'll always have an organ shortage. The solution to the organ shortage is simple -- if you don't agree to donate your organs when you die, then you go to the back of the waiting list if you ever need an organ to live.

The Houston Chronicle chimed in with an editorial. While acknowledging that directed donations are legal, it says Mr. Krampitz' solicitation of a donation "poses unsettling ethical questions."

Among the "unsettling ethical questions" not mentioned in the editorial are these: Is it ethical to forbid someone from using every legal means to get an organ that will save their life? Is it ethical to deny someone their legal right to donate an organ to a person of their choice?

Click here to subscribe to this blog

Houston man gets liver after billboard ad

Todd Krampitz of Houston, Texas, recently underwent successful transplant surgery after renting billboards to plead for the donation of a liver. He received a liver from a person from another state who had recently died. The deceased person's family, who had read about the advertising campaign, donated their loved one's liver specifically to Mr. Krampitz.

This is an example of directed donation as practiced by LifeSharers. It proves that the LifeSharers form of directed donation is legal.

This story and this story from the Houston Chronicle provide more information.

Click here to subscribe to this blog

Tax deductions for live organ donors

In January, Wisconsin became the first state to offer a tax deduction to live organ donors. The Wisconsin law lets live organ donors deduct up to $10,000 of transplant-related out-of-pocket expenses from their state income taxes. Legislatures is several other states, including Georgia, Minnesota, New York, and South Carolina, are considering similar legislation.

Rewarding organ donors is a good thing to do. It causes more people to become donors, and that saves lives.

But if government is going to reward organ donation, it would be better off rewarding people to donate their organs when they die. Live organ donors face serious health risks, but there's no health risk to an organ donor who is already dead.

An excellent way to reward people for agreeing to donate their organs when they die is to move them up the waiting list if they ever need an organ to live. That's what LifeSharers does.

Click here to subscribe to this blog

Putting Organ Donors First

(The following is the text of a speech, as prepared for delivery, at a Cato Institute policy forum titled "Remedying the Organ Shortage: The Ethics of Market Incentives" in Washington DC on May 13, 2004.)

PUTTING ORGAN DONORS FIRST
by
David J. Undis

There is a simple, effective, ethical, and already legal way to reduce the organ shortage in America and make the organ allocation system fairer in the process. You can donate your organs to people who will do the same for you. You can tell everyone: “If you don’t agree to donate your organs when you die, then you will go to the back of the transplant waiting list if you ever need one of my organs to live. When it’s time to decide who gets my organs, I am putting organ donors first.”

A grass-roots network of organ donors called LifeSharers is making this a reality one member at a time. LifeSharers is a 501(c)(3) non-profit organization staffed by unpaid volunteers. Members agree to donate their organs when they die. Furthermore, they agree to offer their organs first to fellow members, if any member is a suitable match, before offering them to others. Membership in LifeSharers is free and open to all at www.lifesharers.com. LifeSharers is two years old, and currently has about 2300 members in 49 states and the District of Columbia, including about 300 children enrolled by their parents.

IS IT LEGAL?

The first question most people ask when they hear about LifeSharers is: “Is it legal?” The answer is yes. LifeSharers is a form of directed donation, which is legal in all 50 states, in the District of Columbia, and under federal law.

Most states have enacted a form of the Uniform Anatomical Gift Act which permits donation to “a designated individual” for transplantation needed by that individual. That is exactly what LifeSharers members do. We donate each of our organs to a designated individual, using language carefully crafted to conform to the UAGA’s directed donation provision. Specifically, every LifeSharers member says: “for each part of my body donated, I designate as donee that LifeSharers member who is the most suitable match as defined by the criteria in general use at the time of my death.” That means, for example, that I want my liver to go to the highest-ranked LifeSharers member on UNOS’ match run.

In a handful of states, donation to “a designated individual” is not permitted. In those states, LifeSharers members give their organs to their fellow member’s surgeon or hospital, which is permitted.

At the federal level, the OPTN “Final Rule” governs organ allocation policy. It explicitly permits directed donation. The section that lays out how organs are to be allocated concludes by saying: “Nothing in this section shall prohibit the allocation of an organ to a recipient named by those authorized to make the donation.”

Again, LifeSharers carefully conforms to the law. When a LifeSharers member dies in circumstances that permit recovery of their organs, LifeSharers provides their family with the names of individual LifeSharers members, if there are any, who need their organs. The member’s family then directs donation to these named individuals.

WILL IT WORK?

So, LifeSharers is legal. Can it really reduce the organ shortage in America? Again, the answer is yes.

We don’t need medical breakthroughs to reduce the organ shortage. All we need is behavior change. Only about 30% of Americans have signed up to donate their organs when they die. And Americans donate only about half of the organs that could be transplanted. They bury or cremate the rest.

Dr. Thomas Peters, director of the Jacksonville Transplant Center in Florida, has estimated that if the consent rate from suitable post-mortem donors was raised to 85%, everyone currently on the transplant waiting list could get a transplant within three years and newly listed patients could get transplants much faster.

We can get there by giving Americans an incentive to donate their organs when they die. LifeSharers creates such an incentive, and it is a powerful one. That incentive is preferred access to the organs of all our members. Simply put, LifeSharers gives you a better chance of getting an organ if you ever need one. When you consider that more than half of the people who need an organ transplant in the United States die before they get one, the chance to move up the waiting list, even just a little, can literally mean the difference between life and death. Donating your organs after you die is a small price to pay for a better chance to get an organ if you ever need one to live.

As the number of LifeSharers members grows, so does the incentive to join if you are not already a member. Consider, for example, what it will be like when LifeSharers has a million members. You’d be crazy not to join. If you didn’t, you’d give up preferred access to a million livers, two million kidneys, a million hearts, two million lungs, and more. That’s a powerful incentive to join LifeSharers. And that incentive can put a big dent in the organ shortage in America.

IS IT ETHICAL?

So, LifeSharers is legal, and it will work. But is it ethical? Again, the answer is yes.

The ethical argument for putting organ donors first is clear. As long as there is a shortage, those who haven’t agreed to donate their organs when they die should not be at the front of the waiting list when it’s time to decide who is going to live. Putting organ donors first makes organ allocation fairer.

Professor David A. Peters agreed, in a 1989 paper in the Journal of Law and Health. He wrote: "...under conditions of scarcity...justice demands that those who have consented to be posthumous organ providers, i.e., those who have fulfilled the moral duty to consent, be given first priority access to the cadaver organ pool in the event of need.”

Some say organs should be given to those who need them most, even if they haven’t signed a donor card and even if they’ve refused to sign one. This idea ignores a simple fact. The only alternatives to donating your organs are to bury them or burn them, so failing to donate them is a spectacularly selfish act. It boggles the mind to suggest that anyone who would throw away an organ that could save someone else’s life deserves an organ just because they need one.

Professor Michael Booker put it this way: "The right to receive a donated organ should be tied to the duty to donate organs...It is wrong to consider organ donation to be an act of altruism to be engaged in at one’s whimsy but to consider organ transplantation to be an inalienable right...Individuals who are willing to donate organs should certainly receive priority in the allocation of organs, since they alone can be said to deserve available organs.”

Organ donation is perhaps the greatest gift anyone can give or receive. It is literally the gift of life. Why give that precious gift to someone who won’t do the same thing for others? Why reward someone who is too lazy, too selfish, or otherwise unwilling to share the greatest of gifts?

Imagine a heart is available for transplant. Imagine that two people are a good match for the heart: Mr. Donor, who has committed to donate his organs when he dies, and Mr. Keeper, who has not. Given that there is a shortage of organs, should we treat Mr. Donor and Mr. Keeper as if there is no ethically relevant difference between them? No. Mr. Donor should get that heart, even if Mr. Keeper is sicker or has been waiting longer. Giving the heart to Mr. Donor serves the cause of justice.

Perhaps more importantly, rewarding Mr. Donor’s decision to donate his organs encourages others to do the same. That saves lives. On the other hand, giving that heart to Mr. Keeper encourages others to delay signing donor cards or to refuse to sign them, and that lets more people on the transplant waiting list suffer and die.

There is another aspect to this issue that is important – what about the wishes of the donor? If a person wants to give his organs to people who have agreed to do the same for him, is it ethical to ignore or override his wishes and give his organs to someone else? No, it is unethical. It is also counterproductive, because it causes fewer people to donate their organs, and that causes more suffering and more death.

Imagine you wanted to give a bag of groceries to a homeless person. Then imagine an “expert” criticized your decision, saying that he should decide who gets the groceries, and that they should go to a different homeless person across town. How intrusive, and how bizarre! It’s just as intrusive, and just as bizarre, when experts tell you they should be the ones who decide who gets your organs when you die.

UNOS CONCERNS

So, what does UNOS have to say about LifeSharers? Well, UNOS has expressed appreciation for our interest in promoting organ donation, but has raised some concerns.

First, UNOS says LifeSharers “creates a class of ‘LifeSharers members’ for special consideration in organ allocation.”

LifeSharers does create a class for special consideration in organ allocation, and it’s about time somebody did. Organ donors deserve special treatment in organ allocation, but they haven’t been getting it.

As for LifeSharers members being a class, note that it is a class that anyone can join for free. LifeSharers does not discriminate on the basis of race, color, religion, sex, sexual orientation, national origin, age, physical handicap, health status, marital status, or economic status. We welcome everyone, and we exclude no one.

Next, UNOS says LifeSharers “undermines the current framework for organ allocation” which, they say, “is predicated on clinically-relevant considerations, not personal characteristics.” First, increasing the number of organs to be allocated does not undermine the allocation system, it enhances it. Second, non-clinical considerations already play a central role in organ allocation. Race, geography, and ability to pay are just some examples. So is status as a live donor. UNOS moves live donors up the waiting list if they ever need an organ. LifeSharers is just doing the same for people who agree to donate when they die.

But even if the current allocation system was based totally on clinical considerations, it wouldn’t be as good as a different system that saved more lives.

The third concern expressed by UNOS is that LifeSharers members would accept organs from any donor, while preferentially restricting their donation to members. This means, according to UNOS, that “LifeSharers creates an imbalance by creating an open system with regard to receiving an organ, but a closed system where donation is concerned.”

LifeSharers doesn’t create an imbalance, we correct one. About 70% of all transplant organs go to people who haven’t agreed to donate their own organs when they die. LifeSharers helps organ donors get their fair share of organs. By increasing the supply of organs, we also help non-donors in the process.

And LifeSharers is not a “closed system where donation is concerned.” It is exactly the opposite. Anyone can join, it only takes about two minutes, and it’s free. Sure, we’ll accept organs from any donor. We’d be crazy not to. And yes, we do donate our organs first to fellow members. That’s how we create the incentive to be a donor. That’s how we increase the supply of organs available even to non-members.

But consider the group that is closed and does create an imbalance. These are the LifeHoarders, the people who will accept organs but refuse to donate them. It is the imbalance created by LifeHoarders that needs correcting. That’s exactly what LifeSharers is doing.

LifeSharers deserves UNOS’ support, not its opposition. Will more Americans donate their organs if UNOS says they can’t donate them to other organ donors, or will fewer donate? The question answers itself.

UNOS SHOULD PUT ORGAN DONORS FIRST

Beyond just supporting LifeSharers, UNOS should implement the LifeSharers approach as its own. By doing so, UNOS would slash the organ shortage a whole lot faster than LifeSharers will.

A simple thought experiment shows this clearly. Imagine that UNOS made the following announcement tomorrow: “Beginning January 1 of next year, no human organ will be made available in the United States for transplantation into any person who is not registered as an organ donor. The only exceptions will be directed donations and cases where no registered organ donor can be found to match an organ that is available.”

This announcement, along with the publicity it would generate, would cause people to register as organ donors in droves.

Rupert Jarvis agrees. He suggested in a 1995 Journal of Medical Ethics paper that only those who identify themselves as willing donors be eligible to receive organs. He wrote: "It hardly seems fanciful to suggest that the vast majority of people would elect to join the scheme, since it is so clearly in their interests to do so, with the potential gain (life) being infinite and the potential loss (postmortem dissection which…they might well have to undergo anyway) being zero."

Professor Alex Tabarrok also agrees. He has suggested that UNOS enact a “no-give no-take” rule. Here’s what he says would happen: “if the only way to get an organ is to have previously signed an organ donor card, then many more people will sign their organ donor cards, and the shortage will be alleviated.”

It would be simple for UNOS to put organ donors first. UNOS could simply add a field to its waiting list database to show whether or not each potential organ recipient is a registered organ donor. Then when an organ becomes available, instead of offering it first to the highest-ranked person on its match run, UNOS could offer it first to the highest-ranked registered donor.

No Congressional action is needed for UNOS to put organ donors first. UNOS has the authority to change its organ allocation rules to give organ donors preferred access to organs. The UNOS Ethics Committee acknowledged this fact in its 1993 white paper on “Preferred Status For Organ Donors.” They wrote: “a trial could be implemented without requiring any alteration in existing legislation.”

In fact, as I’ve already noted, UNOS already moves live donors up the waiting list if they ever need an organ. UNOS can, and should, do the same for people who agree to donate when they die.

CONCLUSION

Putting organ donors first can save thousands of lives a year, and make organ allocation fairer in the process. Nothing could be simpler, nothing could be fairer, and nothing is stopping us from making it happen.

Click here to subscribe to this blog