Today 123,000 people are on transplant waiting lists, with another name added every 10 minutes. 18 of these patients die every day, waiting for the organ transplant that could save their lives. In January 2014 2,401 transplants were done from 1,209 organ donors. That puts the system on pace for less than 30,000 transplants this year, far from the number of people waiting.
The shortage of donor organs has many causes, but much of the problem stems from the registration process. Although 90 percent of Americans say they support donation, only about 40 percent have registered as donors.
95 percent of organ donor registrations occur at the Department of Motor Vehicles (DMV). The problem is that there are 52 separate state DMV registries (including Puerto Rico and Washington DC). These systems do not communicate, so if a person dies in one state, but is registered in another the chances are very high that their donor registration will not be found.
Another reason for the organ shortage is the poor nutrition and growing obesity rates of the American population. As America gets heavier, diabetes rates increase. Diabetes often results in end-stage renal disease, and the people are added to the list waiting for kidneys.
80 percent of the people on the organ transplant waiting list need kidneys, and the average wait for a kidney is seven years. During those seven years the patient must go through dialysis three times per week, in sessions of four hours each.
The first organ transplant occurred in 1954, and they became everyday medicine after 1983, when Cyclosporine, the first anti-rejection drug, became widely available. But even with modern medicine there are several things that need to occur to allow organ donation and transplant to occur. First, the organ donor must be healthy and have died (or be about to die) from something that has not damaged their organs. The donor’s immune system must be a good match with the recipient. And finally, organ donation has to be approved by the donor.
There are simply not people who are registered as organ donors. As it is, only about 1 percent of deaths medically qualify for donation.
ORGANIZE is an organization created last year whose goal is to increase the number of transplants, not just improve the registration rates. The right people, not just more people, need to register. ORGANIZE wants to help with the organ donor registration process by making it so that the registration follows the individual nationally.
ORGANIZE hopes to make it easier for people to express their organ donation wishes, through an official, national registry, and also with their friends and families through social media. Determining that it will be too difficult to coordinate all the states, the organization is looking to high-tech solutions to provide a comprehensive registration database. Now there is a mobile app for that, but ORGANIZE still needs to convince states to accept registrations from it.
Living organ donor chains are another goal of ORGANIZE. Both kidneys and livers are perfect organs for living donor transplants. People only need one kidney to lead healthy, functional lives. Livers, which are 15 percent of the transplant waiting list, regenerate, allowing for donation of part of the organ.
One thing the problem is not caused by is the expense of transplants. Billions of dollars could be saved if more people could receive organs. For example, dialysis for the people on the kidney waiting list costs from $30,000 to $80,000 per patient, per year. Medicare pays most of these costs, and Medicare is funded by taxpayers. In 2010 alone, Medicare paid $9.5 billion for outpatient dialysis services, and the cost increases every year.
What can be done to address the problem of organ shortages?
Enforce dying patients’ wishes to be organ donors.
A 2001 article in Southern Medical Journal pointed out that family refusals to donate are a major source of lost donations, even when the patient has clearly stated that they want to be an organ donor. Legally binding donor commitments, similar to financial wills, are needed to insure follow through on the patient’s choice for the fate of their body.
Implement opt-out systems rather than opt-in
The current system requires Americans to opt-in (at the DMV) if they want to be organ donors. Many European countries have adopted opt-out systems, which assumes agreement to organ donation unless there is a specific objection. Countries with presumed consent, or default to donation, have about 25 percent higher donation rates than European countries that have not adopted it.
A 2005 Gallup poll found that 95 percent of survey respondents were in favor of organ donation. An opt-out system could improve the current 40 percent sign-up rate to almost 100 percent. And the expense and hassle of organ donor registration would be removed.
Create national standards for who gets put on waiting lists, who gets moved up and down, and why.
So-called “God Committees” currently maintain the waiting lists at transplant centers, and have significant leeway in moving people up or down on the list. Statistically, white people get more organs per capita than black people, rich more than poor. Rich, white people get more living donor organs, which are considered better than those donated from cadavers.
Most major religions are in favor of organ donations. Pope John Paul II said Christians should accept organ donation as a challenge to their generosity and fraternal love, as long as ethical principles are followed.
Johns Hopkins University School of Medicine’s Andrew Cameron, MD, PhD, inspired Facebook to add a feature that lets users add “organ donor” to their timeline. He says the organ shortage is as much a social problem as a medical problem. The daily deaths of 18 organ transplant waiting list patients who cannot get the organs that would save them is a high cost, whether the problem is medical or social.
By Beth A. Balen