The University Record, December 17, 2001

Organ donations fall critically short of transplant needs

By Lesley Harding

It’s a way to give the gift of life. But despite major efforts to increase organ donors, the United Network for Organ Sharing (UNOS) finds the number of U.S. patients still in need of organ transplants was more than three times higher than the number of people receiving life-saving transplants in the year 2000.

“There are approximately 80,000 people on the organ donor waiting list,” says Jeremiah Turcotte, professor emeritus of surgery and president of the United Network for Organ Sharing (UNOS). “In contrast to the size of that list, there were only about 23,000 transplants performed in 2000. The list is increasing in size much faster than the number of transplants being donated.”

To help encourage more organ donations, the American Medical Association (AMA) recently grappled with the idea of paying would-be donors or their families. In 1984, Congress banned such financial incentives, but because donor volunteers were far fewer than transplant patients, the AMA decided to rethink the issue. A few days ago the AMA’s House of Delegates voted not to consider a change at this time, but “the vote was close, and it’s my guess the issue will come up again,” Turcotte says.

Some states, such as Pennsylvania, have laws that would pay $300 toward the donor’s funeral expenses, but these financial incentives never have been widely implemented.

“The main reason people don’t volunteer to donate,” says Turcotte, “is for ethical and cultural reasons, not religion.” Turcotte says the United States lags behind some countries, especially those in Europe, when it comes to organ donations. He says some people might not understand the whole process. Others might think that they or their family member won’t get as good of care if they agree to donate and still others might not know the wishes of their loved one.

The issue of organ donation now has the attention of a high-profile Bush administration appointee. The Secretary of Health and Human Services, Tommy Thompson, is a major supporter of organ donation. Turcotte says Thompson begins many of his public speeches with remarks advocating organ donation. Under Thompson, the membership of the Advisory Committee on Organ Transplantation (ACOT) has doubled in size to 41 members. The group held its first meeting on Dec. 4 and 5, 2001. Its major missions are to increase organ donation and to review other policy issues surrounding transplantation.

One advance that’s receiving much attention now is the use of “non-heart beating cadaveric donors” versus cadaveric donors who die from total, irreversible brain damage. When the first cadaveric kidney transplant operations were performed in the ’60s, cadaveric non-heart beating donors were usually used. With the development of heart and liver transplantation, donors who died a neurologic death and were supported after death on a respirator were preferred because this method was less likely to damage the more vulnerable heart or liver. However, with improved techniques that reduce damage to organs, donors who die from cessation of heart function rather than neurologic causes now can be used, increasing the donor organs available for transplantation, especially kidney transplantation.

The University Health System, along with some other medical facilities across the nation, is now including non-heart beating cadaver donors as potential sources of organs because of the critical shortage. There are strict guidelines and timetables for the use of these organs as well as for those obtained from patients who expire from brain injury.

Another issue the government and medical community is wrestling with is “presumed consent.” Some countries, such as Belgium and Singapore, make the assumption that you agree to donate. It’s up to you or your family to say you are not a donor, that is, to “opt out.” The United States has not accepted this practice.

Turcotte says despite the donor issue, there are major advances being made in organ transplantation. Genetics is playing a big role as researchers try to alter animal organs so they’ll be accepted in human bodies, and as they study ways to change or “reprogram” the genes that play a role in organ rejection.

Because of the role immunology plays in organ acceptance and rejection, Turcotte says that since the introduction of organ transplantation there’s been an expanded focus on this science. As researchers better understand why and how a person’s body rejects an organ, it’s also helping better understand biology in general.

For more information on organ donations and transplants, visit the Web sites, www.unos.org or www.ustransplant.org.


Facts about organ transplantation

78,000 people waiting for transplant in U.S.

Every 13 minutes another person is added to the list.

An average of 15 people die everyday, one every 96 minutes while waiting for an organ.

Without a donor, transplant surgeons can’t save even one life. With just one donor, they can save as many as 50 lives.

Tissue donation provides skin grafts for thousands of burn patients; restores sight through cornea transplants and benefits patients in need of bone, cartilage and tendons.

Kidney is the most needed organ, followed by the liver, heart and lung.