Increasing The Supply Of Organs

The following policies are in use or have been proposed to increase the supply of organs and tissues. Some are based on altruism, while others involve some type of incentive. The reader must decide which of these conform to his or her own moral, religious, and philosophical beliefs.

• Organ Donor Cards. The Uniform Anatomical Gift Act of 1968 established the legality of organ donor cards. However, most hospitals do not consider a signed and witnessed organ donor card sufficient grounds to remove organs. Hospital personnel will usually ask for permission from the next of kin before proceeding.
  
  
• Brain Death Determination. Legal establishment of brain death (as opposed to heart stoppage) greatly increases the availability of transplantable organs. In 1997, Japan became the last major nation to adopt brain death legislation.
  
  
• Artificial Organs. Research is fast progressing on the development of portable and implantable artificial organs. Man-made devices might soon be permanent substitutes for failing hearts, lungs, kidneys, pancreases, and livers.
  
  
• Required Request. In most states, hospitals are required to ask the families of potential donors to donate the organs. Often, family members are too distraught to make a reasoned decision.
  
  
• High-Risk Donors. Organs from those who are likely to have been exposed to incurable diseases, such as AIDS, are usually declined. These organs represent the only hope for some terminally ill patients.
  
  
• Mandated Choice. This system would require each individual to decide (upon renewing a driver's license, for example) whether or not to become an organ donor.
  
  
• Presumed Consent. In the absence of a signed statement to the contrary, this policy would assume that each person has consented to having his or her organs removed following death.
  
  
• Directed Donation. Many states allow donors to specify the individual(s) who will receive their organs. This results in donations that might not otherwise occur. One variant of this policy would allow donors to specify or exclude certain classes of recipients, such as convicted felons.
  
  
• Xenotransplantation. This is the use of organs or tissues from other animal species, such as baboons. Xenotransplants have thus far been unsuccessful, but research in this area continues.
  
  
• Organ Trading. More than a third of all transplanted kidneys come from living donors. However, few of these are from "unrelated" donors, such as spouses, due to antigen or blood type mismatches. Live donation rates could be increased by allowing an unrelated person to donate a mismatched kidney to a "pool" in exchange for a matching kidney.
  
  
• Preferred Status. Those who agree to become organ donors would have preferential access to organs if the need were to arise. This is the approach taken by LifeSharers, a network of individuals who have agreed to donate their organs only to other members of the network.
  
  
• Preemptive Preservation. Some U.S. hospitals infuse patients with organ-preserving drugs or ice-cold liquids while attempting to obtain family consent for organ removal. When ice-cold liquids are used, doctors must make deep incisions in the patient's abdomen and groin.
  
  
• Death Benefits. The families of cadaveric donors would receive estate tax deductions or funeral expense reimbursements, the latter coming possibly from the organ recipient(s). To improve his state's very low donation rate, Hawaii Governor Ben Cayetano once suggested that state government pay the families of organ donors.
  
  
• Prospective Sale. Individuals would sign a contract ensuring payments to designated persons upon harvesting of the organs. Payment amounts would be based on the type and number of organs harvested or used. The beneficiary could also be a charity or any nonprofit organization.
  
  
• Paid Donation. Living organ providers are directly paid for one of their kidneys, bone marrow, etc. This was legal and commonly practiced in India until 1995; the donor received cash and free health care following the operation. For many Indians, it was the only possible way to escape grinding poverty.
  
  
• Free Market. Cadaveric organs would be sold like other commodities, with proceeds going to the family of the deceased. To prevent abuse, the deceased would have had to include such provisions in his will. It should be noted that the poor are more likely to die under circumstances (homicide or accident at a young age) that favor organ harvesting.
  
  
• Anencephalic Fetuses. Organs could be harvested from fetuses that are born without fully developed brains and are therefore incapable of long-term survival. Such organs are suitable for transplantation into infants.