The Global Organ Shortage: An Unforeseen Consequence of Medical Advancement
4,761. That is the number of people who died in one year waiting to receive an organ donation. Another, 3,668 in the same year became too sick to qualify for an organ donation, essentially locking in their fate of dying from a curable disease (“Organ Donation”). This tragedy is called the Global Organ Shortage and it affects every well-developed nation across the world today. Many people are on the organ donation waiting list for years, suffering as a result of their failing organ, only to be told that no match has been found, and that they have run out of time. The problem, however, is not a lack of suitable organs for donation. Rather, the issue is a shortage of people who are willing to legally sign over their organs to those in need, either as heroic living donors, or, more commonly, after death. The Global Organ Shortage facing our world today stems from the broken system currently in place, along with a lack of education on the process of organ donations, and can ultimately be solved through expanded education on the topic along with compensation paid to organ donors.
While organ transplantation has only been around for roughly one hundred years in the United States, the leaps and bounds that have been made in the field have been immense. The early days of organ transplantation were filled with failure after failure with the first transplants actually being attempted using animal organs in 1906. These initial attempts were entirely unsuccessful, but hope for the practice remained and thirty years later another attempt occurred, this time dealing with a human kidney from a deceased donor. The problem with this attempt was that blood typing did not yet exist in the 1930’s, so the patient’s body rejected the foreign organ. The first successful organ transplant didn’t occur until 1954, when Doctors Joseph E. Murray, John Hartwell Harrison, and John P. Merrill conducted a kidney transplant between identical twins. This worked well because identical twins have the same exact biological markers that keep the immune system from rejecting the organ. After 1967 transplants were able to really take off due to widely available immunosuppressants which block the body’s natural reaction to attack the foreign organ. Many firsts in transplantation happened in the following years, including heart, pancreas, and lung procedures. With time came even greater medications to aid in the transplant process, and by 1995 the rate of survival five years after a kidney transplant was up to 70-80%. Today the success rate of transplants has reached 90%, almost a miracle when compared to where the practice was just 100 years ago.
However, with a greater success rate along with improved medical technology such as dialysis, the waiting list for organ donation has started to grow at an unanticipated rate. People who were given only weeks or months to live before can now live ten, twenty, sometimes even thirty years on dialysis. While the new technology extends their life expectancy it also, unfortunately, dramatically increases the number of people on the waiting list for organs. In fact, according to Donate Life America, “in the last ten years, the number of patients requiring an organ has doubled, while at the same time the actual number of transplants has barely gone up” (“Statistics”). The technology that prolongs the lives of people with certain organ failure has improved, but the problem will not ultimately be solved until we have a waiting list that is shrinking, not growing. The growing list of those in need and the rate at which people are dying from these treatable diseases is why it is imperative that we have an increase in organ donors.
Becoming an organ donor might sound intimidating to some but it is actually very simple and straightforward. The United Network for Organ Sharing posted the following steps on their website:
The organ donation process begins with a decision. You recognize the opportunity to help others by donating your organs when you die. You enroll in your state’s donor registry and share your decision with your family and friends. When your time comes, your organs may be used to save many lives. (“Donation”)
With just three simple steps one has the opportunity to positively impact, and even save, the lives of many people. With such a straightforward process it is perplexing that over 200 million people in the US are still not registered organ donors.
Though the process might be simple, the positive impact that becoming an organ donor can have on the lives of many individuals is an extremely rare opportunity. For instance, the website page “Why Donate?” on organdonor.gov states that, “one organ donor can save up to eight lives.” For most people it is hard to imagine saving even one person’s life but, incredibly, that is the reality of becoming an organ donor. In addition to the organ recipient, those who donate positively impact the life of every person who loves and cares for the organ recipient by saving their loved one’s life. The possibility of making such a direct impact on so many people’s lives is unique to the organ donation process and is part of what makes it so incredible.
Although many lives are saved every year by organ transplantation, there are a few major flaws in the system that is currently in place. A couple of these issues are a lack of authority granted to organizations dedicated to organ donations, along with a lack of incentive to become an organ donor. Many experts agree that these flaws in the system are directly causing the tragedy that is the Global Organ Shortage.
There are many well regarded foundations, such as the Kidney Foundation or the United Network for Organ Sharing, who are dedicated to finding matches for organ donors and recipients but are not granted the authority to reach out to living donors. In the gap that is caused by these organizations being unable to find living donors via the internet, other less trustworthy websites have popped up. These new websites allow those in need to pay a large sum to become members of the website, and receive the website’s organ matchmaking services in return. In “An Expert Interview With Arthur L. Caplan” done by Laurie Barclay MD., Barclay asks many questions regarding the ethical concerns of websites geared toward finding strangers to become live kidney donors for those who pay to be members of the website. Caplan is the department chair of medical ethics and director of the Center for Bioethics at the University of Pennsylvania, so he is able to give his expert opinion on the ethics of the websites. Throughout the interview Caplan makes it clear that while he is not against the principle of people recruiting strangers to donate their organs, he has many concerns about the process via the internet, specifically the lack of regulations on the new process. The main concerns Dr. Caplan has with it are the potential lack of truthfulness by those requesting donations, the lack of screening of those who wish to donate, possible extortion brought on by the process, and the general unfairness and inequality of opportunity for the potential transplant recipients taking part in the website. Overall, Caplan thinks the websites are not the proper way to go about searching for living organ donors. He states that a better alternative to these sites is to give the existing organizations, such as the Kidney Foundation or the United Network for Organ Sharing, the authority to extend their search to living donors, which they are currently lacking. Since the matchmaking websites only offer their services to those who can pay their fee, it leaves a lot of room for nefarious behaviour to occur. It makes sense that Dr. Caplan would rather the matchmaking be under supervision of one of the many trusted, non-profit organizations that exist already. If allowed the authority to do so, these organizations would have the potential to significantly decrease the number of people currently on the organ donation waiting list by reaching out to individuals interested in living donations.
Another flaw in the current system that is causing the Organ Shortage is the National Organ Transplant Act. This law essentially eliminates all incentive to become an organ donor other than for altruistic purposes, leading to a lack of incentive to register. In an article in New Republic titled “America’s Organ Transplant Law Is Criminally Unfair to Donors” authors Sigrid Fry-Revere and David Donadio explain how “the law bans almost any non-medical payment to living organ donors, whether by the government, health insurance companies, or charities.” If this law did not exist more people could be incentivised to become organ donors, ultimately leading to many of the people who are currently waiting on the organ donation list being cured. Eliminating the law might even lead to the eradication of the Global Organ Shortage.
Along with the flawed system currently in place, another major issue is the lack of education on the practice of organ donation and transplantations. Education on the process, as well as clearing up common misconceptions of organ donation is important for the future of organ transplantation and the elimination of the global organ shortage.
An increase of education on the benefits and process of organ donation has been shown to increase a person’s likelihood of becoming an organ donor. For example, in the article “Impact of Organ Donation Education on US Undergraduate Nursing Students”, Jane McCausland Kurz describes a study in which a research group of nursing students was given a supplementary course on the process and benefits of becoming an organ donor while a control group of nursing students was not educated specifically on the matter. Kurz explains how the study found that “more members of the research group than the control group registered as organ donors after the intervention.” This increase of organ donors following just one informational course on the matter supports the idea that education is a major key to solving the organ shortage crisis. If we can increase the number of donors significantly by integrating organ donation education into schools across the country, we could be one step closer to ending the Global Organ Shortage.
While lack of education is a problem, misinformation compound the problem. Many people refrain from becoming donors because of common misconceptions that circulate around the topic. One of the most common myths pertaining to organ donation is that if an organ donor gets in a serious accident, the doctors will not try as hard to save that person’s life so that they can use their organs to save someone else’s life. While the myth is undoubtedley scary, the website TransWeb.org, sponsored by the University of Michigan Transplant Center, elaborates on how it is simply not true. They explain that:
If you are sick or injured and admitted to the hospital, the number one priority is to save your life. The medical team treating you is separate from the transplant team. The team coordinating the donation is not notified until all lifesaving efforts have failed and death has been determined. The transplant team would not be notified until your family has consented to donation. (“Top 10”)
As TransWeb explains, there is a process that a person goes through once admitted to the hospital that is not flexible. It is important for anyone who might believe this myth to understand that any doctor who is attempting to save the life of a patient is sworn under oath to do so, regardless of whether the patient has chosen to become an organ donor or not.
A second common misconception many people have is the belief that a person is discouraged by their religion to become an organ donor. TranWeb.org also refutes this myth by stating the fact that “all organized religions support donation, typically considering it a generous act that is the individual’s choice”(“Top 10”). This is a very important fact but is, sadly, not widely known. This misunderstanding could be easily cleared up if religious leaders made an effort to emphasize their organization’s stance. It is imperative that these myths be eradicated so that those who are held back from becoming donors by believing them are freed from their fears and reservations. The ultimate result of debunking these misconceptions would be an increase in organ donors and, therefore, a decrease in the Global Organ Shortage.
Although education on organ donation is an extremely important step in solving the shortage, many believe think that it will not be enough to solve the problem on its own. Another way to save the lives of the thousands on the waiting list is to offer compensation for those who are willing to donate. While there are different ways to set up a compensatory system for organ donation, many believe it is the key step to be taken if we wish to solve the Global Organ Shortage. However, there is controversy over whether any such system would be morally sound.
Despite the thousands of lives that could be saved by creating an incentive to donate organs by compensating the donors or the donors’ families, there are still many who believe it is unethical to put such a system in place. For instance in the article titled “Paid Organ Donation: The Case against” authors Anya Adair and Stephen J Wigmore explain that “the buying and selling of human organs and tissues can never be made ethical because it will always penalise the weakest.” By this they are saying that a system of compensated organ donors would target the poorest in society, therefore making it an unethical system. There are a couple flaws in this logic. The first is that they fail to acknowledge how the poorest in society are already being disproportionately targeted by our current, non compensatory, system that allows for the black market of organ procurement to flourish. If someone was desperate enough to sell their organs today for money, they would already have an opportunity to do so, albeit an illegal and most likely unfair opportunity. An organized system of reimbursement would be a safe, legal, and fair alternative to the black market we have now. The author’s argument is also flawed by presuming that a system must be unethical just because it affects one socioeconomic class more than another. If the system were to be put into place and the potential donor deemed healthy enough for the procedure, as well as thoroughly informed on what the donation entails, then why does it matter how much that person makes per year? It seems widely more unethical to deny those who are in need of organ donations a realistic opportunity to actually receive one based on a flawed interpretation of the compensatory system.
While the ethics of compensation paid to organ donors might be debated, the effect it would have on solving the Global Organ Shortage is enticing to those who recognize the immediacy of the situation we face. In the book The Global Organ Shortage: Economic Causes, Human Consequences, Policy Responses, authors and economists T. Randolph Beard, David L. Kaserman, and Rigmar Osterkamp explain that the organ shortage crisis facing every major developed country of the world could be nearly eradicated by only implementing a monetary compensation for donated organs. Assuming that the economists’ prediction is correct, the ethical argument against paying donors for their organs becomes even harder to make. Surely preventing 10,000 deaths every year, even if it means monetary reimbursement for organ donors, is more ethical that letting people waste their life away on a waiting list, dying from a curable disease.
Benefit-In-Kind Reimbursement is a similar route but it is not the same as just receiving a check for organs. With a Benefit-In-Kind system, the donor is still compensated but it is done by giving the donor options of reimbursement such as income tax credit, tuition vouchers, or money towards a charity of their choice.This system is more attractive to those who might have ethical concerns about a reimbursement system. Many experts think this is the best option when it comes to compensating donors. In the interview “An Organ Shortage Kills 30 Americans Every Day. Is It Time to Pay Donors?” that was conducted by Keith Humphreys, Dr. Sally Satel expresses her support for benefit-in-kind reimbursement by stating, “If we keep thinking of organs solely as gifts, there will never be enough of them. Deaths will mount, needless suffering will continue, and the global black market in organs will continue to flourish.” Satel’s words are chilling and reflect the immediacy of the situation we are currently facing. With Dr. Satel’s predictions, it may even be fair to argue that it is unethical to refuse compensation to donors, since refraining from doing so is a major reason for the current organ shortage that kills many people each day.
With the vast growth that has occurred in the field of organ transplants since the early 1900s, the shortage of available organ donors is inexcusable. With the growing disproportionate need for organs to those available, it is more important now than ever to reform our current broken system of strictly altruistic organ donation. While fixing this problem may initially sound like a daunting process, in reality there are a few realistic steps that can be taken to vastly reduce the Global Organ Shortage. Education on the matter is imperative, as well as the influence of societal authorities encouraging people to join. Finally, compensation paid to organ donors or their families will incentivize the donation of organs, encouraging people to register. The Global Organ Shortage takes 20-30 lives each day and is not something that we can afford to continue to ignore. Thousands of lives are currently at stake and everybody has the potential to make a change.
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