Organ Donation

Updated 3/2017 -- all links (except to my own posts) removed as many no longer active and it was easier than checking each one.

Last week my friend and fellow blogger Vijay (Scan Man) asked me for information regarding organ donation in the United States.  He was preparing a talk for a local Rotary Club to try to increase organ donation in his country.  My Oct 13th issue of the AMA News arrived a couple of days later and had an article on the same issue here – trying to increase the number of organ donations in our own country.  The article is “Other Nations, Other Answers”.  I think it is a free, open link, but in case it doesn’t here are the highlights.

The highlights:

• In late September, 99,728 people were on the United Network for Organ Sharing waiting list.
• One waiting patient dies every 73 minutes.  Three in four waiting patients need kidneys.
• Iran has the world’s only legal, regulated system of kidney donor compensation.  They claim to have nearly eliminated their country’s waiting list.
• Iran implemented its unique kidney donor compensation system in 1988, and by 1999, the wait for kidneys was eliminated, according to a study in the Nov. 1, 2006, Clinical Journal of the American Society of Nephrology. By the end of 2005, nearly 20,000 kidney transplants had been performed in Iran, with more than three-quarters of the supplied kidneys coming from unrelated living donors who were paid.
• Iran's regulated, legal system of compensating living kidney donors aims to eliminate black market organ brokers and transplant tourists, encourage cadaveric organ donation, and give both rich and poor a chance to get a kidney. Once a potential kidney recipient -- who must be an Iranian citizen -- is identified, a screening process occurs. (reference article below explains the system)
• Spain, by law, presumes organ donation after death unless the individual said otherwise while alive.  Their cadaveric organ procurement rate is 35% higher than ours. If the U.S. could do what Spain does with its presumed-consent law, the U.S. would net nearly 14,000 more organs a year.
• Extreme poverty, endemic corruption and a growing demand for transplants, especially of kidneys, have allowed black market trafficking to flourish in countries such as the India, Philippines, Pakistan and South Africa. This unregulated trade is universally condemned, as there is no assurance that donors are treated well or that recipients get healthy, matching organs.
• On the black market, donors are often paid as little as $1,000 for kidneys, which sell for nearly $40,000.
• The American Medical Association is examining solutions to the organ shortage. The AMA favors studying presumed consent as well as compensation for families of cadaveric organ donors. The Association will lobby Congress to change the 1984 National Organ Transplant Act, which bans "valuable consideration" in exchange for donation, to allow for ethically designed trials of financial incentives.

This referenced article gives the Iran system.  Organ Sales and Moral Travails: Lessons from the Living Kidney Vendor Program in Iran, Policy Analysis No. 614, Cato Institute, March 20;  Benjamin E. Hippen, MD

Other References
"A Gift of Life Deserves Compensation: How to Increase Living Kidney Donation with Realistic Incentives," Cato Institute, Nov. 7, 2007
Do Presumed Consent Laws Raise Organ Procurement Rates?" DePaul Law Review, Winter 2005-06, in pdf
AMA meeting: Delegates seek to change law on organ donor incentives July 7
Economists' study says paying for organs would cut wait lists Jan. 28
Campaign targets TV's skewed view of organ donation Sept. 3, 2007
Prisoner organ donation proposal worrisome April 9, 2007
Kidney transplant turns doctor into activist July 17, 2006

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I am an advocate of organ donation.  My driver’s license is states that I wish to be an organ donor.  I would have no problems with doing as Spain does and making everyone a “presumed” donor.  I applaud the AMA for pushing for ethically designed trials of financial incentives.