A Fair Trade

The United Network for Organ Sharing is trying out a promising new organ exchange program as an incentive to encourage kidney donation. In this program, someone who wants to donate a kidney to a friend or family member but is not a match can donate to another transplant patient in order to move his or her loved one up on the waiting list.

Donors can either arrange an exchange with a matching family in the same situation or they can donate the organ into the general pool in exchange for a cadaver kidney. Obviously, this arrangement directly benefits the specific recipients, but it also benefits the transplant community as a whole since more kidneys are donated into the system. Check out Initiative May Shorten Wait For Kidney Transplant for more information.

Improving the System

Forty years ago, countless people died because doctors could not successfully perform a transplant and prevent rejection. The knowledge of immunosuppressive drugs was minimal, and the surgery involved was extremely difficult.

Today, science has advanced to the point that most transplant operations are considered relatively low risk. The success rate is phenomenal for kidney transplants, liver transplants, cornea transplants, pancreas transplants -- even heart and lung transplants. But more than 5,000 potential transplant recipients die in the United States every year, not because of scientific obstacles, but because of social ones.

In the United States, the vast majority of the population is in favor of organ donation, but only a small percentage of people actually end up donating their organs when they die. There aren't anywhere near enough organs to meet the demand, which means an average of 16 potential recipients die every day from a curable condition.

This is partly due to human psychology and partly due to donation consent laws. Under current U.S. law, the final decision to donate a deceased person's organs is left to whoever has power of attorney or to the person's family. Organ donor cards or organ donor indications on a driver's license are important legal documents, but the consent of family members takes precedence.

Naturally, most people don't want to dwell on the thought of their own death, so few take the time to discuss their feelings about organ donation with their families. When it comes time to make the decision, the family members aren't sure what to do. They may be so troubled by the thought of surgeons cutting their loved one's body that they decline to donate the organs.

The main problem, then, is that donating organs requires at least two people to take decisive action that may be uncomfortable. The donor must take the initiative to talk to his or her family and the family must take the initiative to adhere to the donor's wishes. If these things don't happen, and in the majority of cases they don't, nobody gets to use those organs.

This has created a national medical crisis in the United States, and hundreds of surgeons, scientists and politicians are clamoring for a solution. One interesting possibility is xenotransplantation, the transplantation of organs between different species. The study of xenotransplantation is still in the early stages, but there have been some promising results. It is not a totally viable alternative at this time for a number of reasons. Chiefly, many scientists are worried that transplants between animals and humans could introduce new diseases into the human population. Xenotransplantation is also problematic ethically, as it would involve killing animals for their organs.

Another interesting avenue is the development of artificial organs. But while there have been tremendous advances in this field over the past decade, artificial organs don't work nearly as well as natural organs for most patients. It is still a very young science.

At this time, many doctors and politicians suggest legal and social changes as the best option. In some European and Asian nations, it is automatically assumed that you are an organ donor unless you notify the government that you do not want to be. Few people take this necessary action, and this has greatly increased the supply of available organs. Many feel that the United States should follow this model, but the idea has met with a lot of resistance. It would mean exerting greater control over people's bodies.

Most experts agree that the ideal solution to the problem would be a shift in national consciousness. To this end, the United Network for Organ Sharing, the American Medical Association, the National Institute of Health and many other organizations have stepped up efforts to educate the public about the benefits of donation. These groups hope that if more people understand the need for organs and the tremendous benefit of donation, they will begin to see donation as their social responsibility. They will understand that organ transplantation is truly one of the most remarkable achievements of modern science, and that organ donation is among the greatest opportunities to serve humanity.

For more information about organ transplants and related topics, check out the links on the next page.