Creating a new donor system

[paul.karen]

Creating a new system

Six-year-old LifeSharers, based in Nashville, is itself an attempt to create a preferential system in miniature. LifeSharers' 10,000 members all have agreed to donate their organs upon their death, with the stipulation that first priority goes to any LifeSharers member in need.

Undis says the idea has not yet been put into practice because no members have died. Incorporating the LifeSharers model into the national waiting list has not gained much traction with UNOS, which has committees tasked with tweaking the waiting list protocols.

UNOS president Robert Higgins, a heart surgeon, concedes that there are problems with the list, starting with the fact that minorities are disproportionately represented. "Certain populations wait a long time. We need more organs."

UNOS processes 7,000 to 8,000 organ donations each year. And while organ transplantation, once a chancy procedure, has become more routine, Higgins says the demand has increased as the U.S. population has aged and people have become less healthy.

Higgins contends the LifeSharers' proposal raises some complicated questions.

"If you had a child who had liver failure who wasn't a donor, that child deserves to have a transplant even if they weren't a donor," Higgins says.

Likewise, some people — those without driver's licenses, for instance — might never have been presented with the option of becoming a donor, he says. Higgins acknowledges that the problem will get worse as Baby Boomers age and chronic illnesses become even more common.

Logical, but will it work?

Mark Fox, associate director of the Oklahoma Bioethics Center at the University of Oklahoma-Tulsa, says fixes such as the LifeSharers plan have "inherent logic" to them.

Perhaps prior willingness to donate could factor in as a "tiebreaker" in awarding organs, but he says there is no evidence such a plan would increase donation.

"We are an age- and death-defying society," he says. Most people do not sign up to donate because they do not think about their own medical frailties, he says.

Fox says a benefit of the current system is that is it based on science and has been developed in a thoughtful and open matter.

Billions of dollars have been poured into refining organ transplant procedures and the medical machinery needed to keep patients alive while they wait, he says, but less effort has been put into healthy living strategies.

"We haven't managed the demand side of the demand-supply equation," he says.

Joyner reports for the Clarion-Ledger in Jackson, Miss.

[okarol]

The problem again is that the members would have to die under a unique set of circumstances rendering brain death and be on life support. Not really a feasible program but that's my opinion.

[rose1999]

I may be misunderstanding this but I thought you couldn't stipulate who got your organs - you just donate them and the most 'needy' person (who is a match) gets them.  Well that's the way in the UK and I assumed it was the same everywhere - perhaps not?

[okarol]

Rose, our system is the same as yours, but this LifeSharers group is trying to develop a club where they can designate who gets their organs. Since no member has died it has not been tested legally.

[paul.karen]

I know at Johns hopkins in Boston that say,  Karen wants to donate me her kidney but she isn't a match. That Hopkins Hospital has a program that will put me and Karen into there database.  Since Karen doesn't match me if she were to match someone else on the list and there spouse matched me we could swap partners so to say and we would both get the other spouses or sons/daughters kidney in place of ours.   This is a win win program IMO.
Did that make sense?

[rose1999]

Thanks Karol, I understand now.

Paul, yes that makes sense too, but that's with a living donation where, IMO. if a donor is  willing to go through surgery then they ought to be able to say who gets their organ (or benefits from it through a domino effect), the Lifeshare group are talking about organs after death. Maybe some people would say we should have a say in who gets those organs too but I believe once we are dead as long as our organs are put to use then that's all we should worry about. But all of the above is just my opinion and I wouldn't want to force it up on anyone.

[paul.karen]

i also understand it now. 

[okarol]

Kidney paired donation matches one incompatible donor/recipient pair to another pair with a complementary incompatibility, so that the donor of the first pair gives to the recipient of the second, and vice versa. In other words, the two pairs swap kidneys.

Paired Kidney Donation Exchanges are becoming more common:

Here's the one at Johns Hopkins http://www.hopkinsmedicine.org/transplant/Programs/InKTP/kidneypaireddonation.html

Some states have the Alliance for Paired Donation http://www.paireddonation.org/ - they also operate the NEAD (Never Ending Altruistic Donor) Program - the world's first NEAD chain began in July 2007.

The Paired Donation Network (PDN) began in Ohio and has expanded to some surrounding states http://www.paireddonationnetwork.org/

Another group facilitating a continuous chain of kidney transplants http://www.kidneyregistry.org/ The National Kidney Registry