What is Being Done to Increase the Supply of Donor Organs?

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What is Being Done to Increase the Supply of Donor Organs?

By M. Jill McMaster, MA, CAPT, USNR (Ret.)
   
[Editor's note: "Organs for Organ Donors" is a concept initiated by David J. Undis, Executive Director of LifeSharers, which he describes as a "non-profit organ organization." The concept, briefly described here, has been highly controversial, and questions about possible, if not probable, legal and ethical dilemmas have arisen. Undis says that LifeSharers now has nearly 10,000 members, including individuals from all 50 states and the District of Columbia, who agree to donate their organs when they die and also agree to offer their organs first to other LifeSharers members. He further claims that, if the United Network for Organ Sharing (UNOS) were to implement his concept nationally, it could save the lives of all those (around 8,000) who die each year waiting for an organ. The great majority of those involved in the transplant community do not believe in the Organs for Organ Donors concept. Meanwhile, transplant-related organizations around the country are working to ease the organ shortage.]
 
Mr. Undis has focused on a significant problem in the United States. The number of candidates on the deceased donor organ waiting list is increasing at a faster rate than the number of deceased organ donors. His solution is to change the organ allocation system so that those candidates who have indicated that they are organ donors for at least six months prior to their need for an organ go to the top of the waiting list, an "A" list so to speak. All others are in a second category, a "B" list. They would only receive an organ if there are any still remaining after the needs of the "A" list are addressed.
 
UNOS, the government contractor that runs the national Organ Procurement and Transplantation Network (OPTN), has heard and considered Undis’ proposal. UNOS/OPTN, in consultation with the Department of Health and Human Services (HHS), decided not to endorse the proposal on legal and ethical grounds. Undis has been informed of this decision.
 
Nonetheless, the shortage of organs suitable for transplant is a significant problem.
 
What can be done?
 
Keeping Off the List
I believe that the most important thing that could be done is to keep people from needing an organ transplant. That way, individuals would be kept off the waiting list all together.
 
First, I would encourage individuals to take responsibility for their own health and that of their children. Here are a couple of ways that can be done:

    * Lifestyle factors such as diet, weight, exercise, alcohol consumption, and smoking have an impact on end-stage diseases. For example, approximately one-half of the candidates on the kidney transplant waiting list have either hypertension or diabetes. These diseases are often associated with obesity and lack of exercise. Imagine if we could reduce by half the number of transplant candidates with hypertension or diabetes...
    * Early diagnosis often aids in effective treatments. I would encourage people to take advantage of health screenings from their doctors or from schools and work places, health clinics, and churches. Learning that one is at risk for a disease is a step in the right direct. Doing something about it comes next.

Support Medical Research
Second, I believe we should support and encourage medical research through universities, pharmaceutical companies, foundations, and the National Institutes of Health. Such research plays an important role in reducing the number of candidates on the waiting list by developing effective therapies to prevent end-stage diseases.
 
Research also leads to improved post-transplant immunosuppressant regimens. Improved drugs are needed to reduce rejection rates. Also, we need drugs that are not nephrotoxic. Why should a heart transplant recipient subsequently need a kidney due to the drug he or she must take to preserve the heart?
 
What is being done?
   
"Best Practices" and Education Programs
The Department of Transplantation within HHS has had an intensive effort to increase organ donation and transplantation rates by developing public awareness campaigns and identifying and replicating organ procurement organization (OPO), donor hospital, and transplant center best practices. The results have been impressive. See the following website for more details: www.organdonor.gov/research/execsum.htm.
   
Education programs to increase donor awareness continue to show positive results. A recent Gallup Opinion Survey shows growing support for donation over the last 10 years. Changing public opinion takes time, but the trend certainly is in the right direction.
 
Donor Registries and Live Organ Donors
Major progress has been made in many states with the introduction of donor registries. These statewide databases allow an individual to easily document his or her wishes for organ and tissue donation. An individual’s wishes are available to medical professionals and families 24/7.
 
Experience shows that we need not be confined to organ transplants from deceased donors. A carefully screened living donor may provide a kidney or a portion of a liver, lung, or intestine. The number of living kidney donors has been approximately the same or even greater than the number of deceased kidney donors since 2000. In fact, we are learning that the recipient of an organ from a living donor often has a better outcome than the recipient of an organ from a deceased donor. What a wonderful way to share life and reduce suffering!
 
A relatively new matching process allows those desiring to donate a kidney to do so, even if they are incompatible with their desired recipient. The process, called Living Donor Paired Kidney Exchange, matches two or more incompatible donor/recipient pairs so that each donor has a compatible recipient. Simultaneous surgeries lead to multiple suitable transplants that otherwise would not have happened. This matching technique is expanding to many parts of the country and soon will be offered nationally. The greater the number of pairs, the greater the number of suitable matches there are. This process has the potential of significantly reducing the kidney waiting list.
 
Conclusion
The above listing is a brief overview of efforts to increase the number of recipients who benefit from a lifesaving transplant, whether the donor is living or deceased. It is not comprehensive. The concern about the availability of suitable organs will continue as long as there is a waiting list. I am confident that such entities as the Renal Support Network’s (RSN) Kidney Talk! bi-weekly web-based radio show, Live & Give newsletter, and KidneyTimes website will continue to highlight developments as they happen.
 
I believe it is important to have candidates and recipients, as well as their families and friends, become ambassadors for transplantation. We can communicate hope, gratitude, and joy in ways that are just not possible through pamphlets, health fair give-aways, or threats of A and B lists. I would encourage those who are impacted by organ transplantation to stand up in their communities, their churches, their schools, and work places and put a face on organ donation.
 
You can make a difference... one friend at a time!
 
About the Author
M. Jill McMaster, MA, CAPT, USNR (Ret.), is a member of the OPTN/UNOS Board of Directors, Executive Committee, and Kidney Transplantation Committee. She is retired from the Central Intelligence Agency and the US Navy and Naval Reserve. Jill has been a volunteer with kidney- and transplant-related organizations for over 25 years and is currently an RSN volunteer. She is a renal patient herself as the recipient of a deceased donor kidney. For more information on the organ donor process, log onto: www.unos.org.
 
Last Updated January 2008
http://www.ikidney.com/article.php?id=20071121181213