Organ demand outpaces supply

February 24, 2009

Organ demand outpaces supply

By Liv Osby
STAFF WRITER

There are awareness campaigns, donor registries and designation boxes on driver’s licenses, but thousands of Americans still die every year waiting for a transplant because there aren’t enough organs.
One solution, says Charlotte transplant surgeon Dr. Benjamin Hippen, would be to increase the number of living kidney donors by offering them money like they do in Iran.

“The typical response is a shudder,” said Hippen, who spoke at an event in Greenville sponsored by Clemson University’s Rutland Institute for Ethics last week.

“But in the U.S. and elsewhere, a number of different solutions have been proposed, and we’re still not keeping up with demand,” he said. “That suggests we have to look elsewhere.”

More than 100,000 people are waiting for organs in the United States, the vast majority for kidneys, according to the United Network for Organ Sharing. Nine of 10 patients on South Carolina’s waiting list also need a kidney, says Mark Johnson, spokesman for LifePoint Inc., the state’s organ procurement agency.

“There is no doubt we need to increase the number of donors to save more lives,” he said. “But this is obviously controversial.”

Iran is the only country where organ sales are legal, said Hippen. The practice arose not only out of the need for organs, but for a cheaper way of treating kidney failure, he said. Iran’s health care system was struggling under the high cost of dialysis, which has a five-year survival rate of 35 percent compared with transplant at a 10th of the cost and a 75-percent five-year survival, he said.

So people needing kidneys wait six months for a deceased donor, and if there are none go to centers set up by charities to be matched with people who want to sell their organs, he said. The donor, who must be a citizen, is paid about $1,200 by the state and $2,300 to $4,500 by the recipient, or charity if he is poor, he said.
And since it was instituted, Hippen said, the waiting list for kidneys has been eliminated.

Abolishing the wait would be wonderful, says Johnson. But he fears that organ sales could hurt altruistic donation. And then there’s the specter of a middleman in the process.

“People dying waiting for an organ is a concern,” he said. “But so is putting a price on the gift of life.”

Hippen allows there are ethical concerns about exploitation, coercion and commodification of body parts, and that incentives should address them. But he believes altruistic and incentive systems can coexist, noting the percentage of uncompensated donors in Iran hasn’t changed. And, he says, the incentive doesn’t have to be cash. It might be lifelong medical care or college tuition.

Johnson also worries about the source of Hippen’s data.

“If the research came from another country instead of Iran,” he said, “I think we’d be more comfortable.”

Hippen said his data is from articles in peer reviewed journals by Iranian doctors with whom he corresponded, though he has no independent way to confirm it. However, he said those doctors acknowledge some problems with their system, including the lack of follow-up on donors.

“There’s not a lot of great data on the donors,” he said. “Most are men. Most are undereducated and disproportionately poor. The lack of information is worth deep moral concern. And we can’t help recipients at the expense of donors.”

Yet that’s what happens on the black market, he said. Illegal organ trafficking preys on desperately poor people, usually women, who may be coerced.

“The money is spent quickly, it’s not as much as promised, and the long-term outcome is not good,” he said, adding those complications aren’t seen in Iran.

The National Kidney Foundation doesn’t support incentives, said foundation spokeswoman Ellie Schlam, who also expressed concern it could limit altruistic donation. Instead, it recently announced a plan to increase the number of organs.

Among the recommendations:
* Cover the recipient’s immunosuppressive drugs for life instead of three years
* Guarantee living donors reimbursement for all expenses related to donation, including lost wages, as well as access to health care related to donation and insurance, and
* Ensure deceased donor families get help with expenses, such as funeral costs.

Hippen says that aside from saving lives, an incentive program could save millions of taxpayer dollars by reducing dialysis. The U.S. spends $22.7 billion — or 6.5 percent of the Medicare budget — on kidney failure each year, with $2.2 billion of that going to transplants and the rest to dialysis, he said.

“It may turn out that, even if a system of incentives is introduced in the U.S., it won’t work,” he said. “Maybe this isn’t the answer. But if it isn’t, I’m not sure what is.”
Additional Facts
WAITING FOR ORGANS IN SOUTH CAROLINA

• Kidney – 715
• Liver – 32
• Pancreas – 6
• Kidney/Pancreas – 32
• Heart – 9
• Total: 793

Source: United Network for Organ Sharing

Since last month’s launch of the South Carolina Organ and Tissue Donor Registry, more than 45,000 people have signed up.

In your voice
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livingdonor101 wrote:
These articles (& policies) seem to forget that being a living donor is not without risks, both short & long-term.

There is NO comprehensive long-term data regarding living donors' health &well being. Despite the transplant community's edict 'you can life a normal life with one kidney', they really DONT KNOW.

LDs can suffer from bleeding, blood clots, hypertension, proteinuria, intenstinal binding, reduced adrenal gland function, chronic fatigue, hernias, testicular swelling &reduced kidney function, etc

It's also well-known that LDs can suffer from depression, anxiety &PTSD-like symptoms, yet the transplant centers offer NO support or aftercare.

Let's not forget that LDs can be denied life & health insurance post-donation.

There is also the assumption that a transplant is always successful, that a recipient will go on to have a 'normal' 'healthy' life span, which is completely erroneous. An LD must live w/ the consequences forever.

www.livingdonor101.com
2/24/2009 1:59:05 PM
These articles (& policies) seem to forget that being a living donor is not without risks, both short & long-term. There is NO comprehensive long-term data regarding living donors' health &well being. Despite the transplant community's edict 'you can life a normal life with one kidney', they really DONT KNOW. LDs can suffer from bleeding, blood clots, hypertension, proteinuria, intenstinal binding, reduced adrenal gland function, chronic fatigue, hernias, testicular swelling &reduced kidney function, etc It's also well-known that LDs can suffer from depression, anxiety &PTSD-like symptoms, yet the transplant centers offer NO support or aftercare. Let's not forget that LDs can be denied life & health insurance post-donation. There is also the assumption that a transplant is always successful, that a recipient will go on to have a 'normal' 'healthy' life span, which is completely erroneous. An LD must live w/ the consequences forever. www.livingdonor101.com livingdonor101
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LP_Media wrote:
Every 11 Minutes another person is added to the Transplant Waiting list. South Carolina joined the majority of the United States with a state registry by establishing the S.C. Organ and Tissue Donor Registry on January 14th. Persons with a heart and "Y" on their driver’s license are not automatically in the registry. That information was not transferred from the SCDMV. Thus individuals must now register their legal consent to be a donor in order to be in the new confidential and secure donor registry.

Registering is easy, quick, and heroic. Individuals can register now by visiting www.Every11Minutes.org and/or by obtaining, renewing, or changing your SC driver's license/ID at any SCDMV office.

Individuals who go through the SCDMV will get a new logo representing legal consent placed on their license/ID. Register today at www.Every11Minutes.org and always say "YES" to donation when you are at the SCDMV. Also be sure to tell your family members of you wish to become a donor.
2/24/2009 9:39:55 AM
Every 11 Minutes another person is added to the Transplant Waiting list. South Carolina joined the majority of the United States with a state registry by establishing the S.C. Organ and Tissue Donor Registry on January 14th. Persons with a heart and "Y" on their driver’s license are not automatically in the registry. That information was not transferred from the SCDMV. Thus individuals must now register their legal consent to be a donor in order to be in the new confidential and secure donor registry. Registering is easy, quick, and heroic. Individuals can register now by visiting www.Every11Minutes.org and/or by obtaining, renewing, or changing your SC driver's license/ID at any SCDMV office. Individuals who go through the SCDMV will get a new logo representing legal consent placed on their license/ID. Register today at www.Every11Minutes.org and always say "YES" to donation when you are at the SCDMV. Also be sure to tell your family members of you wish to become a donor. LP_Media
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boernomore wrote:
wow this article thru me for a loop, buy organs, sounds absurd, the truth is there are many many issues here, can you get health care, a mortgage, a job after you give away an organ, have you filled out a medical lately? and then i thought why aren't the families offering a kidney if it is such a simple process, oh yeah, lots of kidney disease runs in families, it can be genetic. if you clone an organ from a geneticcally imperfect individual, say one with kidney disease, don't you get the same organ, there doesn't seem to be a simple answer, sounds like education and cadaver donation still is the best option. this buying organs will lead to the poor being used by the haves, disgusting. oh yeah, can they get their money back if the organ fails in say less than 3 years?? a serious issue that needs real discussion by family members and a well informed nation. American can do this, educate them, no one knows how this is until it touches their family.
2/24/2009 9:17:31 AM
wow this article thru me for a loop, buy organs, sounds absurd, the truth is there are many many issues here, can you get health care, a mortgage, a job after you give away an organ, have you filled out a medical lately? and then i thought why aren't the families offering a kidney if it is such a simple process, oh yeah, lots of kidney disease runs in families, it can be genetic. if you clone an organ from a geneticcally imperfect individual, say one with kidney disease, don't you get the same organ, there doesn't seem to be a simple answer, sounds like education and cadaver donation still is the best option. this buying organs will lead to the poor being used by the haves, disgusting. oh yeah, can they get their money back if the organ fails in say less than 3 years?? a serious issue that needs real discussion by family members and a well informed nation. American can do this, educate them, no one knows how this is until it touches their family. boernomore
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ludwig wrote:
THis is all the more reason to clone organs using stem cells. The prefered source for such cells would be the patient since there would be less chance of rejection. Cloning is a natural process which nature herself does but in higher mammals needs the help of man. We already can grow ears, noses and other such parts. Attemps to grow hearts have been at least partially successful.

Those who oppose stem cell use are far more immoral that they worse case scenario that maybe imagined in their phobic minds about the use of stem cells. You would would commit murder rather than to give someone life with new organs..

One of the secrets to living for 200-300 years is in cloning body parts and replacing those which over time wear out and make cellular errors leading to death.

2/24/2009 3:02:45 AM

http://www.greenvilleonline.com/article/20090224/YOURUPSTATEHEALTH/90222030