Decline in altruism could worsen organ shortage

[okarol]

Decline in altruism could worsen organ shortage

By Joseph Brownstein
 
updated 9/2/2011 2:51:18 PM ET

Recent advances have given organ donors easier surgeries and faster recovery times, but the advances have not tackled one primary issue in organ donation: the limited supply of organs.
A new paper argues that a trend in society toward less altruism bodes further problems for the availability of organs.
The paper's data show that while donations from living people increased 250 percent between 1995 and 2007, donations from people upon their death have risen only 7 percent. The organ donation shortage study was based on donations in Australia, the Netherlands, Canada, Germany, the U.K. and the U.S.
Those numbers show that people are less willing to give for altruistic reasons (organs donated upon death are given to a stranger) but are increasingly willing to give kidneys while alive (generally done directly to someone the donor knows), where a measure of payback may ultimately be expected, the author said.
"The shift toward restricted altruism is, in my view, the first step in a privatization process that ends with organ trafficking," said Hagai Boas, a sociologist at Tel Aviv University in Israel.
His findings show "that we can search the roots of organ trafficking in the shift to direct donations, or even in the problem of organ shortage," he said.
Who donates?
Kidneys, which can come from a living or deceased donor, are the most needed organ. According to the Organ Procurement and Transportation Network (OPTN), part of the U.S. Department of Health and Human Services, there were more than 50,000 people waiting for kidney transplants. The total waiting list for all organs includes 72,000 people.
In 2008, according to OPTN, there were just under 6,000 kidney transplants from living donors and 10,500 from deceased donors, meaning living donors outnumbered deceased ones. (Deceased donors provide two kidneys.)
Boas said his study shows that while there may be a growing number of people willing to give a kidney, there are fewer willing to part with their organs at death. And that necessitates more donations from the living.
"The stagnation in cadaver donation has many reasons," Boas told MyHealthNewsDaily. "Some of them are related to policy, to the decrease in brain death incidence and, of course, to fears and reluctance from [would-be organ donors]. This creates the chronic shortage of organs in the public sector of organ donations, which in turn leads to an increase in living kidney donors."
There may be other reasons for the shortage as well.
"A lot of it is just reluctance to think about it," said Alvin E. Roth, a professor of economics at Harvard University.
Less altruism, or just easier surgery?
The numbers might be more of a reflection of the trend toward minimally invasive surgeries to remove a kidney from a living donor, said Roth, who helped design the New England Program for Kidney Exchange, in which patients who have a willing but incompatible live donor are paired to "exchange" kidneys with another incompatible pair, so that two transplants are completed.
"I'm not convinced that it reflects changes in people's altruism — I think it reflects changes in circumstance," he said. "What you're also seeing is a technological change in the surgery. The cost of nephrectomies to the donor has gone down dramatically."
But he agrees that the lack of deceased donation is a problem that needs tackling.
"The place in the world that does best is Spain. They attribute it to the professionalization of the task," he said.
For a potential donor who has passed away in the U.S., he said, "The first person to ask your wife [if your organs may be donated] is likely to be one of the surgeons."
"In Barcelona, it's someone from the organ bank."
Another solution, undertaken in Israel, gives people who sign up to become organ donors priority on the transplant list, should they ultimately need a transplant. Spouses and close relatives of people who sign up as donors are given similar consideration.
Roth said the idea is worth exploring but, he acknowledged, "It's less purely altruistic to say that in return for your donation, you're going to get something, which is priority."
Boas, who received a kidney transplant when he was 13, said that programs to increase the pool of available organs are needed, and may overwhelm concerns about what's motivating people to donate.
Long waiting lists leave no hope for some patients, so private donation is a life-saving option— that overshadows its ethical or social shortcoming, he said.
"The only way of battling this trend is by dramatically increasing the pool of public organ donors. I am, however, pessimistic, as I see no real option of enlarging the public pool."
Boas' paper was published online on Aug. 27 in the journal Social Science & Medicine.

http://www.msnbc.msn.com/id/44373824/ns/health-behavior/

[kristina]

Thanks for sharing this article with us, okarol.

Organ donations get often a very bad publicity,
and it puts many people off to think altruistic about organ donations.

Only recently I heard on the radio of a family who donated a kidney of a deceased loved one
in good faith because they wanted to assist someone to have a better quality of life.
This kidney went straight into a private Hospital where a rich person from abroad had paid lots of money
and waited for a kidney-transplant. And with the help of his money, he got this kidney,
leaving the country after the successful transplant.
The family who donated the kidney were very disappointed
that their good faith was being exploited in such a bad way.

A few years ago I watched by chance a TV-programme on the Continent
and it was reported that very young motorcycle-drivers were involved
in minor accidents i.e. fractured leg etc., and they died under mysterious circumstances,
after they were admitted to hospital.
 
Their parents were interviewed and wondered whether the death of their sons
was connected in any way to their sons carrying a donor-card ?

[okarol]

I have heard that concern, about ER doctors more interested in saving one patient over another.
It's mentioned as a myth on the US UNOS site:

Myth: If emergency room doctors know you're an organ donor, they won't work as hard to save you.

Fact: If you are sick or injured and admitted to the hospital, the number one priority is to save your life. Organ donation can only be considered after brain death has been declared by a physician. Many states have adopted legislation allowing individuals to legally designate their wish to be a donor should brain death occur, although in many states Organ Procurement Organizations also require consent from the donor's family.

You can read the other myth here http://www.unos.org/donation/index.php?topic=fact_sheet_7

[Bill Peckham]

I am confused. How is a 7% increase a decline? Because living donations increased faster? Of course they did, not only has technology and criteria increased this option it was starting from a smaller base.


This whole premise makes no sense. Are they really saying the increase in living donors is causing or has the same cause as a relatively slower increase in deceased donors? That's bizarre. um because the living donors can only donate one if they die? piffle

[okarol]

I am confused. How is a 7% increase a decline? Because living donations increased faster? Of course they did, not only has technology and criteria increased this option it was starting from a smaller base.


This whole premise makes no sense. Are they really saying the increase in living donors is causing or has the same cause as a relatively slower increase in deceased donors? That's bizarre. um because the living donors can only donate one if they die? piffle

Right... makes no sense 

[Bill Peckham]

It's a case of shabby reporting and/or poor writing; here is a much clearer article on the study:


http://www.myhealthnewsdaily.com/kidney-transplant-presumed-consent-101122-0779/


In Kidney Donation, 'Presumed Consent' Policy May Reduce Living Donors
Nov 22, 2010 | 5:19 PM ET | By Rachael Rettner, MyHealthNewsDaily Staff Writer 

Policies that presume people will donate their organs upon their death unless they specify otherwise — also known as presumed consent — may have the unwanted side effect of lowering the number of kidneys from living donors, a new study suggests.

The study examined the rates of kidney transplantation between 1997 and 2007 in 44 countries — 22 with presumed consent and 22 with explicit consent, the latter of which individuals must register or make clear they want to donate their organs upon their death.

Perhaps as expected, nations with presumed consent, such as Austria and Norway, had higher rates of kidney transplantation using organs from the recently deceased. However, countries that require explicit consent, such as the United States and United Kingdom, had higher rates of kidney transplantation from living donors.

This suggests switching policies from explicit consent to presumed consent might decrease the number of living kidney donors, the researchers said. Such a decline is important to consider because patients who receive transplants from living donors generally have better survival rates and shorter waiting times than those who receive transplants from donors who are deceased.

The findings should inform the ongoing debates in nations considering changing their consent policies, the researchers said. In these countries, it has been argued that presumed consent would increase the organ supply, and therefore ease the growing demand for transplant organs. In the United States, for example, there are currently close to 110,000 people waiting for an organ donation, according to the United Network for Organ Sharing, or UNOS, the nonprofit organization that tracks all transplants in the U.S. The majority of the people on the list are waiting for kidneys.

In the new study, nations with presumed consent policies had an average of 22.6 kidney transplants from deceased donors per million people in their total population, while countries with explicit consent had an average of 13.9 transplants per million people. On the other hand, countries with presumed consent had 2.4 kidney transplants per million people from living donors, while countries with explicit consent had 5.9 transplants per million.

In countries that utilize a presumed consent policy, the lower number of transplants from living donors may be due to a general public perception that the need for organs has been met by the legislation, the researchers said. It's also possible that programs for transplants from living donors are not as developed in these countries.

While some experts agree with the study researchers that presumed consent policies may decrease kidney donations from living donors, they say it is important to consider the affect such policies may on the donation of other organs.

"There is no living donation for hearts, intestines, lungs, and really for practical purposes, livers," said Arthur Caplan, director of the center for bioethics at the University of Pennsylvania, who was not involved in the study. More of these organs would be available under presumed-consent policies, Caplan said, and there would be no downside for living donations, because living donations, for the most part, refer to kidney transplants.

However, countries that switch to presumed-consent policies should make strong efforts to maintain programs for living kidney donors, Caplan said. "You do not want to fail to go to presumed consent because you're worried about living donation, you just have to do everything you can to preserve living donation," he said.

And when such a policy switch occurs, it is important to inform and educate the public and health care professionals about what the change means, he said.

The study was published in the November issue of the journal Annals of Internal Medicine.