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What To Do About America's Organ Donation Crisis By: Robert Locke
FrontPageMagazine.com | Thursday, April 12, 2001

SOME SOCIAL PROBLEMS are not ideologically interesting; they are just terrible problems.

What if, for example, there was a national health problem that was unnecessarily costing the lives of 5,000 people annually? That's the equivalent of sinking the Titanic every four months. There is. It’s called the shortage of organ donors, and that's the number of people who die waiting for donor organs each year. While the EPA fusses over minor pollutants that might kill one person a year on average, this problem is getting worse with every advance that extends the applicability of transplant technology.

Currently organs are removed from people who have signed organ-donor cards (and, de facto, gotten their families to go along) and transplanted to recipients according to a complex and cumbersome region-based system. This system is itself part of the problem, but the bigger problem is the simple lack of available organs. The key problem creating this shortage is not a shortage of people dying under the sudden circumstances (i.e. auto accidents) that enable their organs to be harvested. It is the fact that far too few of these people have signed the donor cards that are required in order to harvest their organs, resulting in a profligate waste of parts that could be saving other people's lives.

This shortage has led to a black market in organs. It has led to people selling their own kidneys in countries like India. It has led to serious, and quite understandable, proposals for creating a free market in organs in the US. These proposals have consistently been rejected for a number of obvious reasons, including fairness to the less-well-off, the threat of organ theft, and a desire not to drive up the cost of already-expensive transplant operations by paying people for something they are willing to give away. Not to mention a natural distaste at chopping up people and selling the pieces.

Various proposals to increase the percentage of people whose organs are available for transplant have been made. A concept called "presumed consent," in which people are presumed donors unless they stipulate otherwise, has been suggested, but raises the obvious legal and moral objection that society does not have the right to presume people's consent, no matter how worthy the cause. There have also been attempts to legally require physicians to ask the families of the deceased, the de facto gatekeepers, for permission to remove organs, something physicians are often loathe to do under the circumstances in question. Publicity campaigns and other measures have been tried, with limited success.

None of this is necessary. What we actually need is legislation that would give priority for available organs to people who have themselves signed the organ donor card. Those who have signed would go ahead in line of those who have not. To keep people from waiting until they need an organ before signing the card, there should be a priority (adjusted for age, of course) for people who have been signed up longest. This would give people an incentive to sign the card immediately in case they ever needed an organ later. To get right to the point, fear is a very efficient motivator.

This way of getting more people to sign up is morally unimpeachable, as it makes the benefits of organ transplantation available to those who are willing to donate their own organs to others. They are clearly more deserving of a transplant that someone who has refused, either deliberately or by neglect. This would replace a system based on handouts with one based on individual responsibility, something conservatives should appreciate.

The other issue that has to be dealt with is family obstructionism. If someone consents to be a donor, hospitals today are still legally required to obtain the permission of next-of-kin. This is unjust, it kills people, and it should stop. When the autonomy of the donor, and the life of the potential recipient, are at stake, the rights of families are distinctly secondary, even if they are not nonexistent. We do not allow families, except under special legal circumstances, to veto the deceased's will with respect to their property, so why should the families have a veto power concerning their body? It is morally right that someone who want their organs donated should have them donated, even if their family disapproves.

Since organ transplantation is already governed by a legislative framework, changing the rules would be controversial but not legally infeasible. It would probably be easiest, since donor cards are generally on the back of drivers' licenses, to have people register their willingness to donate whenever they renew their drivers' licenses, since motor vehicle departments already keep records on everybody. A large new bureaucracy would not have to be created. Naturally there might be some problems, but this is as nothing compared to the thousands of lives that might be saved every year. The exact quantitative effectiveness of these two proposals is unpredictable, but even an incremental improvement would translate into thousands of lives.

I know it's an awfully cliche, but people will die every day until we do something. One of them just might be you.

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