Recent news reports have raised questions about the number of persons in the United States waiting for organ donations. You can read the Washington Post story here and a commentary by ethicist Arthur Caplan here.
It has been a truism for years that the number of those who might benefit from organ donation has been roughly four times the number of organs donated. In one sense, it doesn’t seem to make a lot of difference whether that multiplier is closer to three times than to four times organs donated. At the same time, critics are correct that it certainly can make a difference. Caplan cites a number of examples.
There are several issues regarding distribution of organs that don’t lend themselves to simple resolution. For example, should distribution of organs be on a national or regional basis? Some large centers, with larger numbers of patients on their own lists (or better, perhaps, their portions of “the list”), would like national distribution of organs to the first appropriate donor, rather than assessing first those patients geographically closest to the donor patient. However, increased transportation time does have an effect on the viability of the organ, and conceivably on the viability of the waiting patient. Those extra hours can make a significant difference. And certainly patients who might benefit from transplant are spread all across the country. On the other hand, the larger transplant centers argue, and not without reason, that in doing more procedures they have more experience and so greater likelihood of having good outcomes. Some patients and families literally move so as to be closer to those centers. Currently, the norm is regional distribution first, but the discussion recurs periodically.
Another issue is “presumed consent” vs. “presumed denial.” There are patients who die, sadly, with no family or community at all, and sometimes completely without identification. Many patients who die suddenly have expressed no opinion on donating their organs. In those cases, should the presumption be that they would wish to be generous and donate their organs; or should it be that they would decline to donate? Donation is certainly generous, and Americans are certainly generous people, at last over all. At the same time, to what extent should that guide our presumption in the individual case? At this time the practice is to presume denial, to presume that if the individual did wish to donate the individual would have made that known, whether by joining a donor registry or informing family, or at least signing the appropriate line on a driver’s license. However, in much of continental Europe the norm is “presumed consent,” and the position certainly has its advocates in this country.
The concerns about the number of patients awaiting transplant do point out the importance of transparency in the entire process of donation and transplantation of organs and tissues. I think that would be a matter of general agreement of everyone involved. That said, for the good of patients who might or might not benefit from transplantation, and for the good of families who might consider donating the organs of a loved one, there’s no such thing as “too much” transparency. We need to keep these issues out in public discussion. That way both as individuals and as a society we can decide according to our wishes and our values.