The Gift Of Life

An article on the dearth of organ donations appeared in the Friday edition of the Wall Street Journal:

Despite years of publicity about the virtues of organ donation, the number of people who need transplants has been growing about five times faster than the rate of donations. Most new suggestions for closing this gap are controversial, particularly among professionals who administer or advise the national listing and matching program of the United Network for Organ Sharing, or UNOS. But nobody denies that there is a tragic shortage of organs.

In a way, the imbalance between supply and demand reflects a positive development. Before medical advances made more transplants of all kinds an option, many of those on a waiting list today would have died without hope.

So far, however, scientists have not found a way around the basic imperative that organs be taken undamaged, and quickly, from their donors. And only about 15,000 people a year die in circumstances -- such as brain death after a car crash -- that make them suitable donors for life-saving transplants.

Yet that number is not as small as it looks, because each of those people may have organs of use to several recipients -- including two separate kidneys. In any given year, there might even be enough organs to prevent the 6,700 or so waiting-list deaths that occur annually now.

The real problem, experts say, is that many of the 15,000 do not become organ donors. No matter how often Americans tell pollsters that donating an organ is a wonderful thing, less than half the population has signed up -- say, on a driver's license -- to actually do so. When it falls to a family to decide after a loved one's death, only about 50% give permission. By some estimates, 20,000 transplantable organs are buried or cremated each year.

I've never understood why people don't agree to have their organs donated. The idea that your death, as much of a bummer as it might be for you personally, could help prevent the death of another person would seem to make it a no-brainer. It's selfish to hold on to organs that aren't going to do you any good anymore. When you're dead, you're dead and that spleen ain't going to be of much help. Not only is the captain going down with the ship, he's taking the life rafts with him.

In order to encourage more organ donors, one group is offering a practical reason to sign on:

It's statistics like those that have led more than 3,500 people to join a nonprofit organization called LifeSharers. Each has signed a legal document authorizing the donation of his organs and -- this is the significant part -- requesting that they be offered first to another member of LifeSharers if a suitable recipient is on the UNOS waiting list. Kindness aside, each member's goal here is to increase his chances of receiving a transplant, should he ever need one, by giving other people an incentive to sign up in the hope of increasing their chances.

This is called a directed donation, and directed donations are not popular at UNOS, where the watchword is "fairness." Somebody's willingness to donate is not supposed to count when scarce organs are rationed out.

The principle of equality among sick people is morally attractive. An even greater good would be saving more lives with more transplants. Dave Undis, who heads LifeSharers, may sound harsh when he says that the current system "seems to be more interested in the equal distribution of death than in preventing deaths." Yet his incentive-based organization is at least offering a strategy for boosting the organ-donation rate -- at a time when appeals to disinterested altruism are no longer enough.

I have mixed feelings on this approach. On the one hand, it does offer an incentive for people who may have hesitated about agreeing to be an organ donor. And the more organs available, the better. But it does seem to be a little cold-blooded, especially if the potential recipient just happens not be a member of the particular pool.

But, no matter what you feelings about groups like LifeSharers are, the bottom line is that there is no good reason why everyone should not be an organ donor. If you need to put a face on the need, look no further than Captain Ed's First Mate. Sign up to be an organ donor. Today.

UPDATE--David J. Undis, the Executive Director of LifeSharers, e-mails to share his perspective on the issue:

Thanks for mentioning LifeSharers on Fraters Libertas today.

You said LifeSharers "does seem to be a little cold-blooded". Perhaps. But what's really cold-blooded is burying or cremating your organs when your only other choice is donate them to save lives.

It boggles the mind (my mind, anyway) to think that someone who won't donate his own organs deserves to get an organ that a registered organ donor needs. But about 60% of the organs transplanted in the United States go to people who haven't agreed to donate their own organs when they die. So LifeSharers is making the organ allocation system fairer as we expand the number of organs available. Giving an organ to a non-donor when there's a donor who needs it is like giving the Powerball jackpot to someone who didn't buy a ticket.

I hope you'll decide to join LifeSharers. It's free. It could save your life. You can sign up at http://www.lifesharers.org/enroll.asp