Organ shortage thorny

In this country there remains a serious shortage of human organs such as kidneys for transplantation.

Despite informational efforts aimed at encouraging people to designate themselves as organ donors, many healthy organs go to people’s graves instead of helping to save or better someone else’s life.

More than 114,000 people in this country are on waiting lists.

On June 25, the Wall Street Journal focused on “How can we provide better incentives to organ donors?” by way of a conversation involving three individuals with wide-ranging knowledge of the organ shortage and suggestions about how it might be addressed.

However, that conversation also delved into concerns and differences of opinion that make those purported solutions not as clear-cut as they might seem to be.

One of those interviewed, a doctor and fellow at the American Enterprise Institute and the beneficiary of two kidney donations, said she believes that the only solution is compensation for potential organ donors.

Meanwhile, another, a professor of public health in New York and author of a book on the organ shortage crisis in America, contends that the concept of living donation is the key. Pointing out that about 100,000 of the people needing organs need a kidney, he said a way is needed for getting people to care about the plight of those on dialysis and opt to give up one of their kidneys. People can live healthy lives with only one.

The third person, a top official of the New England agency that coordinates organ and tissue donation in six states and Bermuda, said that beyond increased donation, authorizations through donor registries and surrogate permission, and utilizing technologies to repair and transplant previously non-transplantable organs, nonfinancial incentives ought to be considered.

She said one such incentive could be reciprocity; if a person registered as a donor, he or she would receive priority as a transplant candidate if the need would arise. But should a person more immediately in need or who’s been on an in-need list for a long time really be bypassed?

Discussion centered on questions such as whether a person’s ability to donate, for example, a kidney should entitle him or her to comprehensive health-care coverage forever or for some limited period of time. Who would make that decision?

Noted during the conversation was that the potential problem with lump-sum cash for a living donor is that it could attract desperate, impulsive people who might later regret having donated an organ.

There wasn’t agreement about the option of imminent-death donation, which would involve removal of an organ such as a kidney from someone who, for example, has a non-survivable brain injury. However, there was belief expressed that ethically supportable paths exist for making such donations available.

Perhaps some positive developments could be forthcoming from pilot programs. One such program, underway at UCLA, allows living donors to donate a kidney ahead of time in the name of a family member or friend expected to require a kidney transplant in the future, to prioritize the intended recipient later on.

The Journal-organized conversation made clear that organ donation is an issue requiring much more thought plus open-mindedness, and a willingness to experiment with new awareness initiatives and additional well-thought-out incentives.