On Monday, Jason Lott advocated for the practice of organ solicitation. Although we agree with Mr. Lott's assertion that there is a critical shortage of donor organs, and developing new strategies to improve organ donation is essential to reducing wait times and death on the waiting list, we strongly disagree with Mr. Lott's comments stating that directed solicitation is not harmful to patients.
Currently most organs are allocated based on some type of priority system in which donors are matched to appropriate recipients. This system generally factors in the recipient's severity of illness, immunologic match, blood type and donor size compatibility and/or length of time accrued on the waiting list. Hearts, livers and soon lungs (starting in April 2005) are allocated primarily on severity of illness. Directed donation by families to specific patients who are financially capable of advertising their need for a donor organ, may allow "less sick" patients to receive organs before sicker and needier patients.
Organ donation is a truly altruistic act. Family members of a deceased potential donor decide that in their moment of grief and sadness, they wish to help someone else. Although it is a natural reaction to preferentially help someone we know, anonymity of the recipient does not prevent an altruistic act. We have seen this most recently in the tremendous global outpouring of support for victims of the tsunami. Rather, it is our opinion that improved education, and perhaps legal efforts to promote organ donation, will be more effective at increasing rates of organ donation. For example, Spain has the highest rates of organ donation (33.5 per million compared to only 21 per million in the United States and 14 per million in the European Union). The Spanish model utilizes the principle of presumed consent (the Spanish Transplantation Act of 1979) in which all citizens are considered organ donors unless specifically stated otherwise. In reality, almost every organ donation in Spain still involves family discussions and consent. However, the presumed consent law reinforces the general attitude that organ donation is an important and acceptable way to contribute to society.
One of the reasons why organ donation does not occur more commonly in the United States is there is sometimes a mistrust of the donation process and fear that agreeing to be an organ donor somehow compromises the care of a potential donor and shifts focus away from finding a cure or treatment. Although family members are never approached prior to the declaration of death, this notion nevertheless remains prevalent. Education about the donation process can alleviate many of these concerns. In addition there are also many misconceptions about the fairness of the organ allocation process. For example, some falsely believe that celebrities or rich people get preference over others. Directed donation further undermines confidence in the fairness and equity of the transplant process. This confidence is crucial to promoting organ donation.
Finally, criticism of the United Network of Organ Sharing, the national organization responsible for organ allocation, is unwarranted. Gift of Life, the Delaware Valley's UNOS organ procurement network, has been particularly aggressive and effective at promoting organ donation. Between Jan. 1, 2004, and Oct. 31, 2004, Gift of Life was responsible for placing 1,344 organs from 552 donors. This ranks number one in the nation.
Sincerely,
Vivek N. Ahya, M.D.
Medical Director, Lung Transplantation Program
Assistant Professor of Medicine
Alden Doyle, M.D., M.S., M.P.H.
Assistant Professor of Medicine
Kidney/Pancreas Transplantation Program
Nancy Blumenthal, C.R.N.P
Senior Nurse Practitioner
Lung Transplantation Program
