Cut to heart of transplant shortage

http://www.JewishWorldReview.com | A furor over whether a man who used a Web site to search for a kidney should be barred from a transplant wrongly focuses on the symptom — rather than the problem — of the shortage of lifesaving organs.

At the risk of offending those who might find the analogy cold, the issue is similar to the economic questions we face today.

Public policy focuses less on how to divvy up scarce government dollars among worthwhile programs than on promoting economic growth to generate larger tax revenues.

When it comes to organs, the focus should be less on dividing the existing pie and more on increasing the overall supply.

It is time that Congress rethink the 1980s law, written when transplantation was in its infancy, preventing a potential donor's next-of-kin from receiving money for blessing a transplant. Of course, any change should continue to have doctors designate who gets organs based on medical criteria.

Even with the partisanship in Washington, D.C., this should be an easy call. Red and blue Americans all think living is better than dying.

Compensating live donors is another, thornier question. But why would anyone oppose helping those who authorize the donation of their deceased loved ones' organs to pay for funeral expenses?

Who would be the loser?

Neither the patient nor the donor's family. The payment level could be set by law and paid by insurers that would save on their costs of keeping patients alive.

Of course, it is an emotional matter that will trouble some, and others may oppose transplantation for religious reasons. But no one would require participation.

Or we should adopt the policy of some European countries under which a cadaver is assumed to be a donor absent instructions otherwise or next-of-kin objections. Those nations have a less severe shortage of organs for transplant than the United States.

U.S. policy requires a person to sign papers declaring himself a donor, or the next-of-kin must be located, and then agree to the donation. Time constraints can make the latter problematic.

These are serious questions policy-makers should focus upon rather than fretting about how communications technology should affect one's ability to search for a donor. It seems obvious that a policy change allowing payment or presumed consent upon death would result in higher donation rates that would benefit Americans overall.

However, the unwillingness of Congress to deal with the supply question makes current organ-allocation decisions testy.

For instance, Alex Crionas relocated to Orange City from New York because the waiting time for a transplant is generally shorter, and he sought his own donor. He is reportedly far down the waiting list for a cadaver's kidney, while undergoing dialysis three times a week.

A friend agreed to donate one of his two kidneys, but the organization that oversees organ transplants in the Tampa area refused to allow the operation because Crionas also had a Web site seeking a donor. The transplant organization in Orlando is evaluating him for it without considering his Internet site.

It is not unusual for those needing a kidney to find friends, relatives or, in some cases, even total strangers through word of mouth. There are far fewer cases of live donations of liver sections for transplant.

UNOS, the national organization that oversees transplants, has told regional transplant centers to decide their own policies about live donations, including how to deal with those who advertise — as a Houston man did last year to get a liver — to find a match.

At issue is the understandable worry among medical professionals that if patients can advertise for a donor, the existing organ-allocation system could deteriorate into a black market in which money, not medical need, becomes the coin of the realm.

Regular readers of this column may remember I underwent a liver transplant in 2002 after going through the required medical and psychological testing that allows doctors to determine fitness for the transplant. It is not surprising that I embrace the current system in which doctors have the final word.

Yet, there is no reason why changing the donation system to allow payment to next-of-kin, or a law that assumes consent, has to endanger doctor control.

Efforts to improve cooperation between hospitals — more effective communication with next-of-kin, better sharing of information about potential donors, etc. — have increased the rate of donations in recent years. Yet, in 2003, the last year for which data are available, there were more than 62,000 Americans who needed an organ transplant but did not get one.

It is time for Congress to get off its duff and do something.

Peter A. Brown is an editorial page columnist for the Orlando Sentinel. Comment by clicking here.

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