Organ donation: most are willing to give, so why is there a donor shortage?


Organ donation: most are willing to give, so why is there a donor shortage?

In 1954, surgeons performed the first ever successful kidney transplant - between identical twins - at Boston's Brigham and Women's Hospital in Massachusetts. Since then, transplants have become accepted medical practice for end-stage organ failure, saving or extending the lives of hundreds of thousands of people.

The community is keen to donate organs, but demand exceeds supply.

Progress in the field of transplantation continues apace. From infants to the elderly, from heart valves to faces, donors and surgeons are transforming lives.

Just last month, the Johns Hopkins University School of Medicine in Baltimore, MD, announced that the first organ transplants from HIV-positive donors to HIV-positive recipients would begin soon, following a change in the law that was instigated by the University's associate professor of surgery Dr. Dorry Segev.

There is even talk of a future head transplant, as previously reported by Medical-Diag.com.

From 1988-2015, 653,108 transplants took place in the US. Success rates continue to increase, giving recipients up to 25 years or more of quality life.

Unfortunately, there are not enough organs to meet the needs; although the community is willing, there are too few donors in a position to give.

Strong support for donation in the US

In a comparison against European rankings in 2011, the US ranked third among 13 European nations in terms of organ donation from the deceased, with 26.3 deceased donors per million population. Only the Spanish, at 34.1, and the Portuguese, at 26.7, donate more.

The 2012 National Survey of Organ Donation Attitudes and Behavior reflected "high and sustained support for the donation of organs for transplant" among US adults, with 94.9% in favor of donation.

  • From 1988-2015, there were 650,351 organ transplants in the US
  • There were 384,694 kidney, 139,371 liver, 8,110 pancreas, 62,267 heart, 30,822 lung and 2,644 intestine transplants
  • As of January 11, 2016, 121,678 people were waiting for organs, of whom 100,791 needed a kidney.

Around 40% of Americans "strongly supported" donation in 2005, rising to 49% in 2012. The percentage who registered permission for donation on their driver's license application rose from around 51% in 2005 to 60% in 2012. Of those who had not done so, 60% were considering it. Only 1 in 3 of the "no's" were unsure about donating.

Over 96% said they would fulfill the wishes of family members to donate, and over 75% said they would donate even without knowing their relatives' wishes.

People aged 35-54 years were most likely to have discussed intentions to donate with family members, 82% of them having done so. Only 38% of people aged 66 years and above had shared their wishes, and 67% of those under 35.

The strongest supporters of organ donation tend to be women, those under 65 years and people with higher levels of education.

Nevertheless, every 10 minutes, someone joins the waiting list. Every day, 79 people receive a transplant, but at least 20 people die waiting, because of the shortage of donated organs.

The United Network for Organ Sharing (UNOS) displays an updated record of the number of people in need of organs. On March 2, 2016, that figure stood at 121,524, and it rises every day.

The John Brockington Foundation, based in San Diego, CA, was set up by football national champion John Brockington, following a kidney transplant in 2002.

The Foundation aims:

To create a culture in which organ donation is commonplace; to provide financial and resource support for those donating, awaiting, and/or receiving organs; and to promote health education to minority communities who are disproportionately represented on the transplant waiting list."

Diane Brockington, executive director of the Foundation, told Medical-Diag.com that, although about half of the population is signed up to donate, only.01% die in circumstances that allow for recovery and transplant. In addition, procurement and surgery are not always successful, putting extra pressure on organ supply.

Meanwhile, multiple organs can be recovered from a single donor. UNOS note that one donor can save eight lives.

Types of donation

Organ donation can be either cadaveric, from a deceased donor, or living.

In the case of a deceased donor, the suitability of the organs will depend on the cause of death, medical history and speed with which they can be harvested. Success is a question of hours, to ensure that the organ is as "alive" as possible. Consent is also a factor.

Transplantation of organs has to be carried out quickly, while the organs are most "alive."

A living donor makes a conscious decision to donate an organ, such as a kidney, on the basis that the remaining organ will continue to function. In the US, 45% of organs are given by living donors.

Living kidney donation, in particular, has been made easier in recent years.

Firstly, the National Kidney Registry match living donors with recipients, easing the task of finding an exact match.

Secondly, laparoscopic surgery has minimized intervention for the donor, involving just a small incision and some minor punctures. Recovery is fast and normally requires only 2 nights in the hospital. After recovery, there is no need for dietary or activity restrictions or medications. Donors can quickly return to their normal life.

Thirdly, advances in medication make transplants more likely to last, reassuring the donor that the gift will be worthwhile.

Finally, improved financial assistance means that the recipient's insurance pays for surgery costs, and the donor's transportation and lodging expenses may be covered by the Living Donor Assistance Program, according to the National Living Donor Assistance Center (resource no longer available at www.livingdonorassistance.org). A federal employee who donates is entitled to paid leave.

In addition, the Affordable Care Act has made it easier for self-employed donors to get health insurance.

Why do people not donate?

A number of factors may hinder cadaveric donation. Personal or religious beliefs deter some people from registering or donating. In some cases, consent cannot be obtained in time, either because the deceased did not share their wishes with the family beforehand, or because they never got around to signing up.

For a living donor, health can be a consideration. A living donor needs better-than-average health to start with, and they may run a higher risk of disease in the long term.

A recent study from Johns Hopkins suggests there is a slightly higher risk of developing end-stage renal disease (ESRD) after donation. The figures were gathered in the context of developing a new tool to ensure that only donors with minimal risk are accepted.

A living donor who needs a kidney in the future will have priority, however. And according to Brockington, a living donor should receive good post-donation follow-up care and should never develop renal failure.

Brockington explained to Medical-Diag.com that registration varies widely between states. Utah has an 85% consent rate, while in California and New York, 2 out of 3 eligible donors leave the Department of Motor Vehicles (DMV) without registering.

She added:

The most common misconceptions are that they are too old, the emergency room doctors will prematurely leave off lifesaving measures to recover organs, their religion forbids it, minorities don't receive their share of the kidneys, they could not have an open casket, and somehow it will cost them money. All are false. All contribute to the daily and deadly toll of 21 people a day dying for the organs we burn or bury."


On the next page, we look at some ethical considerations, and how legislation encourages donation.

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