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Organ Donation Problems
by
Ibrahim B. Syed, Ph. D.
Organ donation is the charitable act or gift of an organ to help someone who needs a transplant. Americans are not donating their organs to be used after they die, and hence there are over 78,000 men, women, and children waiting for organ transplants in America, and 14 of these people die every day while waiting to receive an organ transplant. There are more than five people waiting for every organ made available by donation. An estimated two in three Americans have not indicated their wishes about donation. The United Network for Organ Sharing found slow growth in the number of organs from deceased donors. Kidneys from living donors are more likely to survive than those from deceased donors. In 1999, there were a total of 21,715 transplants performed in the United States, up 44 percent from 1990. Some people have religious or cultural objections to donate organs. Living donors--those who volunteer a kidney or parts of their liver or lungs--are understandably reluctant: they must undergo potentially life-threatening surgery and put their own future health at risk. More and more people with HIV and/or hepatitis B and/or hepatitis C are going to need organ transplants, particularly liver transplants. Europe and Singapore have what is called a Presumed Consent organ collection system. That means that when an accident occurs to a person who has not opted out, and brain death is declared, his or her organs can be taken immediately without the time. First transplants Thousands of people have their sight restored by donated corneas. A cornea was first transplanted in 1905. In 1918 Blood transfusion became established and the first successful kidney transplant took place in 1954. Christian Barnard in Cape Town, South Africa performed the first heart transplant in 1967. Deaths on Waiting List The number of deaths on the waiting list has also more than tripled—from 1,958 in 1990 to 6,125 in 1999. In 2001 more than 6,000 people in the U.S. died while waiting for an organ transplant. The dire shortfall of organs compared with patient demand is growing as the population ages and more people experience organ failure. New Immunosuppressive drugs have helped bridge the gap by allowing surgeons to transplant an organ that is a less than perfect match; even then, there just aren't enough organs available. There were 5,849 cadaveric, or dead, donors in 1999 an increase of 30 percent from 1990. Each donor can give 3 to 4 organs. Among cadaveric donors, 85 percent died due to head trauma or stroke. There were 4,712 living donors in 1999, more than twice the number in 1990. Of living donors, 35 percent were siblings, 18 percent were parents and 20 percent came from people who were not related. Survival Rates 89 percent of kidneys taken from a cadaver and 95 percent of the patients who received them survived at least one year after transplant. Among those who got kidneys from living donors, 95 percent of kidneys and 98 percent of patients were alive a year later. 81 percent of livers and 88 percent of liver transplant patients survived at least a year. 85 percent of hearts and 86 percent of heart transplant patients survived at least a year. What organs are transplanted? Kidneys, heart, liver, lungs, pancreas, small bowel, corneas, heart valves and bone can all be transplanted. Skin can be used to treat patients with severe burns. Techniques are improving all the time and it may soon be practical to transplant other parts of the body. An individual can donate heart, lungs, kidneys, pancreas, liver and small bowel. Tissue that can be donated includes corneas, skin, bone and heart valves. Corneas can be transplanted to restore the sight of a person who has a severe eye disease or injury. Bone and tendons are used for reconstruction after an injury or during joint replacement surgery. A bone transplant can prevent limb amputation in patients suffering from bone cancer. Heart valves are used to help children born with heart defects and adults with diseased or damaged valves. Skin grafts are used as protective dressings to help save the lives of people with severe burns. Most people can donate tissue. Unlike organs, tissue can be donated up to 24 hours after a person has died and can be stored for longer periods. Reproductive organs and tissue are not taken from dead donors. Who can be a donor? A person under sixteen can donate an organ provided the parents or guardian agree to donation. Older people can donate in the case of cornea and some other tissue, age does not matter. For other organs it is the person's physical condition, not age, which is the deciding factor. Doctors decide in each case which organs/tissue are suitable. Organs from people in their seventies and eighties are transplanted successfully. Color of the Skin Color of the skin of the donor does not matter. However, organs are matched by blood group and tissue type and the better the match, the greater the chance of a successful result. Patients from the same ethnic group are more likely to be a close match. It is important that people from all ethnic backgrounds to donate organs. Successful transplants are carried out between people from different ethnic groups wherever the matching criteria are met. The organ shortage has led various policymakers to propose radical steps. U.S. policy makers are proposing to provide financial incentives to living donors or to the families of deceased donors. One approach, which has been instituted in Pennsylvania and is supported by the American Society of Transplant Surgeons, offers families who donate a loved one's organs $300 in food and lodging expenses. Medical journals are advocating the program assert that the amount of money is intentionally small to "express appreciation" for the donation but not to serve as a payment. It is similar to the token coffee mug or umbrella one receives after donating to public radio or television. More important, some are agonized that these programs would mark the first step in encouraging an inhumane and delicately coercive market for spare body parts. In Islam, buying and selling of human organs for transplantation is prohibited. It should be done only as Sadaqah. Although the outright purchase of organs is illegal in nearly every country in the world, a number have black markets for living-donor organs, and the results have been frightening. A study of 305 living kidney donors in Madras (Chennai), India, found that 96 percent sold a kidney to pay off debts, receiving Rs.50, 000 or US $1,070 a piece. But 75 percent of the respondents soon faced debt and destitution once again, and 79 percent would not recommend organ selling to others. Permitting trade in organs has already led to the exploitation of the poor. A multitude of bills now in Congress would create a "medal of honor" for donors, offer medical leave for living donors. Living donors will have life and disability insurance in case they experienced unconstructive side effects. There is a need for an expanded public education campaign that would explain the need for organ donation and throw light on the process. Physicians and hospital personnel also require more training in encouraging organ donation It was shown that more than 95 percent of families would consent to organ donation if they knew it was the wish of their loved one. The unusual tactic of appealing to people's better natures may not be the only way to raise the number of organs available for transplantation, but it is the best method to start.
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