On Organs

I’ve been following the story of a surgeon accused of basically killing a patient to harvest his organs with some interest. If you haven’t heard anything about the case, the New York Times has a decent article on it. Basically, the surgeon made some…interesting medical decisions which appear to have been designed to hasten the death of a disabled patient, after discussion about harvesting his organs for a cardiac death transplant (most transplants in the United States are performed after brain death, but cardiac death transplants are possible). It was clear that the patient was going to die anyway, so his ventilator was removed, with consent from his mother, and when he didn’t die immediately, drugs were prescribed. Depending on how you view the case, the drugs were given for comfort, or to try to speed the patient’s death. Either way, he still didn’t die immediately, and his organs turned out to be useless for donation.

This case intrigues me on a number of levels. For one thing, the surgeon hasn’t been convicted yet, so information may come out in the trial to justify his actions. Given that I’m not a medical professional, I am obviously not qualified to comment on the patient’s treatment. But it does raise the specter which organ transplant advocacy organizations have been fighting for years: the idea that people could be killed for their organs. Or simply that surgeons could be a bit, er, hasty.

I’m not surprised that this case is getting a lot of press, since it’s such an easy thing to write a story about. It’s kind of unfortunate, though, because I think it may scare some people off, making them decide they don’t want to donate their organs for fear of a case just like this. And that’s unfortunate, because I think that the bulk of organ harvests in the United States are perfectly legal and well within ethical guidelines. And organizations which promote organ donation here are probably incredibly frustrated that this case has become so high-profile.

The “donated” organs coming from China which have been linked with executed prisoners are far more sketchy, and should be a cause for serious concern, rather than an isolated and as-yet unproved accusation here in the US. And maybe people wouldn’t be turning to a very shady source for organs if we had a more organized donation system in the United States, say an “opt-out” system like they have in many countries. In an opt-out system, it is assumed that everyone consents to organ donation, and people must specifically request that they not be considered for donation if they are opposed to it.

I’m a fan of opt-out systems because I think that a lot of people would be perfectly ok with having their organs donated, but they haven’t explicitly stated that, and as a result their organs go to waste when they die. And these systems greatly increase the supply of organs, making it possible for more people to get them, and I happen to think that this is a good thing. For people who don’t want to donate, it’s generally easy to opt-out.
We aren’t allowed to sell our organs here in the United States, which I think is probably a good thing. We are allowed to freely give them to each other, bypassing transplant queues, which I think is also a good thing. But I think we could avoid awful cases like this one if we made organ donation a mainstream, assumed thing, like vaccinations. And maybe transplant surgeons wouldn’t be faced with situations like this if they knew that the organs their patients need were readily available.

I am curious to see how this case impacts the rate of organ donation in the United States; maybe there will be a decrease, maybe not. If we don’t notice a decline in confidence about organ donation, it will be a testimony to years of patient education on the part of donation advocates.

2 Replies to “On Organs”

  1. It will be a real shame if the Ruben Navarro case causes people to refuse to donate their organs when they die. We need all the organ donors we can get.

    Over half of the 98,000 Americans on the national transplant waiting list will die before they get a transplant. Most of these deaths are needless. Americans bury or cremate about 20,000 transplantable organs every year. Over 6,000 of our neighbors suffer and die needlessly every year as a result.

    There is a simple way to put a big dent in the organ shortage — give organs first to people who have agreed to donate their own organs when they die.

    Giving organs first to organ donors will convince more people to register as organ donors. It will also make the organ allocation system fairer. People who aren’t willing to share the gift of life should go to the back of the waiting list as long as there is a shortage of organs.

    Anyone who wants to donate their organs to others who have agreed to donate theirs can join LifeSharers. LifeSharers is a non-profit network of organ donors who agree to offer their organs first to other organ donors when they die. Membership is free at http://www.lifesharers.org or by calling 1-888-ORGAN88. There is no age limit, parents can enroll their minor children, and no one is excluded due to any pre-existing medical condition.

  2. While I can understand the concept behind LifeSharers, I personally do not support it. I agree with UNOS; directed donation in this sense is not really sensible, or logical. If someone wants to donate organs to a specific person, I’m behind that, but saying that we should treat committed donors preferentially is kind of elitist. I also think it adds another layer of complication to the process of organ donation, which should be kept simple and streamlined.

    There are valid religious and health reasons to choose not to be a donor, and I think that people with this reasons should not “go to the back of the list.” UNOS is a fair and workable system for a country which has a clearly demonstrated organ shortage, awarding organs on the basis of medical need and the time at which someone was added to the list.

    The shortage, I think, is not due to people refusing to donate organs, but rather to a lack of clarity. Most people are perfectly willing to donate, but they haven’t specified this, and therefore their family members decline the option to donate, preferring to err on the side of caution. The organ shortage illustrates a need to clearly discuss your wishes with your family, and to carry a donor card. And, of course, it suggests that we should consider an opt-out system!

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