Tuesday, July 17, 2007

Do You Deserve an Organ?

**Today, I'm blogging for organ donation, which is sponsored by Blog Catalogue. Want more info, visit UNOS or OrganDonor.gov. Also visit the British Organ Donor Society. The Blog Catalogue site will let you know who else is participating. **

Do You Deserve an Organ?

Occasionally, I come across commenters who say they don't believe in organ donation. Curious, I think, because unlike Tinkerbell one doesn't need to close their eyes and clap their hands to know that organ donation saves lives. Also, on occasion, such comments make me irate.

I've been going to Ask Sister Mary Martha, because a Google alert showed she had a post on organ donation. Sister states correctly that the Catholic Church is in favor of donation. She argues that people's fear of donating is a lack of faith. However, many of her commenters think otherwise. Can people really not believe in brain death? I ran into similiar opinions at this site. I won't go into my whole argument again, you can read my comments at her blog or read this. Through the marvels of modern medicine, we can keep a body going long after nature would have called it quits. Yet for some people, "pulling the plug" at this point is against God's will. Unfortunately, I don't have a cozy enough relationship with the Big Guy to pretend to know his will. I speculate that keeping a body going, not alive-just going, is man's will, not God's. At least Sister's readers aren't hypocrites. Most of them said they wouldn't accept an organ either.

What about that? What about people who wouldn't donate, but would accept an organ if they needed one. You might think that once a person has had an organ transplant, they would agree to donate. You'd be wrong. I have asked families of patients who, following their transplant, developed complications and became brain dead. Some have said no. If I get past my annoyance, I can understand, I think, their response. Perhaps they're mad that the transplant didn't work. You don't know what kind of relationship they had with the doctor or the hospital. This is not a time for people to be logical or selfless and it's hard to analyze why a person makes the decision they do in the small window of time we have with them.

Should someone who's against donation get an organ? Organs and organ donors are rare, I think we can all agree on that. Less than 1% of all deaths are brain deaths and medically suitable to be donors. In NJ, there are currently over 3000 people on the waiting list. Last year we had about 300 potential organ donors. A little more than 2/3 consented. That's why the waiting list keeps growing. Into this mix are people, patients and institutions who are trying to come up with solutions, sometimes controversial ones.

Dave Undis from LifeSharers wrote an op/ed piece in the Baltimore Sun last week in which he says that organ donors are "getting the shaft".

registered organ donors who need transplants are treated no better than
people who have declined to donate their organs when they die. As a result,
every year, thousands of registered organ donors die waiting for transplants
when the organs that could have saved their lives are given to nondonors.

He's very persuasive. Why should people who won't donate receive an organ?His argument takes a creative leap, however. More accurately would be to say that every year organs go to people whose beliefs regarding donation are unknown. There are many requirements for getting onto a transplant list. Your feelings about being a donor yourself is not one of them. He goes on to say,

But shouldn't organs be given first to the people who need them the most? Not if these people aren't willing to donate their own organs. If people are unwilling to save their neighbors' lives, should we really elevate their needs above everyone else's?

In other words, if you join LifeSharers, you agree to donate your organs, if you are brain dead and medically suitable, to other LifeSharers members. That in itself is a big "if", given the small likelihood that you will be a donor. This falls under the "direct donation" stipulation, that families are able to direct who will get the organs and bypass the national list. If you see a cute kid on TV or know someone at church who needs an organ, you can direct an organ to them, as long as it's a medical match and the recipient's surgeon ok's it. What Mr. Undis is saying is that, even if a person on the waiting list is a status 1A, they shouldn't receive an organ if they won't agree to be a donor. But what if that person has never heard of LifeSharers? How would you know what their wishes are? If I'm a LifeSharers member and I become an organ donor, my organs will go to other LifeSharers members, even if there are people ahead of them on the waiting list. Even if some of those people(the status 1A's) will die if not transplanted immediately. Tough Nooggies, is his response.

LifeSharers is at least free. MatchingDonors has a fee of several hundred dollars to be listed for a living donor transplant. Go to his site and you'll see requests, "help my dad lead a nrml life" or "desperately need kidney, blood type A+". What's wrong with this? It brings to mind, my mind at least, women who go to a sperm bank looking for the perfect donor. Ooh! Pick this one-he's Norwegian and he speaks three languages! And he's a doctor!" There's nothing wrong with paired kidney exchange programs when there is oversight. The two biggest problems with these online programs are 1. they are not accessible to all and 2. they aren't accountable to anyone. The day people can advertise for a kidney donor is the day that money will exchange hands and the day that some people will be considered "not worthy" of an organ.

It's easy to say that people who won't donate shouldn't receive an organ. I have said it myself. Then a respected colleague and friend reminded me that putting restrictions on who can get a certain treatment could lead to restrictions for other illnesses. A person who had unsafe sex wouldn't get HIV treatment, for example. If nothing else, your insurance company would love to find some more reasons to deny your claims. Fat people receive treatment for heart blockages, smokers get help for their COPD and alcoholics sometimes get new livers. If you don't think that's fair, ask yourself if you've always gotten what you've deserved. I haven't, and that's a good thing.


sailorman said...

The AIDS example isn't accurate; it discusses refraining from an activity as opposed to participating in an activity.

I see it as being three categories of people, who should all get treated differently.

The first category are actual DONORS. I think that anyone who has voluntarily donated an organ or bone marrow to help another person should automatically get bumped to the top of the list. 1A category not withstanding.

That's not that big a deal, since there aren't all that many living donors out there who then need their own transplants. But it's eminently reasonable: if you are going to be a 100% buyer of the "organ donation is a public duty!" line then you should get the public benefit.

The second category are people like me: I'm a donor (in theory) but since I'm not dead yet and haven't voluntarily given up a kidney or a hunk of liver; and since I've never been called by the bone marrow registry folks; I've never donated.

I agree with you that this category shouldn't get any special treatment. After all, as you note it's not a yes/no split, it's a yes/don't know split.

The third category are actual recipients of organs. I think that it would be perfectly ethical to require all recipients to contract to donate at their death. This also makes sense: they're dead (so they don't care). The only people who would be "hurt" are their family members. And obviously, their family members would be much MORE hurt if they didn't get the transplant in the first place.

this third group is almost like "loaning" organs: it attempts to increase the return on folks who get something provided to them by public goodwill.

Anonymous said...

I've followed various threads on Free Republic re: Organ Donation, and many of the negative comments center around the fear that if the person agrees to donate, the doctor will end their life prematurely in order to harvest their organs, as well as other common misconceptions.

Their are others on that forum (Libertarians) who feel that donors should be allowed to sell their organs. The rationale is that by doing this, the free market would allow for a more abundant supply of organs.

(btw, I'm a Pediatric RN and am on the list for a kidney transplant due to PKD)

Richard Unplugged said...

Thanks so much for your blog and what you are doing. My wife of 24 years is in renal failure and needs a living type o kidney. No family members are a match for her and dialysis is not a good option b/c she has many vascular issues. She is on "the list" at the Univ of Michigan and doctors have advise her not to wait for a cadaveric kidney. Any advise anyone has on how to find a that special living donor who is willing to be tested is much appreciated.



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