Washington. -- The trouble with the organ-transplant system is that it is based on altruism in a greedy and squeamish country -- a formidable combination when it comes to obtaining permission to extract hearts, lungs and kidneys of dead next-of-kin. As a result, organs from an estimated 10,000 suitable corpses go unused. Meanwhile, about 40,000 people are on waiting lists for hearts and livers at any one time, and a third of them eventually die for lack of organs.
The number of needless deaths will inevitably increase as transplant techniques become more sophisticated and applicable to patients now considered too ill for the rigors of the procedure. But, with present methods, the number of organs is not expected to keep pace. There must be a better way.
About the squeamishness, little can be done, especially since the most promising sources of organs are healthy people who die unexpectedly, usually in traffic accidents. If their driver's license contains a donor option and they haven't checked it -- intentionally or neglectfully, as is the case with many -- the choice usually falls to soliciting their organs from shocked, grieving relatives.
Medicare and half the states require hospitals to discuss donation with relatives of suitable candidates. But a recent study found that agreement was obtained from fewer than half of those who were approached in such difficult circumstances.
According to a recent report in the New York Times, the reasons seem to vary, from religious compunctions to reverence for the bodily remains of a dear one. Another factor cited was fear that the organ potential might have a negative influence on life-saving medical care.
Whatever the reasons, the present system of appealing and cajoling is not producing the needed organs. And it is not likely to become more productive with the passage of time and increased public familiarity, as was the case with voluntary whole-blood donations. Giving one's own blood makes people feel good, while signing away one's own organs or those of a dead or dying relative is a spooky business.
Sales of organs are forbidden by federal law, and properly so, given the animosity that would arise from precious, life-saving organs going to the highest bidders.
Under the present system, allocation is supposed to be solely on the basis of medical criteria. But dark suspicions instantly arise whenever a celebrity receives a transplant. No matter what the doctors say about the purity of Mickey Mantle's almost instant rendezvous with a desperately needed liver, grave doubts persist among many members of the public. The real issue isn't fairness. It's supply.
Various proposals have been made in recent years for the delicate introduction of economic factors into organ donation. It has been suggested, for example, that the shock of the request for a relative's organs might be tempered by a modest financial contribution toward hospital and funeral costs. That approach may strike some as grisly, and it might not be fruitful. But the present approach is not filling the need.
Another possibility for expanding the pool of donors focuses on influencing more people to check that box on their driver's license. Of questionable value is the idea of pushing people toward becoming donors by legislatively declaring that they are willing unless they state otherwise. Though the method may work, it possesses a distasteful element of coercion, if not deception. A better approach might be a reduction in licensing fees, and perhaps in auto insurance, for those who sign up as donors.
The great barrier to increased donations is an unwillingness to think about dying and being dismembered. It's as basic as that, though the public dialog on the organ shortage prefers to avoid direct confrontation with such gory matters. Further compounding the difficulties is a veneration of altruism -- which is a wonderful quality, deserving of all encouragement. Except it doesn't seem to work in this case.
All else failing, perhaps a bit of monetary inducement might make the difference for some of those many thousands whose lives could be saved.
Daniel S. Greenberg publishes the newsletter Science & Government Report.