The critical shortage of organs available for life saving medical procedures is one that governments around the world are tackling in their own imaginative ways, but with varied degrees of success and a fair amount of criticism.
In the UK, 2014/15 saw more than 4400 people have their lives saved or improved by an organ transplant, yet the same year also saw the first drop in registration of organ donors in a decade. This called for everyone in the UK to discuss organ donation in a new light.
One of the debates to arise, was whether those registered as organ donors, should be given priority if ever they found themselves on the recipient waiting list. Under the current system in the UK, being unwilling to contribute does not lessen your chances of receiving a transplant. Something now termed as ‘free riding’.
Should those who are willing to be donors receive priority in the receipt of organs? Such an approach has been adopted in the US, Singapore and Israel.
It might be argued that this would unfairly penalise those who object to donation on the grounds of religion. However, if the incentive structure worked to increase the supply of organs, then even those who objected may have a better chance of receiving an organ should they need one. Could this not work for all?
It’s a little bit like insurance, if you pay the premium, you can receive the benefit.
exploring the OPTIONS
It is estimated that 18 patients on the waiting list in America die every day. The United States, as in many countries, relies on a simple system of altruism, or what might be called the opt-in approach. They hope that enough people will register as organ donors because they think it is the right thing to do. But this system is not resulting in nearly enough organs for all the patients who need them.
Other countries, like Spain, Wales and Austria, have tried an opt-out approach, or presumed consent. Every patient who dies is assumed to have consented to organ donation, unless they have specifically said otherwise. Problem is this hasn’t necessarily increased the number of organ donations, in part because often families oppose the donation at the time of death.
HOW SPAIN leads the way
Transplants are a matter of statistics, says Rafael Matesanz, the director of Spain’s National Transplant Organisation (ONT), and man behind the numbers that have Spain as the undisputed world leader in donations and life-saving operations.
Spain’s transplant law presumes consent unless otherwise stated, although families do always have the final say here too.
“Spain has not been a leader in surgery or research; we have hardly chalked up any firsts in transplant operations. What we have brought to this area is organisation. Following a philosophy that states that donors do not simply fall from the heavens, we have provided organisation and professionalisation.”
Part of the success is that the ONT is part of Spain’s Health Ministry, keeping the importance of private hospitals in transplant surgery to a minimal. Matesanz also implemented the role of intensive care specialists as transplant coordinators in each hospital. These 16000 specialist trained health workers are aware of the opportunities to gain donors and follow the right protocols to protect organs and tissues.
Could implementing these organisational and procedural changes make significant improvements to the organ donor rates in other countries?
israel’s APPROACH TO ORGAN DONATION
There is also the model pioneered by Israel who were until recently ranked at the bottom of Western countries on organ donation. Jewish law prohibits desecration of the dead, which has been interpreted to mean that Judaism prohibits organ donation. As a result, many patients died waiting for organs.
Until Israel decided to try a new system that would give transplant priority to patients who have agreed to donate their organs. In doing so, it has become the first country in the world to incorporate non medical criteria into the priority system, although medical necessity would still be the first priority.
The unfairness of a segment of society unwilling to donate organs, but happy to accept them, is what drove Dr. Jacob Lavee, a cardio-thoracic surgeon who heads the heart transplant program of Sheba Medical Center in Tel Hashomer, to bring about the policy. This was accompanied by a huge public awareness campaign about organ donation, with extensive media support and distribution of organ donation information. The response was overwhelming, as people registered as potential donors.
The consent rate from families as well as the number of organs available for patients increased, leading to 60 percent more transplants in the last year.
Will these solutions work elsewhere?
Now the question arises, will these methods work in other countries or are they successful only within a certain context? Nations around the world are evaluating the options as they try to address the chronic shortage of organs, but can we copy and paste solutions from one country onto another?
How would you feel about these changes? Do you think it’s unfair to force people to ‘opt out’? Do you think it’s unfair to take an organ if you don’t plan to ever donate one? Are there other solutions to this problem? Why do you think people might not want to donate their organs?