Some Bad Ideas That Won’t Help Solve the Organ Shortage

In “The Solvable Problem of Organ Shortages” [New York Times, 8/28/07], Jane Brody makes suggestions which, if implemented, will rob Americans of fundamental rights and do nothing to solve the organ shortage. Her suggestions may even make the problem worse.

The organ shortage can only be solved by increasing, not decreasing, the control people have over the disposition of their organs. Only an increase in liberty, not a restriction of liberty, has any chance of solving the organ shortage. New and innovative ways to motivate individuals to donate, including the option of compensation for donation both in the case of deceased and live organ donation, are what we need, not new ways to take organs without people’s consent.

One option Brody discusses is donation after cardiac arrest. There is nothing wrong, in principle, with retrieving organs after cardiac arrest, but what defines death and when to give up on a patient are not decisions that should be motivated by a need for organs. It is never appropriate for a doctor to alter how he treats one patient in order to provide an organ to save another patient. Just last month, a San Francisco transplant surgeon was charged with three felonies for allegedly hastening the death of a patient in an attempt to harvest his organs.

A policy of donation after cardiac arrest will drastically erode an already waning trust in the medical profession. Such a policy is likely to result in a backlash both against the medical profession in general and organ donation in particular. People will see such a policy as encouraging doctors to give up on patients when in fact there might still be some hope of improving their condition, just in order to harvest their organs. The net result will be a decrease, not an increase, in organs available for transplant.

The other major option discussed by Brody is presumed consent. Presumed consent is no consent at all, it is taking organs without asking unless an individual knows enough to follow the government’s predetermined method for objecting.

 Brody writes: “In Europe, where you are considered a potential donor unless you expressly declare[s] that you do not want to be one, more than 90 percent of people are organ donors.” Americans, unlike Europeans, will not give up their right to self-determination so easily. There will be an outcry both on religious grounds and from those who believe in patient autonomy. Americans will demand to be asked, let alone the question of whether such a law would even be constitutional.

Now these proposals, as great an affront to human dignity as they are, could perhaps have some utilitarian appeal if they had the slightest chance of solving the organ shortage, as Brody’s title suggests. Donation after cardiac arrest and presumed consent, even if implemented simultaneously and without the predicted backlash, would do very little to solve the organ shortage.

If every single American were an organ donor, the U.S. implemented universal organ harvesting after cardiac arrest, and adopted European style presumed consent, there would still be people dying on the transplant list waiting for organs that never come. This would be so because of the simple fact that not enough Americans die each year under conditions that make harvesting their organs for transplantation feasible. Estimates very greatly, but there is no doubt that even if every death that could possibly result in a donation resulted in the maximum number of harvestable organs, we would still not have enough organs for everyone that needs one.

The real solution is to find new ways to ask and motivate Americans to donate, not to take their organs earlier than they may wish and/or to take them without asking. First, abolish the National Organ Transplant Act of 1984’s prohibition on compensating people for their organs, and be creative in putting together incentive packages to encourage people to donate. Offer them life-time health insurance, seed money for health-care savings accounts, long-term care insurance, scholarship money to send their kids to college, a combination of these or any number of other creative ways to encourage people to donate. Along with these incentives, there should be an effort to increase people’s trust in their healthcare professionals by promising Americans that they will always be asked – And that their organs will never be taken without their consent!

 Furthermore, efforts must be made to assure that informed consent is a real and effective tool for assuring that people know what they are agreeing to, whether they are agreeing to donate their organs at death or to a live-kidney or liver donation (the two types of live donation that can currently be done relatively safely).

Only if these measures are taken to increase options, not limit them, is there any chance that the organ shortage can be solved. Hopefully, unlike this week’s article, Brody’s column on live organ donation, promised for next week, will offer some more realistic and liberty-friendly solutions.