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Summer 2006 Vol. 6 No. 2

Table of Contents

©Timothy John/ The Gift
of Life

Motivating More Americans to Become Organ Donors

Every year, thousands of terminally ill patients are given a new lease on life thanks to donated organs. Yet, the need for these vital organs far exceeds the current pace of donation. Just over 28,000 organs were donated in the United States last year; more than 90,000 people started 2006 waiting for a transplant.

The expanding gap between supply and demand has generated several proposals for increasing the number of organ donations. Some suggest that hospitals presume everyone is a willing donor unless they explicitly opt out or their next of kin do so on their behalf. Others say that the situation warrants experimenting with financial incentives, such as cash payments to donors or contributions to the charity of the donor's or family's choice. Or, people who carry donor cards could be moved to the top of waiting lists for organs if they ever need a transplant.

The best ways to boost organ donation in America are to strengthen efforts to educate the public about the benefits of donation, expand opportunities for people to record their decisions to become donors, and continue to enhance donation systems, said a committee convened by the Institute of Medicine to evaluate the various proposals. The committee also supported initiatives to increase donations from people whose deaths are the result of irreversible loss of heart function, adding to the pool of potential donors whose deaths are determined by permanent loss of essential brain functions.

However, given the amount of apathy, reluctance, and even apprehension about organ donation among a significant proportion of the American public, the United States is not yet ready to enact policies that presume consent to donate or mandate that people record a choice, the committee determined. Nor should financial incentives be used, even on a trial basis.


"Evidence shows that raising awareness about the benefits of donation and improving the way health care providers and administrators interact with potential donors and their families can increase willingness to donate," said James F. Childress, chair of the committee. Without greater awareness and acceptance of organ donation among Americans, more radical reforms "could backfire," he noted.

Individuals who have declared their willingness to be organ donors should not be given preferential status as recipients, the report adds. Inequities in access to health care, information about organ donation, and opportunities to sign up as donors led the committee to conclude that this approach should not be adopted. Moreover, everyone has an equal stake: The fact that we are all potential organ recipients as well as potential donors can be a powerful motivator to donate, Childress added.

The report also addressed donation by living individuals, which reduces recipients' waiting times and, in some cases, improves the chances for a successful transplant outcome. However, these operations place otherwise healthy people at risk, and government oversight of the living donation process is limited. To ensure that everyone's decision to donate is fully informed and voluntary, hospitals should provide an independent advocacy team to each person who volunteers to be a living donor, the report says. The committee recommended further scrutiny of the process and additional assessments of living donors' risks.
  -- Christine Stencel

Organ Donation: Opportunities for Action. Committee on Increasing Rates of Organ Donation, Board on Health Sciences Policy, Institute of Medicine (2006, approx. 390 pp.; ISBN 0-309-10114-X; available from the National Academies Press, tel. 1-800-624-6242; $55.00 plus $4.50 shipping for single copies).

The committee was chaired by James F. Childress, professor of ethics and medical education, and director, Institute for Practical Ethics and Public Life, University of Virginia, Charlottesville. The study was funded by the U.S. Department of Health and Human Services and the Greenwall Foundation.

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Copyright 2006 by the National Academy of Sciences