Discussion on Organ Donation Shortage

Mass Com – TR 10:30
Term Paper

Have A Heart

Medicine has evolved since the days of bloodletting, but from the perspective of a waiting recipient on the organ donor list, we still live in the dark ages. With a list of 110,941 hopeful candidates for organ transplant, the status of organ donation as a taboo subject in the Intensive Care Unit (ICU) has left an average of 20 people dead each day.(1) The high demand and low supply has led to creative solutions from both medical and government sectors, but what’s the answer? Is government intervention necessary, or should the fed keep their laws off my liver?

While the fourth annual National Donor Designation Report Card prepared by Donate Life America shows 94.7 million people were enrolled in state donor registries at the end of 2010,(2) it still doesn’t address the need that exists today.

The shortage of organ donors in the U.S. is a problem. There are many factors that lie behind the reasons for shortage. From socioeconomic and demographic factors to religious beliefs, candidates just aren’t surfacing like they could.(3)

“All the doctors and nurses I know are donors,” says Dr. Joshua Gitter, a practicing M.D. at John Muir Medical Center in Walnut Creek, California. “We can’t be the only ones providing organs here, ya know? The general public needs to step up.”

The reason organs are in chronically short supply is partly due to the U.S. policy that requires voluntary giving. Dr. Gitter says most organs for transplant come from accident victims, who become brain dead after serious head injuries. These victims are typically put on life-support, and the next of kin 's consent is required to turn off the machine and donate the organs.

Dr. Gitter says there are usually good chances of receiving donations from the families of accident victims, but each case changes on a family by family basis.
Studies have shown the chances of donation from families who had prior knowledge of the patients’ wishes regarding donation have a higher rate of donation from the ICU,(4) but how often does mortality come up in a healthy conversation with family?

Craig Gammel, a San Jose resident says he never had a conversation with his family members on the topic of organ donation, so when his father suffered a brain aneurism in the summer of 2009, Mr. Gammel possessed no pre determined ideas of donating his fathers organs during his drive to the ICU where his father waited in a coma.

“You’re never ready for a call like that.” Says Mr. Gammel, reflecting on the day he got the call about his father’s aneurism. “We didn’t wait long before the doctors confirmed my father was brain dead.” Craig made the decision to take his father off life support after hearing the news, and agreed to donate his fathers hazel eyes to a waiting recipient.

When the nurse initially approached Mr. Gammel with the request for eye donation, she did so in a tentative and reserved manner. Craig says he appreciated the way the topic was introduced, and grateful for the opportunity to assist another person in need.

“Of course I wanted his death to at least help someone.” He said. “The old man would have wanted the same, I think.” Craig says he wouldn’t have thought about organ donation at the time if the nurse hadn’t asked him.

Since organ transplant candidates cannot rely solely on these cases, the concept of mandated choice was proposed by the American Medical Association in 1994.(5) Mandated choice would make it so people are required by law to state in advance whether or not they will be an organ donor.

The American Medical Association 's Council on Ethical and Judicial Affairs supports mandated choice. In a 1994 report, the council said: “Requiring a decision regarding donation would overcome a major obstacle to organ donation - the reluctance of individuals to contemplate their own deaths and the disposition of their bodies.”(6)

“Frankly, I’m shocked that people need the government to tell them plan for their mortality. I wouldn’t want to be brain dead and have my family refuse organ donation because I never told them I wanted to donate. It’s tantamount to being buried with your money. Donate it for Christ sakes.” Concluded Craig.

However, everyone does not share this belief of Craig’s.

“I would never allow my daughters body to be chopped up and shared like a joint at a doobie brothers concert.” Said Santa Barbara resident David Martin when asked if he would donate the organs of a family member in the unlikely event of their sudden or accidental death.

David’s cited his strict belief in Christian Science as support. His decision to abstain from all medical practices and remedies is a cornerstone in the religion, making the concept of organ donation implausible. While David’s beliefs are of a minority opinion, it still reflects a refusal to donate healthy organs to dying people.

With factors influencing donation ranging from family or patient attitudes and beliefs to deaths from trauma being the decision factors, it’s hard to come up with a method for determining the right time to approach a family.

“We have been trained to approach the subject with as much care and tact as possible.” Says Hillary Gitter, a practicing nurse at John Muir Medical Center. “You’d be surprised how many people are open to the request if you approach them at the right time and in the right tone.”

Because Hillary interacts with patients that are waiting for organ transplants, she firmly believes the need trumps any social awkwardness that arises when asking for organ donations.

“How would you look someone in the eyes and say their chance of finding a donor is slim to none? You’ve sealed their fate and dashed all hope with that fact, so you do what you can to help people get donors. I think even false hope is better than a death sentence.” Said Hilary.

Bibliography

1) Organ Procurement and Transplantation Network, May 6, 2011 http://optn.transplant.hrsa.gov/latestData/rptData.asp 2) National Donor Designation Report Card - 2011, http://donatelife.net/wp-content/uploads/2011/04/DLA-Report-BKLT-30733-2.pdf

3) Ebony L. Boulware, “Understanding Disparities in Donor Behavior: Race and Gender Differences in Willingness to Donate Blood and Cadaveric Organs,” Medical Care, February 2002, pp. 85-95.

4) Council on Ethical and Judicial Affairs, “Strategies for Cadaveric Organ Procurement,” The Journal of the American Medical Association, Sept. 14, 1994, p. 809.

5) Council on Ethical and Judicial Affairs, “Strategies for Cadaveric Organ Procurement: Mandated Choice and Presumed Consent,” Report 2 – I-93, Sept. 1994.

6) Arthur L. Caplan, “Current Ethical Issues in Organ Procurement and Transplantation,” The Journal of the American Medical Association, Dec. 7, 1994, p. 1708.

Bibliography: 1) Organ Procurement and Transplantation Network, May 6, 2011 http://optn.transplant.hrsa.gov/latestData/rptData.asp 2) National Donor Designation Report Card - 2011, http://donatelife.net/wp-content/uploads/2011/04/DLA-Report-BKLT-30733-2.pdf 3) Ebony L. Boulware, “Understanding Disparities in Donor Behavior: Race and Gender Differences in Willingness to Donate Blood and Cadaveric Organs,” Medical Care, February 2002, pp. 85-95. 4) Council on Ethical and Judicial Affairs, “Strategies for Cadaveric Organ Procurement,” The Journal of the American Medical Association, Sept. 14, 1994, p. 809. 5) Council on Ethical and Judicial Affairs, “Strategies for Cadaveric Organ Procurement: Mandated Choice and Presumed Consent,” Report 2 – I-93, Sept. 1994. 6) Arthur L. Caplan, “Current Ethical Issues in Organ Procurement and Transplantation,” The Journal of the American Medical Association, Dec. 7, 1994, p. 1708.