Scientific American June 2003 [antikvár]

^ SA Perspectives A Pound of Flesh In 2001 more than 6,000 people in the U.S. died while waiting for an organ transplant. The dire shortfall of organs compared with patient demand is growing as the population ages and more people experience organ failure. Although new immunosuppressive drugs have helped bridge the gap by allowing surgeons to transplant an organ that is a less than perfect match, there just aren't enough organs to go around. The reasons vary. Some people have religious or cultural objecrions to organ donation; many families simply have a tough time making a decision at a time of personal tragedy. Living donors—those who volunteer a kidney or parts of their liver or lungs—are understandably reluctant: they must undergo potentially life-threatening surgery and put their own future health at risk. The organ shortage has led various policymakers to propose radical steps. Several programs under consideration in the U.S. and elsewhere provide financial incentives to living donors or to the families of deceased donors. One approach, which has been instituted in Pennsylvania and is supported by the American Society of Transplant Surgeons, offers families who donate a loved one's organs $300 in food and lodging expenses. Editorials in medical journals advocating the program assert that the amount of money is intentionally small to "express appreciation" for the donation but not to serve as a payment. It is akin to the token coffee mug or umbrella one receives after donating to public radio or television. Evidence that such programs will boost the organ supply is lacking, largely because of a paucity of studies. More important, some worry that these programs would mark the first step in encouraging an inhu- mane and subtly coercive market for spare body parts. Although the outright purchase of organs is illegal in nearly every country in the world, a number have black markets for living-donor organs, and the results have been chilling. A study of 305 living kidney donors in Chennai, India, found that 96 percent sold a kidney to pay off debts, receiving about $1,070 apiece. But three fourths of the respondents soon faced debt and penury once again, and 79 percent would not recommend organ selling to others. Permitting trade in organs has already led to the exploitation of the poor. This is an extreme example, but it illustrates the danger of attaching monetary value to whole organs. Society should redouble its support of less drastic steps to encourage families and to reduce the dangers to living donors. A host of bills now in Congress would create a "medal of honor" for donors, offer medical leave for living donors, or establish life and disability insurance for living donors in case they experienced negative side effects. These initiatives could be paired with expanded public education campaigns that would explain the need for organ donation and demystify the process. Physicians and hospital personnel also require more training in encouraging organ donation. Many European countries either have implemented or are experimenting with "opt-out" laws, whereby the deceased is presumed to have consented to an organ donation unless he or she indicated otherwise. (Family members still have the final say.) These laws raise their own questions, but they bear watching. Studies have shown that more than 95 percent of families would consent to organ donation if they knew it was the wish of their loved one. Appealing to people's better natures may not be the only way to raise the number of organs available for transplantation, but it is the best place to start. THE [email protected]