Innovative Solutions to the Shortage of Transplant Organs

Millions of people suffer from kidney disease, but in 2007 there were just 64,606 kidney-transplant operations in the entire world.

Today in the WSJ I discuss innovative solutions to the worldwide shortage of transplant organs from places like  Iran, India, Singapore, Israel and elsewhere.  One interesting bit I haven't blogged about before is routine removal of organs without the donor's or their families consent.  China?  No.  America.  It's been legal here for decades.

In a number of U.S. states, medical examiners conducting autopsies may and do harvest corneas with little or no family notification. (By the time of autopsy, it is too late to harvest organs such as kidneys.) Few people know about routine removal statutes and perhaps because of this, these laws have effectively increased cornea transplants.

Here is another bit on the shadowy definition of death:

Organs can be taken from deceased donors only after they have been declared dead, but where is the line between life and death? Philosophers have been debating the dividing line between baldness and nonbaldness for over 2,000 years, so there is little hope that the dividing line between life and death will ever be agreed upon. Indeed, the great paradox of deceased donation is that we must draw the line between life and death precisely where we cannot be sure of the answer, because the line must lie where the donor is dead but the donor's organs are not.

In 1968 the Journal of the American Medical Association published its criteria for brain death. But reduced crime and better automobile safety have led to fewer potential brain-dead donors than in the past. Now, greater attention is being given to donation after cardiac death: no heart beat for two to five minutes (protocols differ) after the heart stops beating spontaneously. Both standards are controversial–the surgeon who performed the first heart transplant from a brain-dead donor in 1968 was threatened with prosecution, as have been some surgeons using donation after cardiac death. Despite the controversy, donation after cardiac death more than tripled between 2002 and 2006, when it accounted for about 8% of all deceased donors nationwide. In some regions, that figure is up to 20%.

More on markets for organs, presumed consent, and point systems at the WSJ,

Comments

Life was too short and it is getting shorter. For abortion not to be a crime, some people are willing to argue that life starts some time after birth. And for organ "donation" not to be a crime, some people are willing to argue that life ends some time before death. It's not because of new scientific knowledge. It's becasue there are too many lawyers.

So someone suffers from a car accident, and the estimated costs of getting him back on his feet are already approaching the government approved spending limits. Blood tests were done, and apparently the blood type is similair to the niece of 'important_senator'.

Welcome to mandatory organ donation.

Bravo Alex! I've blogged about your article over at www.cyclingprof.blogspot.com.

Best.

Dan

You might want to look at Thaler's book, Nudge, and the effectiveness of opt out systems for organ donation.

I know a lot of people who have come back from cardiac death. It frightens me that we can start harvesting right after cardiac death.

This is insane. Heck just a month ago one of my mother's friends had a hart attack in her kitchen and came back from not having a pulse for multiple minutes.

the more the line to harvest organs gets moved, the more i think about un-signing my donor card. i don't want to be declared dead after 2 minutes of heart stoppage, or to have a doctor have an incentive to give up on me sooner. I do a lot of boating, and it is not uncommon for hypothermia/near-drowning victims to come back after 10-20 minutes of heart stoppage due to the mammalian cold water-shutdown reflex. I only want to donate if i am clearly completely dead, if the doctor did try his hardest to keep me alive, and only for actual life saving organs, not for faces, hands, tendons for football players, etc.

in the end of course, the only solution is growing new ones, e.g. stem cell research, which has moral questions of its own but seems much less problematic than ever-changing definitions of death.

Mandatory donation is coming. Not signing or unsigning your organ donation card will eventually matter not.

The ultimate estate tax.

I linked to Alex Tabarrok's article earlier on my blog and I created a follow up post with some links to other articles, media, and policy analysis on the subject of market solutions to organ shortages.

Figured I would share the information.

_____

Follow me on Twitter @LibVoluntaryist or on my blog, LibertarianVoluntaryist.com

How about organ donation is a sort of opt out type clause instead of opt in? If you opt out you will not receive an organ for the registry. It's ridiculous that somebody refuses to give their organs up, but demands that somebody else does for their own life.

Presumed consent is common in Europe and appears to raise donation rates modestly, especially when combined, as it is in Spain, with readily available transplant coordinators, trained organ-procurement specialists, round-the-clock laboratory facilities and other investments in transplant infrastructure.

The combination of de jure presumed consent laws together with de facto next-of-kin veto is common in Europe. Only Austria and (to a lesser extent) Belgium have true presumed consent, with no kin veto. In the most successful countries (Spain, Italy) investment in infrastructure, staffing and logistics is responsible for high procurement rates. The legal presumption of consent acts at best as a kind of general public policy signal about the preferences one ought to have, rather than a direct mechanism for procurement.

I assume that only through science uncertainty may decrease, although in this particular case it's taking a lot of time, much longer than anyone can infer from reading scientific journals (by long I mean decades).

I only want to donate if i am clearly completely dead, if the doctor did try his hardest to keep me alive, and only for actual life saving organs, not for faces, hands, tendons for football players, etc.

Nice article,I only want to donate if i am clearly completely dead, if the doctor did try his hardest to keep me alive, and only for actual life saving organs, not for faces, hands, tendons for football players, etc.

Greater attention is being given to donation after cardiac death: no heart beat for two to five minutes (protocols differ) after the heart stops beating spontaneously. Both standards are controversial—the surgeon who performed the first heart transplant from a brain-dead donor in 1968 was threatened with prosecution, as have been some surgeons using donation after cardiac death.

I see nothing but win-win all around. This is really no different from people selling their plasma. Regulating it will protect both the donor and the receiver.
I have heard of some really heinous stories on the rich sheiks from the middle east countries going to countries like India & Philippines where they buy organs from the very poor folks. I call it heinous because the amount that reaches the donor after all the hefty brokerage costs is pittance. If it is regulated, then the black market organ trading will be eliminated.
I have also heard about unscrupulous practices where they remove organs from unsuspecting patients during some other simple procedures. In all these situations, it is the poor & uneducated that are always the victims and thanks for this post

According to a new survey by Donate Life America 43 percent of people are undecided, reluctant or do not wish to have their organs and tissue donated after their deaths. Is this because Americans don't know there is an organ shortage? No. The survey also reports that 78 percent realize there are more people who need organ transplants in the U.S. than the number of donated organs available.

Organs can be taken from deceased donors only after they have been declared dead.

It's been legal here for decades...It's not because of new scientific knowledge. It's becasue there are too many lawyers.

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