January 22, 2001

6:03 AM

organ transplant needsOnly the extreme of religious people might object to organ transplants, but what do we do with an increasing need and insufficient donors?
posted by Postroad (33 comments total)

Assuming that organ donation wasn't a problem, the demand for organs would probably still exceed the supply. I can see only one potential solution to this problem...organ cloning.
posted by saturn5 at 6:46 AM on January 22, 2001

A (somewhat) more free market -- large parts of the world are decades away from having the economic and scientific capability to offer organ transplantation and post-transplant medical support as a routine medical procedure to most of their people.

In these countries, hundreds of thousands, if not millions, of people die every year in circumstances under which they are eligible to donate organs. However, laws both there and here either directly prohibit the export / import of organs or indirectly prohibit it through the imposition of financial controls.

Admittedly there is a distasteful character in having an "American Organ Harvesting Clinic" which extracts organs from the corpses of poor foreigners and brings them to the US to implant in sufferers from diseases of which poor people in the source country suffer without any hope of succor ... but, ultimately, should we allow the perfect (everyone everywhere having all possible medical access) to be the enemy of the good (Americans surviving who otherwise die, and the families of poor foreigners who were already dead gaining massive payments in local terms which could replace their lost loved one's earnings as well as possibly propel them from poverty)?
posted by MattD at 6:58 AM on January 22, 2001

Don't allow anyone to be an organ recipient without signing an organ donor card.

Seems simple enough to me. I'd allow people to change their minds, but if you decide you want to receive an organ, you immediately become an organ donor, but you have to wait (say) 10 years to get on organ recipient lists. And vice versa -- if you decide you no longer want to be an organ donor/potential recipient, you immediately lose your right to receive an organ, but you have to wait (say) 10 years to get off of the organ donor list. And these rules would have to supercede any instructions/wishes of the next of kin.

The free market solution only works for a kidney, which is its major downside. But I'd (personally) be willing to consider implementing that as well if the solution above failed to garner enough kidneys.
posted by UrineSoakedRube at 7:14 AM on January 22, 2001

I'm a donor, but the years of booze and smokes have probably taken their toll. I imagine my innards would be put to better use as photo fodder for some kind of "what not to do with your life" brochure.

One look at my liver would probably be enough to scare Keith Richards off the sauce and turn Robert Downey, jr. into a Jehovah's Witness.
posted by Optamystic at 7:28 AM on January 22, 2001

I don't think it's a religious issue so much as it's an issue of still being alive when they're removing the organs for transplant.

I grew up with my mother telling me that if you're a donor, they barely wait until you're dead before they take your organs, keeping them the freshest possible for transplant. It scared me enough to never donate!! Of course, I live in Canada, where doctors are not near as trigger-happy to pull the plug
posted by jpate at 7:33 AM on January 22, 2001

Start
cloning
organs.
posted by thirteen at 7:46 AM on January 22, 2001

Hello. Uhh, can we have your liver?
posted by Aaaugh! at 7:58 AM on January 22, 2001

Why are we NOT already cloning organs? Is the technology there? Because if we CAN conceivably build some kind of Kidney Farm, and we're NOT doing it, we'd better have a damn good reason.
posted by Optamystic at 8:19 AM on January 22, 2001

We haven't even cloned a whole human yet, let alone a part of them.
posted by kindall at 8:22 AM on January 22, 2001

I think the idea of importing organs from poor countries to rich countries is morally contemptible. While it might save some lives in rich countries, all the other effects of such a policy are horrible. Thirteen is right; this is a problem which requires a technological solution, and patience until one is developed.
posted by Steven Den Beste at 8:22 AM on January 22, 2001

So the other day I woke up in a bathtub full of ice..
posted by zempf at 8:29 AM on January 22, 2001

"I grew up with my mother telling me that if you're a donor, they barely wait until you're dead before they take your organs, keeping them the freshest possible for transplant. It scared me enough to never donate!! Of course, I live in Canada, where doctors are not near as trigger-happy to pull the plug"

i was reading that, thinking: hey, that sounds just like what my mother told me. and then i saw the poster. he's my brother.

i love the internet age.
posted by will at 8:48 AM on January 22, 2001

What's this? Selling organs? I'll put mine up on EBAY now.....asking price $1,000,000. The internet auction site will make me rich for just donating an extra organ or two. Heck, I'll just start having sex with as many people as possible and sell my future kids organs. You wait your two or three years, just sign over the money. You might see some twisted people who actually would do something such as organ farming. For me, I feel sorry you must be on the waiting list, but just as Walter Payton needed help and not much could be done to save him, I for one wouldn't like to see this happen. Cloning only spells more trouble.
posted by brent at 8:49 AM on January 22, 2001

We haven't even cloned a whole human yet, let alone a part of them

I know that we (ostensibly) have yet to clone a whole person. But I seem to recall reading about efforts to grow organs independant of a human body. Then again, maybe I've just seen one too many cheesy science fiction movies.
posted by Optamystic at 8:54 AM on January 22, 2001

Steven, which effects are morally contemptible? This solution = more people live, more people prosper, all around the world. Not one person is made worse off, and many people are made better. A moral conception or a political structure which can deem this "immoral" is one which is fatally detached from the real world.

Donors are already dead. The things which kill them (car accidents, etc.) are completely not affected by the process.

The monies transferred benefit the families of the dead, who would otherwise have nothing. Do you really think that people are going to start killing members of their own families to get the organ price? Not too likely...

One thing it does is draws attention to who is rich and who is poor, and unveiling the truth is certainly never morally wrong. Maybe will cause the governments of poor countries to do something about the apalling state of their healthcare infrastructure which makes the vast majority of their sick ineligible or incapable of receiving transplants.

Perhaps there could be a creative middle ground: 50% of the net monies paid would be diverted into local healthcare improvements rather than paid to the bereaved families. Or maybe even some kind of "life tax" -- 10% of the marginal income of the recipient of the organ is to be paid into the source-countries national health fund in perpetuity.

If one worries about endemic corruption in the third world (as well one should) the "life tax" or 50% healthcare share could be directly paid to an NGO which would build transplantation and recovery suites in third-world hospitals and purchase anti-rejection medications and provide facilities for on-going outpatient monitoring during the post-transplant period.
posted by MattD at 9:01 AM on January 22, 2001

MattD, you're essentially creating a new trade in organs for transplanbtation yes? Children's and especially infant's organs are the most difficult to obtain, so following market forces, they would attract a higher price and be the most profitable commodities on this new market.
Who polices where the organ comes from? How do we know how the donor died, it's a morbid thought, but what's to stop baby-farming or similar?
Even if we don't take it to that extreme, what a descision for a subsistence farmer to make - my child could get medicine which will cost me money I scarcely have or I could let nature take it's course and feed the rest of my family for the next 10 years.
Like Steven says, whichever way you look at it it's morally conteptible and not in any small way arrogant.
posted by Markb at 9:20 AM on January 22, 2001

Matt, it's not certain that the donors will really actually be dead, or even that they'll have suffered any injury. What's to stop someone in the third world from going out and kidnapping someone young and healthy looking, killing them for their organs and faking the records, and then selling them? If there's a lucrative market for organs, unscrupulous people will find horrible ways to fill the demand. There are a lot of people out there who don't mind harming those around them -- just look at the cocaine trade.

Skin has been cloned already. There's also advanced progress in synthetically growing livers. Significant progress has been made in cloning the Isles of Langerhans (the parts of the pancreas which makes insulin). Other things are not as far advanced but progress is being made.

Kindall, things have gone a lot further than you think. The big problem has been life support; once the nascent organ reaches a certain size it's difficult to keep it alive outside the body. The solution to that is interesting: it gets transplanted early so it can hook into the patient's blood supply, which nourishes it as it continues to grow. But it's not otherwise plumbed into the body; temporarily it's a parasite. Once it reaches full size, the idea is to do a second operation and really hook it up right.

Things have moved a long way; they may begin clinical trials as early as ten years from now. Synthetic skin has already passed clinical trials and is now used for treatment of burns.
posted by Steven Den Beste at 9:58 AM on January 22, 2001

Markb, I could not agree with you more.

MattD wrote: "The monies transferred benefit the families of the dead, who would otherwise have nothing. Do you really think that people are going to start killing members of their own families to get the organ price? Not too likely..."

Not too likely? How about, EXTREMELY LIKELY. Selling children into slavery and prostitution, to help with family finances, is a common practice in many developing countries. If one can do that to their own flesh & blood, what makes you think that people won't murder a complete stranger for the organ bounty? MattD, you just don't see the long-term implications and consequences of your solution.
posted by saturn5 at 10:01 AM on January 22, 2001

Seeking compromise:

If the motivation for profit-by-murder is presumed to be the payoff, how about a worldwide donation program, with no compensation for the donors (similar to what exists in the U.S.)? Hospitals worldwide could qualify as recipients, receive quotas based upon demonstrated need, and redistribute to their patients requiring transplantation. The program could be funded by monetary donation and a cut of what each patient or their insurance pays for the organ received.

It seems silly to let such a valuable resource rot in the ground. I'm all for cloning organs, but until that's feasible, this might be a temporary stopgap.
posted by rushmc at 11:46 AM on January 22, 2001

Cabbage Patch Kidneys!
posted by sonofsamiam at 12:41 PM on January 22, 2001

As my best friend's mother lay dying in a local ER, from a condition that could only be solved by a new heart, she sat in the waiting room and watched a woman refuse permission to take the organs of her son who had massive, irreversible brainstem trauma after a donorcycle accident. Her son was in his late twenties, and not only had a donor sticker on his driver's license sticker but carried a signed organ donor card in his wallet. The man was willing, but his mother's ridiculous selfishness (I want my baby's body intact, weep moan, blah blah) sent all of his organs to rot.

Since that time, I have taken every possible opportunity to lobby for a change in US law and policy which makes organ donation the standard; instead of the current scheme wherein people must choose to become donors, I'd like to see a phase-in of a system in which those with some objection would have to opt out. In addition, grief-stricken next of kin would no longer have the right to override the donation decisions made by an adult. I've yet to hear any rational objection to the idea, save the "people own their own bodies" claim which doesn't really apply once you're dead.
posted by Dreama at 1:28 PM on January 22, 2001

I didn't know your family could override your organ-donor intentionage. That's ridiculous. If you were maybe gonna keep 'em or something, but they're just burying 'em? And they do so much to a corpse to embalm it anyway, what's the difference if it's missing a lung?
posted by sonofsamiam at 1:41 PM on January 22, 2001

In the 23 states which have adopted the Uniform Anatomical Gift Code, the relatives could not impair a validly stated gift:

"[a]ny signed statement that is in compliance with this chapter, or a driver's license or identification card that meets the requirements for validity set forth ... shall be honored and no further consent or approval from the next of kin or other person ... shall be required."

However, doctors are frequently reluctant to utilize the powers it vests in them to extract organs from dead bodies over the objections of weeping survivors.



posted by MattD at 2:27 PM on January 22, 2001

Great suggestion, MattD.

Actually, the free market system you are proposing is already in existence and its being run by organized crime.

Hell, Third World people are a good source because they're going to die young anyway. It'll be helping their economies.

Just think: Human...Abattoir...Industry!.

posted by lagado at 3:02 PM on January 22, 2001

rube, you can't have a rule that says everyone who is allowed to be an organ recipient must also be an organ donor. a lot of the people who need organs simply can't give them away, because of disease or whatever other problem lead them to be on the waiting list in the first place.
posted by rabi at 3:03 PM on January 22, 2001

The miracles resulting from transplantation are only possible with a supply of organs. Surgeons are extremely careful to make sure they don't give anyone just cause to make a stink. The nightmare scenario is that they take organs from someone, and their relatives then do the talk-show circuit stirring up trouble, leading to more restrictive legislation, possibly cutting way back on the supply of organs.

It's still a procedure fraught with political peril, and the doctors know it. There are a whole lot of people who'd probably be willing to be a receiver of a transplant when faced with that or death, who nonetheless are morally opposed to themselves or anyone they know being an organ donor.
posted by Steven Den Beste at 3:21 PM on January 22, 2001

I can't find the link right now (anyone?), but I recently read an article that claimed that much of what is used from organ donors goes for cosmetic procedures: collagen for lips, skin for cosmetic surgery, and the like.

I don't like that. I wish I could sign a card that said "use any organ for a life-saving procedure" or better still:

"use any organ for a life-saving procedure; other organs to be paid for by donee, with proceeds going to a fund to provide emergency transplants for those who cannot afford to pay."

rcb
posted by rebeccablood at 3:59 PM on January 22, 2001

I can't find the link right now (anyone?), but I recently read an article that claimed that much of what is used from organ donors goes for cosmetic procedures: collagen for lips, skin for cosmetic surgery, and the like.

I am pretty sure that was from Harpers, which means the chances of it being online are poor.
posted by thirteen at 4:24 PM on January 22, 2001

rabi>rube, you can't have a rule that says everyone who is allowed to be an organ recipient must also be an organ donor. a lot of the people who need organs simply can't give them away, because of disease or whatever other problem lead them to be on the waiting list in the first place.

I should have clarified: they don't have to actually have donatable organs, but they do have to sign an organ donor card. If someone needs a liver transplant, they can't just sign an organ donor card and get on the recipient list -- they have to have signed an organ donor card at least 10 years ago. But you're right -- people shouldn't be punished for not having donatable organs.

posted by UrineSoakedRube at 4:41 PM on January 22, 2001

Rebecca, it depends on how you count. Some of it is used for that, but by weight the vast majority is used to save people's lives. In some cases they can take the lungs, the heart, the liver and both kidneys, plus corneas to treat certain kinds of blindness. In addition, sections of bone can be valuable as well as sections of larger arteries and veins. All of those things are used to save lives or rehabilitate people who are handicapped. A lot of skin is used sometimes but the most common use of it is as a temporary covering for large areas of burns while the victim's own skin is regenerating. Skin for permanent cosmetic surgery is usually taken from elsewhere on the patient's own body, because that way there's no risk of rejection.

Some things are not subject to rejection (corneas and bone) but most kinds of tissue are; no-one's going to accept cosmetic surgery which requires them to take immunosuppressants like cyclosporin for the rest of their lives.

By the way, "cosmetic" surgery isn't necessarily frivolous. Reconstructive surgery is used for things like burn patients, and to treat various kinds of natural or traumatic disfigurements. If you're thinking of old rich women having face lifts, that's the wrong image. There's a lot of that, but a lot of it is more important. This woman is a better conceptual model. Read her history here.

In the movie Battle of Britain, an otherwise rather forgettable film, there's one character with a badly burned face. He's introduced to one of the leads, and mentions that he had had some problems with fire in the Hurricane he had been flying. The man who played that role actually was burned in the face while flying a plane during the Battle of Britain; what you're seeing isn't makeup. It is what he really looks like. But it would have been a lot worse without all the changes done in various operations to reconstruct his face as much as they have. He has a pleasant cultured voice; he's probably a nice man. To give someone who has been maimed a new face is to give them back a social life. I consider that just as important as a kidney transplant.
posted by Steven Den Beste at 4:50 PM on January 22, 2001

steven, no argument from me there. I used to work at the university of washington department of surgery, whose plastic surgery/burn center pioneered a lot of reconstructive techniques.

I would gladly give all of the skin off my cadaver for reconstructive surgery; it's cosmetic surgery I object to.

let me see if I can find the reference in one of my old harper's and let's see how they worded it.

rcb
posted by rebeccablood at 6:03 PM on January 22, 2001

rebecca, that was probably the Orange County Register series The Body Brokers, from last spring, or the Chicago Tribune's later series which built on it, The Tissue Trade. Very disturbing.

In a nutshell: if you sign to give away your heart to a needy dying person, it probably happens for free; but you may also give away your skin, your stem cells, your platelets, and other useful parts that are eventually sold at a profit. The non-profit organ donation agencies are almost always run in conjunction with for-profit body-part harvesters. There's no suggestion of illegality, but there is an implication that the profit motive underlies at least some of the organ-donation cause and that it could taint the selection process.
posted by dhartung at 6:39 PM on January 22, 2001

There are a whole lot of people who'd probably be willing to be a receiver of a transplant when faced with that or death, who nonetheless are morally opposed to themselves or anyone they know being an organ donor.

Umm...rather smacks of hypocrisy, don't it?

posted by rushmc at 8:48 AM on January 23, 2001