I am just a number
November 19, 2005 8:25 PM   Subscribe

Sign a Donor Card! Organ transplantation has taken great leaps and bounds. What used to take twelve to fourteen hours for, say, a liver transplant, has now been reduced (in some cases) to a three-hour operation. Holding times (the length of time for which an organ can be between donor and recipient) have increased. What hasn’t increased are the number of donors. (mi)
posted by MiHail (47 comments total)
To address these problems in the short term, medical centers and UNOS (the United Network for Organ Sharing) have developed gruesome things like the MELD calculator, which is an attempt to fairly allocate organs to the sickest persons. Various complaints have been leveled about the MELD (Model for End-stage Liver Disease), including that it tends to favor patients with hepatitis (the most common reason for liver transplant) rather than those with more unusual diseases such as PSC (primary sclerosing cholangitis). The real cause for dickering about such things: organ shortages.

There are a lot of misconceptions about organ donation; the main one seems to be that doctors won’t work on you very hard if they see “donor” on your drivers’ license in a life-threatening emergency. Some have expressed concern that “no one will want my organs”—and it’s true; they may not be able to use EVERY organ but they may be able to use some. My 97-year-old grandfather was able to donate his corneas when he died. Every organ donor can save as many as 10 people. Others raise religious objections. Many (Christian) religions regard donation as akin to Christ's gift to humankind; others make it a matter of personal choice. Some strongly urge donation, as with Judaism, where it is considered an obligation to save a life if one can. There are some religions with very specific burial rites that do not allow for donation, but these are very few indeed.

Tragically, in third world countries such as India, wealthy "organ tourists" go there to get kidneys where it is legal to do so. Quite a few impoverished people sell a kidney for as little as $1000, often because of a debt. There are also urban legends about donation (the guy in the bathtub of ice being one); there are also persistent rumors in Mexico that wealthy Anglos steal children with the purpose of killing them and stealing their organs, none of which help increase awareness or rates of donation.

What is the solution to the organ shortage? Sure, we can all sign a donor card (note that THE KEY to doing so is to tell ALL YOUR FAMILY about your wishes. A signed donor card and an unwilling family means no donation. In fact, families who decide against donation in spite of a signed donor card are one of the biggest obstacles to donation right now). Taiwan has an opt-out program—i.e. you are an organ donor unless you specifically say NO to it. Legislation has been proposed in this country that funeral costs would be covered for an organ donor. Some have suggested giving the family members a payment if they allow donation. It’s a sticky moral situation that doesn’t help the 90,000-some odd patients waiting right now. So—What do we do? Pay people? Opt-out policy? Hold a gun to the collective heads of George Lopez, (who, to be fair, does seem to be working with the Kindney Foundation) David Crosby [note especially how long Crosby had to wait], Larry Hagman (who doesn't blame his failed liver on boozing, but the power lines near his house), and other celebs who have received transplants and force them to promote card-signing?

Sorry this is so long...but I'm really trying to redeem myself after the mushroomy mess of the other day....
posted by MiHail at 8:26 PM on November 19, 2005

Unfortunately, advocacy posts don't go over well here, MiHail. I wish you luck with this one — people may deal with you pretty harshly. Be strong.
posted by Rothko at 8:27 PM on November 19, 2005

I wouldn't call this an "advocacy" post. The meat of the post is :
(1) people are dying because there aren't enough donors
(2) should we and how could we increase donors?

with #2 probably being the most non-advocacy-ish part of the post.
posted by MiHail at 8:31 PM on November 19, 2005

I have *donor* checked of on my driver's liscense, but I am also pretty sure that, in time of need my organs would either go to a celebrity, or someone with a lot of money, before it would go to anyone like me.

So I am very ambivalent about it. . .and every time I renew, I consider not checking the organ donor box.
posted by Danf at 8:42 PM on November 19, 2005

Thanks for posting this - I worked five months in the clinical education dept of my local organ procurement organization. Although working for them was about as refreshing and pleasurable as chewing razor blades, I learned a lot, and really adopted donation as a cause. (Going against my religion, actually.)

One of the most chilling statistics: 19 people die every day while on the waiting list.
posted by kalimac at 8:42 PM on November 19, 2005

Currently we have organ socialism - anyone who needs an organ is allowed access to the organ pool regardless of whether or not they contributed to the upkeep. As with other resources owned in common we get over-exploitation and under-investment. Consider, instead a "no-give, no-take policy" - only those who have previously signed their organ donor cards are allowed access to the pool. Not only is this more moral than the current policy it creates an incentive to sign your organ donor card. Signing your card becomes the ticket to joining a club - the club of people who have agreed to share their organs should they no longer need them. Equivalently signing your organ donor card becomes analogous to buying insurance.
posted by Kwantsar at 8:44 PM on November 19, 2005

Don't miss the corresponding MeTa for this thread.
posted by ThePinkSuperhero at 8:55 PM on November 19, 2005 [1 favorite]

Currently we have organ socialism - anyone who needs an organ is allowed access to the organ pool regardless of whether or not they contributed to the upkeep.

I can't find a link, but Countdown with Keith Olbermann did a segment last night about a service started by a transplant surgeon -- organ swapping -- a service whereby patients who have willing donors who are incompatible can be matched with other patients with willing and incompatible donors.

Maybe someone here can find it, or knows something about this.
posted by edverb at 8:55 PM on November 19, 2005

Danf, it may reassure you to know that the donor/recipient process is designed to be anonymous. There are very rare cases in which the recipient might know the donor; for example, a father recieved a "directed donation" from his daughter because she had been in a car crash and his other family members agreed to it.

You also raise an objection that someone brought up to me: "What if President Clinton [the guy was a raving Repub.] is dying and needed my organ? They could take me out just to get my liver or something." This occured shortly after the Taiwanese adopted their opt out policy. I tried to explain the way organs are allocated but he wasn't buying it. I'd suggest digging deeper into the UNOS site for more on this. Additionally, patients are not identified by name; they are identified by number.

UNOS works very very hard at trying to be fair in organ allocation, because one such case would destroy their credibility and then the organ shortage would be even worse.
posted by MiHail at 8:56 PM on November 19, 2005

I've read about that too--it relates mainly to living kidney donation, though I think they are starting to consider it for livers as well.

Since kidneys are the organs in shortest supply, it's actually a decent idea; something like the bone marrow registry could even be started.
posted by MiHail at 8:58 PM on November 19, 2005

should read...."be started for kidneys too."
posted by MiHail at 8:59 PM on November 19, 2005

MiHail - have you heard anything about living liver donations? (heh.) It's super new, and I think only one or two surgeons can even manage it, but it's more hope...kidneys are, I believe, the most-donated organ (and corneas the most-donated tissue), because they can come from a living donor.
posted by kalimac at 9:08 PM on November 19, 2005

I would be careful donating organs if you are evil because I have seen many films that imply that your evilness will be incorporated into the recipient and they will see ghosts and/or commit evil acts.
posted by Falconetti at 9:11 PM on November 19, 2005 [1 favorite]

Actually, there was a Saudi bigshot who was able to skip to the head of the line just recently--he got a liver when he wasn't entitled to it yet
posted by amberglow at 9:12 PM on November 19, 2005

I ride a motorcycle! One day, my spleen will save a girl scout! *vrooom... vroom!*

(checked off the donor box, myself)
posted by Eideteker at 9:25 PM on November 19, 2005 [1 favorite]

kalimac-- Living liver donations are becoming more common; most often seen when a small child (infant or toddler) needs a liver and a parent donates a piece. Livers can regenerate. There still are, naturally, issues of blood type and tissue matching, etc.

Unfortunately, with many deseases, cadaveric donations consisting of the entire liver are needed. There have been cases when the donor's liver can be split and given to two different people.

They really are trying to push technology to help with this, even to the point of trying to develop a liver dialysis machine, but the real problem is that there just aren't enough organs to go around...and the Saudi bigshot stories don't help, either.
posted by MiHail at 9:33 PM on November 19, 2005

I've also heard about deathrow inmates jumping to the head of the queue because otherwise the prison would be held responsible if the inmate died as a result of not recieving the organ.

That said, I've checked of the donor box, and I like the idea of the "no-give, no-take policy" that Kwanstar mentioned
posted by kosher_jenny at 9:33 PM on November 19, 2005

I've signed the card, and made my wishes known to my family. But I understand they can still stop any donations.

Wish there was a form you could file with UNOS, like a will, that would let them take the organs without input or approval of the survivors.
posted by Marky at 10:10 PM on November 19, 2005

I don't understand how anyone can be upset that money/status lets you skip ahead in the line. The only reason our nice middle-class society can worry about people with failing organs is that we can afford to. 19 people dying? No way.

Aside from my indifference, though, ThePinkSuperhero's idea seems damn clever, and I would anticipate that if it were effectively implemented there would very quickly cease to be an organ shortage issue.
posted by GooseOnTheLoose at 10:18 PM on November 19, 2005

Metafilter: only one or two surgeons can even manage it.
posted by oddman at 10:22 PM on November 19, 2005

ThePinkSuperhero's idea seems damn clever

What idea is that?
posted by Kwantsar at 10:53 PM on November 19, 2005

As the recipient of a transplanted kidney, I obviously have a biased view of this subject, but I'll post anyway. I do believe that we need to increase cadaver donors by making sure that those who want to donate are allowed to by their families. (The number of possible cadaver donors has decreased significantly over the past 20 years because of increases in auto safety). I do believe that a you can only take if you're willing to give policy would help, but it would be very complicated (I don't think you can ask that of those under 18, for example) and the idea doesn't appear to have much traction. I don't believe that we should pay donors.

Danf - It is extraordinarily unlikely - in the U.S. - that your organs would go to a celebrity or rich person. UNOS works very hard to make the process of organ sharing very fair. It is not completely fair, because people who are poor or uneducated are less likely to try and get on the transplant list and may have problems paying for transplants. But once you are on the transplant list, it is administered very fairly. I don't know of any recent case in the U.S. where someone with pull has been able to use their influence to jump to the front of the line to get a transplant. (I believe that there have been a few cases of doctors providing misinformation about their patients so that they can perform more transplants, but we're talking about one-thousandth of one percent of all transplants)

(Celebrities do seem to attract a lot more live donor applications, however. The live kidney donor donation area is the source of a lot more controversy, such as the question over whether a patient can accent an organ from a strangger they met on the internet who wants to donate their kidney)

kalimac - Living liver donations are not that new, and there are a significant number of doctors who perform the surgery. However, the procedure is far more dangerous than the dangers of live kidney donation (which basically amount to the dangers of having surgery plus the danger that your remaining kidney will be hit by a bus), and most live liver donations are parent-to-child.
posted by spira at 11:23 PM on November 19, 2005

Don't be a donor. There's plenty of Iraqi kidneys to go around.
posted by snakey at 12:39 AM on November 20, 2005

They can take my fingers when they ply them out of my cold dead hands.
posted by seanyboy at 3:00 AM on November 20, 2005

PinkSuperhero's idea was for a corresponding MeTa thread for every donation.

And me? I'm donating my organs to be eaten by whoever kills me. Hopefully, supping on my heart will make my son strong!
posted by klangklangston at 3:05 AM on November 20, 2005

From Kwantsar's link we read

Better immuno-suppressive drugs and surgical techniques have raised the demand at the same time that better emergency medicine, reduced crime and safer roads have reduced organ supply.

Aka those in need of a new organ are really really out of luck, but conversely less people is suffering or dead.

Perhaps because the shortage is growing, opposition to financial compensation for cadaveric donation (compensation for live donors is a distinct issue) appears to be lessening.

It's not a cadaveric donation if there's money involved in the transaction it's the sale of piece of a cadaver and all other
reframings are just excuses, attempts not to call a sale a sale.

A Tragedy of the Commons? Economics provides another way of looking at the crisis. Currently we have organ socialism - anyone who needs an organ is allowed access to the organ pool regardless of whether or not they contributed to the upkeep.

And that's socialism ? So let's see I've got organs who are going to become spoiled or be thrown away willy nilly pretty sooner rather then later ..but hey you didn't sign "i'm a donor" on the donor card so FUCK YOU I'll not give you this organ, I'll give it to my cat to ate. Let's pick a less extreme situation, in which we have three people , two of them with donor card and one without
it and the third technically needs it before the others....would you give preference to which one with donor card , and why ?

Not only is this more moral than the current policy it creates an incentive to sign your organ donor card. Signing your card becomes the ticket to joining a club - the club of people who have agreed to share their organs should they no longer need them. Equivalently signing your organ donor card becomes analogous to buying insurance. I discuss the idea further in Entrepreneurial Economics.

I also discuss about wannabe-economists giving economists a bad name and promoting their books in my posts all over the prestigeous wood selling internets, I'm going to make a book someday.

On top of my head I'd advance the idea that we should use all of the bodies as potential resource of organs, but at the same time
we shouldn't allow any exploitation of people as organ resources , as opening the door to market ideology would pave the way to profiteers making another resource far more expensive then it must be (see attempts to privatize water distribution).

On a tangent, research for organ replacement by "reproduction" in vitro of organs is extremely interesting, including if necessary
stem cell research who some say is a promising method to REPAIR what's broken instead of just throwing the piece away. Religious freaks need to remember God isn't for organ replacement, so if you believe in God you should just die and relieve us of your nefarious influences.
posted by elpapacito at 5:51 AM on November 20, 2005

When "socialism" really figures into this, suicide will be legalized and regulated, with euthansia in hospitals to facilitate easy harvesting of organs.
posted by alumshubby at 6:21 AM on November 20, 2005

I don't have health insurance. If I need an organ transplant, I will be left to die.

I am not going to donate my organs to a system that I can never benefit from.
posted by Jatayu das at 6:57 AM on November 20, 2005

I've had a full donor card in my wallet since I was about 18, thanks. Although god help anyone who gets my liver.

I am not going to donate my organs to a system that I can never benefit from.

How very selfless of you, dickhead.
posted by Decani at 7:02 AM on November 20, 2005

My organ donor box is checked, but you need two witnesses to sign it as well (at least in NY) and that was actually complicated - the first witness was easy because my friend & I went to get our state ID's together, and signed each other's cards - but then we asked a third person (a childhood friend of my friend's) to be second witness and she initially refused. She felt that she'd be encouraging doctors not to save us if we were in an accident, since our organs would save more people. We eventually convinced her to respect our opinion and simply act as a witness, but she remained very reluctant and later said we'd pressured her and she still felt bad. She also said she'd had this discussion with other people and that no one liked to witness on a donor card because it was like saying you didn't mind your friend being harvested...

Anyway, I'd guess that's pretty indicative of a lot of people's attitudes. Kwantsar's idea makes sense to me, to recontextualize the whole thing not as a policy of "donation" or charity, but rather as a community or network to which you belong - you're part of the "organ sharing" group - from each according to his ability (being a corpse), for each according to his need. It's a little sad that people aren't happy to give enough to charity to cover our collective needs, but that's exactly what we've found, so instead we need to implement social systems - you can't pay new hampshire taxes and then take advantage of vermont social programs, e.g. (theoretically). You have to belong to the group as both giver and recipient. (in other words, I don't see how the current system is 'socialist' and this wouldn't be - a 'capitalist' system of organ sharing would be one where those willing to pay the most got to the top of the list... but those economic overtones are really unnecessary for the discussion)
posted by mdn at 7:59 AM on November 20, 2005

Jatayu das - Are you sure about that? I'm not saying you are wrong, but you may be. Medicare will pick up almost the entire cost of kidney and kidney-pancrease transplants if you've contributed into the Social Security system for a while as a worker. (And I'm talking about people of all ages, not just those over 65).
posted by spira at 8:16 AM on November 20, 2005

klangklangston: And me? I'm donating my organs to be eaten by whoever kills me.

*cancels hit on klang*
posted by jonmc at 8:53 AM on November 20, 2005

In some cases, just checking the <Organ Donor> box on your driver's license isn't enough - if you feel strongly about donating, contact your local Transplantation Society.

Living partial liver donation is increasingly common, but since it involves risk to the donor, some doctors feel squeemish about it (the do no harm doctrine). However, a partially donated liver usually regenerates back to ~80+ % of it's original size.

Anecdotally, I've heard that when mandatory motorcycle helmet laws came into effect, the supply of organs drastically fell. Anyway, I'm in favour of an opt-out system rather than opt-in.
posted by PurplePorpoise at 9:53 AM on November 20, 2005

I think they should make it so the deceasing person's wishes override what family members say. It's my damn body, do what *I* want with it. (Presuming that I have taken some clear action indicating in writing my wishes, with my valid signature, etc)

If Aunt Edna is squeamish about my death saving someone's life, well, so fucking what? Why does her opinion get to override mine?
posted by beth at 10:29 AM on November 20, 2005

OK, MiHail, you are trying -- nobody's disputing that. It looks like your longish post covering the entire field of organ transplantation, an approach that generally doesn't work, got more-insided so that all you had on the front page, though, was a Wikipedia link (always save those for comments) and a perfunctory sign-up with a wave in, which amounts to advocacy and framing, which doesn't work out usually either.

The interesting bits you had inside should have been the focus -- stuff like the MELD calculator (is there a generic version?) and the bit about organ tourists, which could have been a good post topic by itself.

Then you could have combined it with some of the recent news such as the business with the wealthy Saudi who apparently scammed the California organ network out of a liver. That would have been newsfilter by itself, but with the other links, an even more acceptable post.

And again: for best results, don't jump into the thread and tell everyone how they should be interpreting the post. Either make the interpretation unmistakeable, or let people derive their own.
posted by dhartung at 11:09 AM on November 20, 2005

I think they should make it so the deceasing person's wishes override what family members say.

I dunno. If a family member didn't want to be an organ donor, and made those wishes known to me, and signed documents to keep it from happening, I'd still go right ahead and tell the hospital to harvest all the organs they could. If it's just the dead person wins, that would stop me, and then someone would die, or lose their eyesight, or otherwise suffer.
posted by ROU_Xenophobe at 11:32 AM on November 20, 2005

I've worked transplant units at 3 major hospitals in the USA.

Among the organ recipients were people on medicare. It's not true that a person with no health insurance can't get a transplant if needed. There may be people who can't; I'm just saying: there's plenty who can.

To you folks who seem to be advocating the ignoring of the wishes of a deceased or soon-to-be deceased person... wow.. just wow.
posted by reflecked at 11:54 AM on November 20, 2005

My husband and I have been debating the merits of the opt-out scheme this past week. We both plan on donating but he says that taking people's organs unless they specifically request the government not to makes him squimish. I say the idea of all those nice organs being injected with embalming fluid and left to molder in graves makes me squimish. Actually the whole American way of death makes me sick-- but that is another FPP.
posted by Secret Life of Gravy at 1:16 PM on November 20, 2005

On the topic of uninsured people in the US not getting transplants: Yes, it is true. I know it is true because there was a 60 minutes story about it while back.

The framing of the story was thus: People in prison have transplants paid for by the tax payer. But people who have worked all their lives (yadda, yadda, yadda) are kept off the list if they don't have insuracne and can't put the money down up front. Conclusion (according to those on the show): It's unfair that criminals get transplants while upstanding citizens are denied. Therefore, people in prison shouldn't get transplants.

I am not kidding. That's what they said.

For a week after this show aired, I cried every time I thought about it. I mean that literally, and I do know what the word literally means.
posted by duck at 2:02 PM on November 20, 2005

Oh...but of course I would donate my organs and have told my family so. I would imagine they won't want my organs (they don't want my blood), but who knows? And I would seriously consider overriding the will of the deceased and donating organs were I ever in a position to do so.
posted by duck at 2:05 PM on November 20, 2005

Would they take the organs of someone with AIDs?

Because of this organ shortage I would think that for some cases
time to live without organ < time to live with AIDs
posted by Iax at 2:41 PM on November 20, 2005

Would they take the organs of someone with AIDs?

Well people who receive organs have to take immuno-suppressants. It would seem like that would be a pretty deadly think to do if you already had AIDS.
posted by duck at 2:50 PM on November 20, 2005

Among the organ recipients were people on medicare. It's not true that a person with no health insurance can't get a transplant if needed. There may be people who can't; I'm just saying: there's plenty who can.

Medicare is health insurance. Were there people with no medical coverage getting transplants?
posted by Paris Hilton at 3:20 PM on November 20, 2005

If you have no insurance, going on dialysis or getting a transplant puts you on Medicare if you've worked in the USA for a while and put money in the Social Security system - regardless of your age. So the answer is no, but only because those without insurance often automatically get insurance.
posted by spira at 3:38 PM on November 20, 2005 [1 favorite]

... What spira said. I should have spoken more clearly. People with no medical insurance who require a transplant are put on Medicare, so at that point, they have medical insurance.

This is in the USA. I haven't worked with transplant patients here in Canada, but everything is different..way different.
posted by reflecked at 4:27 PM on November 20, 2005

Sorry, I'm still laughing too hard at seanyboy's comment to say anymore than please donate your organs.
posted by terrapin at 6:36 PM on November 20, 2005

I don't have health insurance. If I need an organ transplant, I will be left to die.

I am not going to donate my organs to a system that I can never benefit from.
- Jatayu das

Here in the civilized world (Canada) all citizens have health coverage, so no one will be denied a transplant due to money. Everyone has the opportunity to benefit from organ donation. We still have a shortage of willing donors.
posted by raedyn at 8:49 AM on November 21, 2005

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