Monday, September 21, 2009

Organ Transplantation

by Doug King

The number of people waiting for an organ transplant is increasing every year. Sadly the number of transplants being performed is not keeping pace. Too many people will die while waiting on these lists. Despite the best efforts of many organizations and well meaning medical professionals people are dieing waiting. The systems that are in place are just not doing the job and need to be rethought. Obviously the organs are available (we all die someday) but they just aren't making their way through our medical system to the patients that need them.

Statistics from UNOS (United Network for Organ Sharing) show that in the US alone in 2007 more than 6000 people died while on the wait list for an organ. The number of people on that wait list currently stands at over 100,000. The vast majority of those are waiting for a kidney with the liver and heart being a distant 2nd and 3rd. The problem lies in the fact that the wait lists are increasing in size faster than the number of organs being donated. So what are we to do about getting the word out to the masses that we need to sign ourselves up to be organ donors?

Is it just a lack of awareness or are there some other reasons why we feel it isn't something we want to do? Maybe if I have signed up to donate my organs and they know this my doctor or emergency room staff won't try as hard to save my life? Or maybe I believe it is against my religion. What if I'm too old or my health isn't that great anyway, who would want my organs? The rich and famous always move to the head of the list so why would I want to help them?

Of course all these concerns can be answered. Your doctor and those in any emergency room are only there to save you and are not involved with the transplant system. Organ donation is consistent with the beliefs of most religions. Age has very little to do with the viability of your organs for transplant and only the doctors at the time of your death can decide on their suitability. The rich and famous are not given priority and are not treated differently than anyone else. In fact UNOS takes all celebrity transplants to an internal audit to make sure they meet the guidelines of fairness.

Another misconception about organ transplants is that most recipients survive only a few years. According to Donate Life America, long-term survival is becoming much more common. For example, a number of kidney recipients are living 30 years or longer after transplant. Recipients of other organs have survived more than 20 years after transplant. As science and technology improves these numbers will only get better and better.

One disturbing trend is the emergence of organ transplant tourism. Globalization of medical and surgical technology has increased the capacity for countries worldwide to perform organ transplantation. The byproduct of this has been the growth of patients traveling to foreign countries to get their transplants, bypassing the wait lists at home. You can hardly blame them but the reality is that many of the organ donors in these destination countries are somewhat less than consenting. In 2007 it was estimated by the World Health Organization that organ trafficking accounts for 5-10% of the kidney transplants performed annually throughout the world. A commercial transaction with no questions asked.

Is the market just meeting a need or are there more serious ethical questions regarding exploiting the poor who are trying to take care of their family and the sick who are just desperate for a cure? So who owns our bodies? Is it ethical or even legal to allow the vulnerable poor to sell their organs to save a life? Many of these surgeries are still happening and as long as this free market exists they will continue.

Even more disturbing are the stories of organ stealing from unwilling donors. No doubt there is large amount of "urban myth" here. However there is mounting evidence that the Chinese penal system is involved in systematic harvesting of organs from their prisoners for profit. The number of organ transplant procedures in China is surpassed only by the U.S. According to WHO, in 2005 China had 348 transplant centers, which performed 8,204 kidney and 3,493 liver transplantations. In a report by Canada's former secretary of state for the Asia Pacific region David Kilgour and human rights lawyer David Matas they implicated dozens of hospitals and jails throughout China in July, after a two-month investigation. "The involvement of the People's Liberation Army in these transplants is widespread,'' Kilgour said at a press conference. It has also been confirmed that a large number of Canadians have been traveling to China for transplants of organs with dubious origins. No doubt wealthy patients from many countries have been doing the same.

If these practices are happening in China than it's safe to assume that it is happening in other countries where the absence of regulations or scrutiny of medical practices allows for profiteering of the organ trade. You can hardly fault the terminally ill who see a long wait list ahead of them to do whatever it takes to save their own lives. But what if the donor is not a willing participant or is so desperately poor that they want to do anything that will help their family?

It is a case of supply and demand. With so many people willing to pay $100,000 or more for a kidney it will surely follow that the organs will become available. Whether it is through criminal activity or just the gray area of the law patients will find a way to get what they need when their lives are on the line.

It shouldn't have to be this way. Get out there and sign your organ donor card.

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