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Waitlisted: Addressing Our Organ Donor Shortage

Updated: Apr 8

Big Picture:

In the United States, there is a severe organ donor crisis. While the demand for organ donations rises alongside the transplant waitlist, the number of transplants performed is falling behind. Many patients are unable to receive life-saving transplants and, as a result, pass away while on the organ donation waitlist. We've got to do something. 


Operative Definitions:

  1. Organ Donor: An individual, either living or deceased, who donates organs from their body to be transplanted in another individual.

  2. Organ Donation Waitlist: An ongoing list of people waiting to receive an organ transplant.

  3. Organ Transplant: An operation in which organs are removed from the body of one individual and placed in the body of another.


Important Facts and Statistics:

  1. Currently, over 100,000 people are on the waitlist to receive an essential organ transplant.

  2. Approximately 17 people on the waitlist for an organ transplant pass away every day.

  3. An organ donor has the potential to save up to 8 lives after their death by donating their organs.

  4. According to data collected by the Scientific Registry of Transplant Recipients, 2001 was the first year in which the total number of living organ donors was greater than the number of deceased living donors. In 2001, living donors made up 52% of all donors whereas in 1996, they only made up 41%.

  5. Although the number of deceased donors continues to grow, around 7500 patients pass away each year during the time they are on the waitlist to receive an organ transplant.


Five-Point Plan:

(1) Develop an opt-out organ donation system. Currently, the United States uses an organ donation opt-in system. In other words, individuals must actively undergo the process to become organ donors. The implementation of an opt-out system, on the contrary, would automatically register all individuals as organ donors who may undergo the process to opt-out if they choose. Nations that have already implemented an opt-out system, including Spain, Austria and Belgium, have experienced an 18% higher donation rate, on average, compared to nations using an opt-in system. The implementation of an opt-out system would increase the number of organ donors by eliminating the need for people to undergo the process of registering as donors. 

(2) Offer an allocation priority organ donation system. Developing non-financial incentives for individuals to donate organs could increase the number of registered organ donors. Establishing an allocation priority system, in which registered donors receive priority status if they were to need an organ transplant themselves, would serve as a means of motivation for people to become organ donors. While the concept of financial incentives in exchange for donating organs has been subject to much debate, the use of an allocation priority system eliminates the need for people to undergo an operation while they are still living in exchange for financial compensation. Rather, it rewards people who agree to donate their organs once they are deceased in exchange for priority status if they are to need a transplant in the future.

(3) Improve education efforts and public awareness. Investing time, funds and efforts into public education on organ donation will improve the public's understanding of the qualifications, procedures and impacts of organ donation. Educational interventions have successfully proven an increase in organ donation and the rate of consent for organ donation. Educating about both the actual process of organ donation and the organ donation shortage is an effective means of bringing awareness to the issue. 

(4) Enhance organ donation acquisition and processing. While increasing the number of registered organ donors is critical to addressing the organ donation shortage, another area of improvement is increasing the organ transplant success rate. The majority of organs can only survive outside the human body for less than twenty-four hours, with the heart only being able to withstand four to six hours. Therefore, organs must be transported in a safe and time-efficient way. Because there's no established national system to transfer organs, organs with longer shelf lives, such as the kidney and pancreas, often travel as commercial cargo. This transit method has proven ineffective. Organs are frequently left behind, lost or delayed. Improvements and increased funding directed to the organ transport system, including modernizing tracking efforts, could reduce the incidence of failed organ transplants.

(5) Provide support and services to living organ donors. Offering ongoing mental health and psychological support to living organ donors can help create a sustainable, positive experience. Undergoing an operation as serious as organ removal has both physical and psychological consequences. Some living organ donors experience heightened rates of anxiety and distress both pre- and post-donation. Accounting for this during an individual's preparation and recovery, especially by providing therapy, support groups or other mental health services, can improve a patient’s experience. Additionally, covering the cost of time taken off of work during the procedure and recovery is an effective means of incentivizing people to participate in organ donation.


Why this Initiative is Important:

Investing time and effort in improving the organ donation system will save lives. As time goes on, the organ transplant waitlist grows. This initiative would help satisfy the pressing demand for organ donations while simultaneously educating people about how they can make a positive difference as donors. Additionally, this proposal would reduce barriers for donors by making the process more efficient.


Estimated Economic Impact:

Organ donations are often considered cost-effective in comparison to longer-term medical interventions, such as dialysis. A study conducted at the University of Michigan found that increasing deceased kidney donation in the U.S. by just 5% would result in $4.7 billion in healthcare savings. The average organ donor saves 30.8 additional life years through donation. If consent rates for deceased donors reached 100% in the U.S., roughly 250,000 life years could be saved each year. Organ donations can increase economic productivity by lengthening the lifespans of other people who are allowed to return to work after their procedure.


Sources: 

Aleccia, JoNel. “How Lifesaving Organs for Transplant Go Missing in Transit.” Fierce Biotech, 11 Feb. 2020, www.fiercebiotech.com/medtech/how-lifesaving-organs-for-transplant-go-missing-transit.

Chen, Huey-Fen et al. “The Magnitude of the Health and Economic Impact of Increased Organ Donation on Patients With End-Stage Renal Disease.” MDM Policy & Practice, vol. 6,2 23814683211063418. 6 Dec. 2021, doi:10.1177/23814683211063418

DeRoos, Luke J et al. “Estimated Association Between Organ Availability and Presumed Consent in Solid Organ Transplant.” JAMA Network Open, vol. 2,10 e1912431. 2 Oct. 2019, doi:10.1001/jamanetworkopen.2019.12431

Levy, Mélanie. “State Incentives to Promote Organ Donation: Honoring the Principles of Reciprocity and Solidarity Inherent in the Gift Relationship.” Journal of Law and the Biosciences, vol. 5,2 398-435. 19 May. 2018, doi:10.1093/jlb/lsy009

Nathan, Howard M et al. “Organ Donation in the United States.” American Journal of Transplantation: Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons, vol. 3 Suppl 4 (2003): 29-40. doi:10.1034/j.1600-6143.3.s4.4.x

“Organ Donation Statistics.” Health Resources & Amp; Services Administration, www.organdonor.gov/learn/organ-donation-statistics. Accessed 29 July 2023. 

Schnitzler, Mark A et al. “The Life-years Saved by a Deceased Organ Donor.” American Journal of Transplantation: Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons, vol. 5,9 (2005): 2289-96. doi:10.1111/j.1600-6143.2005.01021.x

Sykes, Megan, and David H Sachs. “Progress in Xenotransplantation: Overcoming Immune Barriers.” Nature Reviews. Nephrology vol. 18,12 (2022): 745-761. doi:10.1038/s41581-022-00624-6

Willis, Brian H, and Muireann Quigley. “Opt-out Organ Donation: On Evidence and Public Policy.” Journal of the Royal Society of Medicine, vol. 107,2 (2014): 56-60. doi:10.1177/0141076813507707

Yilmaz, Tonguc Utku. “Importance of Education in Organ Donation.” Experimental and Clinical Transplantation: Official Journal of the Middle East Society for Organ Transplantation vol. 9,6 (2011): 370-5.

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