Tuesday, February 28, 2012

Give and You Shall Receive: A Call for Organ Donors

Successful attempts to increase the number of organ donors have been elusive, confounded by ethical and religious questions and ambiguities. In the US, we have the opt-in system: people can register at any time to be organ donors, but nearly 18 people die every day waiting on the transplant list. Spain and Austria have the opt-out system: people are presumed organ-donors unless they (or family) say otherwise, but the number of donations doesn’t necessarily differ. Is it time to try a new system? If you are willing to donate your own organs, should you get priority to receive an organ? A new law, to take effect in Israel in April, will do just that.

Patients who have organ donor cards or whose family members have donated an organ in the past will get priority for transplant over other patients who are at the same level of medical severity. The law will provide for adequate compensation for the donor, including 40 days of lost wages and medical expenses paid.

The hope is that this law will encourage more people to register as organ donors, and so far it has been effective. After a massive 10-week advertising campaign targeting shopping malls, billboards, and newspapers, 70,000 people registered as donors.

The law was created in careful coordination with rabbis and religious leaders, which should make it appealing to most Israelis. What complicates matters is the orthodox interpretation of brain death and the Haredi rule against organ donation. This puts an entire group at a disadvantage under this new system.

Are systems that grant non-medical priority to some people on the transplant list inherently unjust? Perhaps. But I believe that the real injustice lies in systems where wealth buys an advantage and the poor are taken advantage of. What I like about this new practice is that it paradoxically equalizes the playing field – money can’t buy you priority on the transplant list but altruism can, and we all have the capability for that.

As a fourth year medical student, I did a transplant surgery rotation that taught me that the decisions we make about our organs after death often have effects greater than we had imagined. I will never forget what a new liver meant for my patient, a 35-year-old mother of two. She had become less alert and aware over the course of two weeks, dipping into the phases of inexplicable hemolytic crisis and encephalopathy that characterize hepatic decompensation. We got the call about a donor on a Friday afternoon and by nighttime had successfully transplanted the liver in my patient. The next morning, I went to visit her in the ICU. She greeted me with the first coherent salutation I had heard from her in a long time.

I never knew the name of the donor, just that she was in her 50s, in good health, and brain-dead. What I do know is that her decision to be an organ donor turned a tragedy into an opportunity for new life for a perfect stranger. She would deserve the same.

Check out Dr. Ofri’s post on the NYT Well Blog: