A Two-Tier Approach to Increase Organ Donation
Posted by Bob Aronson
When a human organ is recovered and transplanted everyone involved gets paid, the physicians, the hospital and the OPO, and they deserve it. The donor or donor’s family, however, gets nothing but a thank you. I have long believed that the answer to the organ shortage is a combination of presumed consent and some sort of financial aid for living donors and for deceased donor’s families.
I will address both issues but first, presumed consent. I fully endorse the policy proposed by David W. Courtney, an eminently qualified expert on the subject. His full article and bio can be read at http://www.trioweb.org/resources/YourChoiceFirstCourtney070107.pdf. Presumed Consent is already in place in Austria, Belgium, Bulgaria, Czech Republic, Denmark, Finland, France, Greece, Hungary, Italy, Latvia, Luxembourg, Norway, Poland, Portugal, Singapore, Slovak Republic, Slovenia, Spain, Sweden, and Switzerland
Here is my edited version of Courtney’s proposal. Again, I urge you to read the entire document. According to Courtney, “Presumed Consent Policy in the US should be implemented with these four areas of integral capabilities:”
1) Notification, Education, and Awareness– Every adult will need to be formally notified of the law and given an opportunity to state their choice.
2) A Central Registry– The most reasonable is a national “opt-out” registry. In Europe only 2% opt out of the program, so it would be easier and less expensive to track those that opt-out than those that opt-in.
3) Program management– As an extension of the OPO’s, we need a Dr. or at least a nurse in every hospital with over 150 beds to coordinate and manage the program.
4) Oversight- We would have to guard against abuses. We don’t want a system that promotes “death mongers” and we don’t want a system that allows any one person or part to be ignored or fail.
Courtney goes on to say, “Our current system with the United Network for Organ Sharing (UNOS), our regionally located OPO’s, and the existing transplant centers can be utilized continuing their current roles. We would still need the OPO’s to provide procurement coordination and donor family services and UNOS could be utilized to maintain a confidential “opt out” registry to verify a potential donor’s wishes while continuing their current mission. Making a choice remains the most important part of this policy as no one should be ridiculed for their choice and every one is entitled to have their choice honored.”
Scott Carney, an investigative journalist based in Chennai, India, quotes Eric Johnson, professor of business at Columbia University and a proponent of presumed-consent policy, as saying, “Research shows that there would be an increase of between 16 percent to 50 percent in the availability of organs, and others have speculated that this would eliminate the shortage of organs in some categories,”
My support for the Courtney plan is strong, but I do not think his plan alone will accomplish the goal. In order for us to greatly diminish or even eliminate the organ and tissue shortage, we need to implement a financial incentive program. This, too, could be managed by UNOS.
1. Living donors should be provided adequate lifetime healthcare insurance. While the donor’s surgery and care is currently financed by the recipients insurance, the donor is responsible for any complications that may appear later. They shouldn’t have to bear that expense.
2. Families of deceased donors should receive an amount not to exceed $10,000 to be used only for funeral and related expenses.
These payments could be financed a number of ways. One might be a small surcharge (50 cents) for all drivers’ licenses in the fifty states or we could also involve the private sector and/or utilize other fund raising efforts to help raise the money.
I know full well that this two-tier approach will be difficult to accomplish and may take awhile. But at least it offers a solution to an ever broadening problem. Since 1984 the effort to obtain more transplantable organs and tissue has depended entirely on altruism, on people who will do the, “Right thing.” We have been very patient as a nation but it is now twenty four years after the first donor registered and more people are dying on the waiting list than ever before, fewer than two out of 10 U.S. families donate the organs of relatives after death.
It is time that politicians, regulators, opinion leaders and ethicists opened their eyes to what’s happening. As long as we cannot decide what to do, we will have decided to do nothing, and good people will continue to die.
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