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A Proposal To Legalize the Sale of Human Organs


By Bob Aronson

Plan by David F. Diamond

The story of the organ shortage is all too familiar; supply just can’t catch demand. 

bring your own organs

Since 1984 when Tennessee Congressman Al Gore (D) and Utah Senator Orin Hatch (R) authored and passed the National Organ Transplant Act (NOTA) there have not  been enough organs.  The act makes “Altruistic” donation the law of the land simply meaning that patients who need transplants must depend on the good will of others who upon their deaths will voluntarily donate their organs. 

 After nearly 30 years only 40% of Americans have shown that good will by registering as organ donors.  If the goal was to provide organs for all who needed them then the experiment failed.  I cannot believe that either Gore or Hatch would have supported a plan that would allow thousands to die.

Today there are about 120,000 people on the national transplant list and so far in the first 7 months of this year there have been only 11,600 transplants done. Obviously the system isn’t working the way Gore and Hatch had hoped.

So what to do?  There have been scores of proposals put forward to change the law.  Proposals which include “Opt-out” or “Presumed consent” which means everyone would automatically be considered an organ donor unless they chose to “Opt Out” (our current system is “Opt In”).   Also proposed are programs that would offer transplants only to registered organ donors; mandatory donation; compensation of sorts that would pay funeral expenses or perhaps provide scholarships and outright commercial sales of human organs.  All of those options have been discussed by lawmakers, medical ethicists and the people who run the national transplant program and they have all been dismissed as unethical, unmanageable or just plain unworkable and people continue to die.

NOTA bulletsWhen NOTA was established the authors made it quite clear that organ sales would not be allowed.  NOTA specifically states “it shall be unlawful for any person to knowingly acquire, receive, or otherwise transfer any human organ for valuable consideration for use in human transplantation if the transfer affects interstate commerce.” The penalty of breaking this law is a fine of $50,000 or up to five years in prison, or both,   So that readers have accurate information before them, here is that section of NOTA:

From the National Organ Transplant Act of 1984, as amended through February 1, 2010:
TITLE 42 > CHAPTER 6A > SUBCHAPTER II > Part H > § 274e
Prohibition of organ purchases
(a) Prohibition

body parts for sale
It shall be unlawful for any person to knowingly acquire, receive, or otherwise transfer any human organ for valuable consideration for use in human transplantation if the transfer affects interstate commerce. The preceding sentence does not apply with respect to human organ paired donation.
(b) Penalties
Any person who violates subsection (a) of this section shall be fined not more than $50,000 or imprisoned not more than five years, or both.
(c) Definitions
For purposes of subsection (a) of this section:
(1) The term “human organ” means the human (including fetal) kidney, liver, heart, lung, pancreas, bone marrow, cornea, eye, bone, and skin or any subpart thereof and any other human organ (or any subpart thereof, including that derived from a fetus) specified by the Secretary of Health and Human Services by regulation.
(2) The term “valuable consideration” does not include the reasonable payments associated with the removal, transportation, implantation, processing, preservation, quality control, and storage of a human organ or the expenses of travel, housing, and lost wages incurred by the donor of a human organ in connection with the donation of the organ.

For the past nearly 30 years, the prohibition against buying and selling organs in the United States has been the law of the land.   Efforts to provide financial incentives as a means of increasing deceased donation, for example, have failed because of what was determined as clear Congressional intent that organs not be placed in a commercial market.

When you consider the strong language in NOTA with regard to organ sales one would think the debate would be dead.  Well, it’s not and that’s because of what appears to be a contradiction in public policy.  The law says one thing but we seem to practice in some cases what the law disallows.   

We are prohibited from selling human organs but not hair, sperm, blood, and other “replenishable” body parts.   The question of commercialization of human organs remains unsettled; not so much because of a public desire to sell their organs but rather because of the explosive growth of the biotechnology industry.  

Advances in that arena have generated uses and needs for body tissues that were previously unimaginable. And there’s the rub.  While the law bans the buying and selling of organs for transplantation, they have not banned their use in research, education, and commercial endeavors.  So the bottom line is that you can buy body parts legally but not for transplantation.

David F. DiamondEnter David Diamond and his proposal for legalizing the sale of human organs.  I met David on the internet.  We share backgrounds in politics and broadcasting and in trying to save lives through organ transplantation.  

By publishing his proposal I am neither endorsing nor opposing it.  I am posting it because I believe in an informed public and that he has the right to be heard and have his ideas discussed.

David has not had a transplant nor is he a candidate for one, he simply has an interest in the issue that began with a radio interview. Here’s David Diamonds story in his words:

“In 1984 I was doing a radio talk show in Memphis TN.  My guest one day was the local director of the Organ Procurement group I asked him “Well, couldn’t people buy an organ if they wanted to?”

He answered that was illegal under the new law.  The authors, he said, wanted to prevent the development of a black market.

I didn’t think to ask the logical follow-up question:  “But won’t that seriously limit the supply.”

Days and weeks and months thereafter, the question nagged at me.    Finally I began to develop a solution that I thought could solve the shortage.  And so I talked it up for 20 plus years, getting nowhere fast!  Folks didn’t want to consider or talk about such a “ghoulish” subject.

In 2008 before the Republican Presidential Primary, I had a brainstorm.  I thought, “One way to get publicity for anything is to run for President of the United States but I’ll do it on just the issue of legalizing organ sales.”

Well,  I did it on a shoestring and sure enough I got some publicity and even got a story in the Des Moines, Iowa paper.  Unfortunately John McCain got the nomination and my plan was no longer of interest to the news media.

I say the idea is still good.  I’ve tried to improve it along the way; tried to address all the obvious objections.  But I’m sure I’ve missed a few.  Now you get to give us your thoughts.  Let’s work together and create a huge supply of organs.


The David Diamond Plan to increase the supply of transplantable organs by making the sale of human organs legal in the United States.

The Federal Organ Transplant law needs to be changed.

The Federal Organ Transplant Law enacted in 1984 provides that only donated organs may be used. The following plan to increase the supply of organs for transplant was developed in subsequent years by David F. Diamond of Memphis, Tennessee.
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The shortage of organs is taking the lives of almost 7,000 people unnecessarily each year. Donation is good. It is the highest altruistic step that a person can contemplate. However, for a number of reasons, many people are not willing to donate. The solution is to provide a regulated system allowing the organs of cadavers to be sold as follows:

A. A contract can provide that when a person has decided, for whatever reasons, not to donate organs, he or she (hereafter: the provider) can commit to a plan to have the organs sold if and when the provider is brain dead. This contract will also be signed by the next of kin, spouse or nearest living relative so that that party understands the purpose of the contract and agrees that they will not oppose its implementation when the provider dies. A provider’s option to cancel the contract at any time prior to the provider’s death will be included in the contract. The use of this contract will allow the provider to leave an estate to his heirs or a designated charity. A provider, with few or no assets, might otherwise have none to leave when he or she passed.

B. The sale of organs can be conducted by a broker, attorney or individual (hereafter: an agent) designated by the provider. A licensing procedure would establish that the agent would be certified as fiscally responsible and having financial integrity. Upon determination of brain death, the agent selected by the provider, using email, fax or phones, would immediately advise interested buyers of an organ’s availability and condition, etc. Time would be of the essence, of course. Appropriate compensation to the agent, such as a commission for services provided, would be set forth in the contract. Buyers whose bids were accepted would send payment by wire transfer, cashier’s check or other means approved in the law.

C. The party designated by the provider must maintain a public record (like a broadcaster’s log which is available for public viewing) specifying the individual who gets the organs, how much is being paid and the identification of the provider. The purpose of this transparency is to eliminate the need for a black market, and to stimulate public awareness. If there is a public record, as soon as organ sales begin, the news media will undoubtedly write about it pointing out how much money was involved in the transactions and stressing how much money goes to the heirs. This will persuade a lot of additional people to agree to such a contract, thus increasing supply exponentially. Through the action of the law of supply and demand, the increased supply will cause prices to decrease to a level most people will consider reasonable. Unless you allow prices to be set by the market process you put a limit on the number of organs that might become available. Any fixed price, set by government or a special agency, would diminish the supply which would defeat the goal of making the most organs available. That would cause some individuals to decide not to participate. But if they knew that the organs they might provide are going to bring whatever the market process allows, they’ll have every incentive to take part.

D. The organs would have to be sold only for transplant to U. S. citizens in order to avoid foreigners from bidding up the price and reducing the supply to Americans. Of course, if other countries should adopt model legislation such as ours then we could reciprocate and become partners with them since their organ supply could be shared with ours.

E. The poor will not be discriminated against. They will have access to organs because the law will provide that, just as in Medicare or Medicaid presently, the government will pay for any medical procedure or supplies that the patient needs, upon a doctor’s certification that it is medically necessary. The government would buy organs on the market for those with Medicare or Medicaid unless donated organs were available. The same principle will apply for those with health insurance. And the wealthy, who may choose to be self insured, would be free to arrange for organs in the same market. Of course, people would still be free to donate organs. And participation by providers in the futures contracts would be entirely voluntary.

F. Presently those uninsured or poor, not covered by Medicare or Medicaid, have to raise tens of thousands of dollars before hospitals or transplant surgeons will help them. The added cost of an organ can also be raised in the same way, or the law can require our government to cover that cost, since it will be less costly over time than dealing with whatever the patient’s medical expenses would be otherwise.

G. The plan will require providers to have their medical records maintained by their doctors beginning at least as soon as a futures contract is signed. It would be made available immediately to any parties potentially buying an organ from that cadaver. The purpose, and the result, would be to assure a better, safer organ supply. This plan does not contemplate any sale of kidneys or parts of livers from a living person. There are risks in having such surgery and for that reason and others, we set that aside and take no position on that question. Sometimes, under current law, it is the right thing to do, depending on the circumstances. But in point of fact, the need for such organs will be adequately supplied with adoption of my plan.

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The proposal I’m offering will be, of course, subject to improvement and modification by the federal legislature. Meanwhile, I welcome and will entertain seriously any changes so long as they do no damage to this essential requirement: We have to let the law of supply and demand work in order to maximize the number of organs that will be made available.

David Diamond 82, lives in Memphis, Tennessee.  He is  a retired TV and radio commercial spokesman, an actor, a freelance broadcast sports producer, and a marketing and public relations consultant.

Following four years of service (1953-1957) as a Russian language technician in the U.S. Air Force, Diamond studied foreign affairs at George Washington University in the late 1950’s. He also worked for Maryland state senator Newton I. Steers, Jr: as congressional and state senatorial campaign manager.

Other endeavors include:

·         Serving as executive assistant and deputy commissioner in the Maryland Insurance Department;

·         Legislative assistant in the state capitol in Annapolis.

·         Office manager for U.S Senator Charles McC Mathias.

·         News anchor for WTAE radio; radio/TV

·         News director for the 1973 National Boy Scout Jamboree;

·         Managed a successful congressional primary campaign for Robert Casey

·         From 1982 to 1991 he was the national commercial voice for the Levitz Furniture chain.

IF THE COMMENT SECTION IS NOT VISIBLE GO TO THE TOP OF THE PAGE AND CLICK ON THE NUMBER IN THE CIRCLE IN THE RIGHT HAND CORNER AND IT WILL APPEAR OR.you can email David F. Diamond at david.f.diamond@gmail.com or Bob Aronson at bob@baronson.org 

Bob informal 3Bob Aronson of Bob’s Newheart is a 2007 heart transplant recipient, the founder of Facebook’s nearly 3,000 member Organ Transplant Initiative and the author of most of these donation/transplantation blogs.

You may comment in the space provided or email your thoughts to me at bob@baronson.org. And – please spread the word about the immediate need for more organ donors. There is nothing you can do that is of greater importance. If you convince one person to be an organ and tissue donor you may save or positively affect over 60 lives. Some of those lives may be people you know and love.

Please view our music video “Dawn Anita The Gift of Life” on YouTube https://www.youtube.com/watch?v=eYFFJoHJwHs.  This video is free to anyone who wants to use it and no permission is needed.

If you want to spread the word personally about organ donation, we have another PowerPoint slide show for your use free and without permission. JAgain, write to me and ask for “Life Pass It On.”  I will email it to you immediately.  This is NOT a stand-alone show; it needs a presenter but is professionally produced and factually sound.  If you decide to use the show I will  also send you a free copy of my e-book, “How to Get a Standing “O” that will help you with presentation skills. Just write to bob@baronson.org and I will send the show and book ASAP.

Also…there is more information on this blog site about other donation/transplantation issues. Additionally we would love to have you join our Facebook group, Organ Transplant Initiative  (OTI).  The more members we get the greater our clout with decision makers.

En Espanol

Bob Aronson de Newheart de Bob es un centro receptor de trasplante 2007, el fundador de la Iniciativa de Facebook cerca de 3.000 miembros de trasplantes de órganos y el autor de la mayoría de estos blogs de donación / trasplante.

Usted puede dejar un comentario en el espacio proporcionado o por correo electrónico a sus pensamientos a mí en bob@baronson.org. Y – por favor difundir la palabra acerca de la necesidad inmediata de más donantes de órganos. No hay nada que puedas hacer lo que es de mayor importancia. Si se convence a una persona para ser un donante de órganos y tejidos puede salvar o positivamente afectará a más de 60 vidas. Algunas de esas vidas puede haber gente que conoces y amas.

Por favor, vea nuestro video musical “Dawn Anita The Gift of Life” en YouTube https://www.youtube.com/watch?v=eYFFJoHJwHs. Este video es libre para cualquier persona que quiera usarlo y no se necesita permiso.

Si quieres correr la voz personal sobre la donación de órganos, tenemos otra presentación de PowerPoint para su uso gratuito y sin permiso. JAgain, escribir a mí y pedir “Life Pass It On.” Voy a enviar por correo electrónico a usted inmediatamente Esto no es un espectáculo independiente,. Necesita un presentador, pero es producido profesionalmente y objetivamente sonido Si usted decide utilizar el archivo. demuestro que también le enviará una copia gratuita de mi libro electrónico, “Cómo obtener un Standing” O “que le ayudará con habilidades de presentación. Sólo escribo bob@baronson.org y enviaré el programa y el libro lo antes posible.

Además … hay más información sobre este sitio de blogs de otros temas de donación / trasplante. Además, nos encantaría que te unas a nuestro grupo de Facebook, la Iniciativa de Trasplante de Órganos (OTI). Cuantos más miembros que tienen la mayor influencia en nuestra toma de decisiones.

IF THE COMMENT SECTION IS NOT VISIBLE GO TO THE TOP OF THE PAGE AND CLICK ON THE NUMBER IN THE CIRCLE IN THE RIGHT HAND CORNER AND IT WILL APPEAR OR.you can email David F. Diamond at david.f.diamond@gmail.com or Bob Aronson at bob@baronson.org 


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The Future Of Organ Transplants — No Waiting!


Since the National Organ Transplant Act (NOTA) went into effect in 1984 we have had a shortage of transplantable organs and there doesn’t seem to be any way we will ever not have a shortage as long as we depend on altruistic donation of “natural” organs.
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There are two ways to end the transplantable organ shortage.  One is to prevent organ damage by living healthier lives and the other is to find the means to develop and provide artificial organs which can be mechanical, biological or a combination of the two.
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Popular Science  magazine has been around as long as I can remember and has always fascinated me with its reports on astonishing achievements in science and technology.  The information below comes from one of their issues.  Read these stories with the expectation that a future where there is no waiting for a transplant is possible.  If these reports are accurate the days of organ shortages could be numbered and we will be able to put a stop to the ever increasing number of people who die waiting for an organ transplant. .
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Video: The Doctors Who Made the No-Pulse Heart

              By Jeremiah Zagar                  Posted 02.29.2012 at 2:04 pm                  9
       

Heart Stop Beating is a three-minute documentary film about the no-pulse, continuous-flow artificial heart, which Dan Baum writes about in our Future of Medicine issue. It tells the story of Billy Cohn & Bud Frazier, two visionary doctors from the Texas Heart Institute, who in March of 2011 successfully replaced a dying man’s heart with the device they developed, proving that life was possible without a pulse or a heart beat.

Feature

No Pulse: How Doctors Reinvented The Human Heart

      This 10,000-rpm, no-pulse artificial heart doesn’t resemble an organic heart–and might be all the better for it
              By Dan Baum                  Posted 02.29.2012 at 12:13 pm                  37 Comments
       

Meeko the calf stood nuzzling a pile of hay. He didn’t seem to have much appetite, and he looked a little bored. Every now and then, he glanced up, as though wondering why so many people with clipboards were standing around watching him.

Fourteen hours earlier, I’d watched doctors lift Meeko’s heart from his body and place it, still beating, in a plastic dish. He looked no worse for the experience, whisking away a fly with his tail as he nibbled, demonstrably alive—though above his head, a monitor showed a flatlined pulse. I held a stethoscope to his warm, fragrant flank and heard, instead of the deep lub-dub of a heartbeat, what sounded like a dentist’s drill or the underwater whine of an outboard motor. Something was keeping Meeko alive, but it was nothing like a heart.

Japanese Researchers Create a Pituitary Gland From Scratch in the Lab

              By Clay Dillow                  Posted 11.10.2011 at 11:08 am                  10 Comments
       

The thing about growing working organs in the lab is that the whole enterprise is completely mind-blowing. Yet we just keep doing it, and so we keep blowing minds. The latest: a team of researchers at Japan’s RIKEN Center–the same group who earlier this year engineered a mouse retina that is the most complex tissue ever engineered–have now derived a working pituitary gland from mouse stem cells.

Feature

State of the Bionic Art: The Best Replacements for My Flimsy Human Parts

      In the event of some horrible accident, which bionic parts would I want replacing my own?
              By Dan Nosowitz                  Posted 08.23.2011 at 2:00 pm                  5 Comments
       

We cover biomedical science and engineering a lot, and sometimes I get to wondering: if I was rebuilding my own flimsy, flesh-based body–presumably because I’d had some ghastly dismembering, eviscerating accident–and replacing my limbs, joints, senses, and organs with the most futuristic, top-of-the-line bionics, what would I get? Would I want an artificial lower leg that sprinters use in Olympic-level races, or a motorized leg that can climb a slope as well as a natural leg? I gathered a list of 15 bionic body parts that I’d want to wear, or have installed.

Click to launch a tour of the body parts I’d want in the event of an accident.

A New Artificial Lung Can Breathe Regular Air Rather Than Purified Oxygen

              By Clay Dillow                  Posted 07.26.2011 at 5:06 pm                  10 Comments
       

Researchers in Cleveland have built an artificial lung that is so efficient it can breathe regular air rather than the pure oxygen required by current artificial lungs. The technology makes possible the idea of a man-made lung that is far more portable–and possibly implantable–for the nearly 200 million people suffering from some degree of lung disease.

Lab Builds a Fully Functioning Artificial Small Intestine

              By Rebecca Boyle                  Posted 07.06.2011 at 11:56 am                  5 Comments
       

California researchers have created a tissue-engineered small-scale small intestine in mice, a breakthrough for regenerative medicine and a step toward growing new intestines for humans. The process re-creates all the layers of cells that make up a functioning intestine.

Diabetes Researchers Report New Steps Towards the First Artificial Pancreas

              By Rebecca Boyle                  Posted 06.27.2011 at 1:43 pm                  2 Comments
       

Private companies and hospital researchers are increasingly making strides toward developing an artificial pancreas, supplanting insulin injections and pinpricks for patients with diabetes. Such a system would mimic the functions of a healthy pancreas, delivering insulin and monitoring blood sugar according to a computer’s careful calculations.

This Lung-On-A-Chip Is The First Lab-Ready Mini-Organ to Be Used in Drug Research

              By Victor Zapana                  Posted 10.08.2010 at 11:15 am                  5 Comments
       

This ersatz lung, no bigger than a multivitamin, could represent a new pharmaceutical testing method. On it, researchers have created an artificial alveolus, one of the sacs in the lungs where oxygen crosses a membrane to enter the body’s blood vessels. A polymer sheet that stands in for the membrane is in the blue strip. On one side of the sheet, blood-vessel cells mimic a capillary wall; on the other, lung-cancer cells mimic lung epithelial cells.

Bob Aronson of Bob’s Newheart is a 2007 heart transplant recipient, the founder of Facebook’s nearly 2,500 member Organ Transplant Initiative and the author of most of these donation/transplantation blogs.

You may comment in the space provided or email your thoughts to me at bob@baronson.org. And – please spread the word about the immediate need for more organ donors. There is nothing you can do that is of greater importance. If you convince one person to be an organ and tissue donor you may save or positively affect over 60 lives. Some of those lives may be people you know and love.

Please view our video “Thank You From the Bottom of my Donor’s heart” on http://www.organti.org This video was produced to promote organ donation so it is free and no permission is needed for its use.

If you want to spread the word personally about organ donation, we have another PowerPoint slide show for your use free and without permission. Just go to http://www.organti.org and click on “Life Pass It On” on the left side of the screen and then just follow the directions. This is NOT a stand-alone show; it needs a presenter but is professionally produced and factually sound. If you decide to use the show I will send you a free copy of my e-book, “How to Get a Standing “O” that will help you with presentation skills. Just write to bob@baronson.org and usually you will get a copy the same day.

Also…there is more information on this blog site about other donation/transplantation issues. Additionally we would love to have you join our Facebook group, Organ Transplant Initiative The more members we get the greater our clout with decision makers

UNOS CEO: Study Could Redefine “Medically Suitable” Donors


On August 11, I sent a letter to Walter Graham, CEO of the United Network for Organ Sharing (UNOS) asking what UNOS was doing or was going to do to increase the supply of organs. My letter noted that the number of transplants performed each year has plateaued at about 28,000 while the number of people on the list continues to grow.  Today there are 114,899 people waiting and so far this year there have been 11,469 transplants from 5,677 donors.   As you can see, the gap continues to widen.  With only four months left this year we may fall far short of the 28,000 number.

Below you will first find my letter to Mr. Graham, followed by his response.  You can decide if he responded to my concerns and most importantly, your concerns about how our national donation/transplantation system is managed.

August 11,2012

Walter Graham

Chief Executive Officer

United Network For Organ Sharing

Richmond, Virginia

Dear Mr. Graham:

You might remember me as a Minneapolis, Minnesota based communications consultant that worked with UNOS in the 90’s.  During that period I was diagnosed with dilated cardiomyopathy and subsequently had a heart transplant at the Mayo clinic in Jacksonville, Florida in August of 2007.

I am writing not as a former consultant but rather as a very grateful heart transplant recipient, founder of Facebook’s nearly 2500 member Organ Transplant Initiative (OTI), author of over 120 blogs on donation/transplantation issues (www.bobsnewheart.wordpress.com)  where we have 100,000 readers and writer/producer of three videos on organ donation. I am a very active advocate for organ donation and have been for many years.

I’ll get right to the point.  I have a growing concern about the Inability of the altruistic system to meet the demands for organ transplants and UNOS’ reluctance to make or even recommend significant changes to the system.

I am quite aware of all the ethical and other arguments forwarded by UNOS for rejecting changes that would include presumed consent and donor incentives/compensation among others.  I am puzzled as to how UNOS can find these suggestions unethical or unworkable but has made no statement about the ethics of allowing people to die due to the failure of the altruistic system to generate enough transplantable organs.  How can it be ethical to allow an inadequate system to prevail?

Having been on that list I have first-hand experience with the depression that accompanies it, knowing that the government contractor that is funded with my tax dollars is doing little beyond promoting altruism to significantly increase the number of available organs.  It is discouraging and depressing for those on the list to continually hear that every option other than altruism is either unethical or unworkable.

I am hoping that you can offer some hope that I can pass on to members and other interested parties that the gap not only is closing but will close and soon.  Please offer some explanation other than renewed efforts at increasing altruism of just what UNOS is doing and will do to help those who are languishing on an ever growing list of people who need transplants.  Please prove me wrong.  I would be most grateful to see clear, compelling evidence that the altruistic system can work and is working.

It is almost 30 years since the National Organ Transplant Act (NOTA) was implemented..  I think that is plenty of time to determine if a system works.  Unless you can prove otherwise, It seems clear that with 114,000 people listed and only about 28,000 transplants done every year despite intense and noble efforts at increasing donation rates, altruism alone cannot meet the demand – ever.  .

Please respond as soon as possible.  I plan to publish my letter to you and your response side by side.

Thank you for your consideration and time

Bob Aronson

Return letter from Walter Graham

Received on August 22, 2012

Dear Bob:

Thank you for your letter, and yes, we remember your valuable contributions to us as a consultant in the 1990s.  We are glad you continue to do well with your transplant and engage the public in this vital cause.

Your concern regarding the shortage between available donors and the needs of waiting candidates is widely shared.  Our ultimate goal and fondest hope is to be able to provide transplants for all candidates in need, to prevent deaths and needless suffering while waiting.

As you may recall from your work with us, the primary mandate of UNOS as operator of the national Organ Procurement and Transplantation Network (OPTN) is to allocate organs from deceased donors equitably among transplant candidates.  Other significant roles, as specified in federal law and regulation, including maintaining a clinical database on all donors, candidates and recipients; monitoring compliance with OPTN policies; and investigating donation- or transplant-related issues that may pose a risk to the health and safety of transplant patients, living donors or the public.

Promoting organ donation is interwoven among all of our responsibilities, and transplantation depends entirely on the public’s willingness to donate.  That said, managing the organ donation system is not a fundamental mandate that federal law or regulation has assigned to us.  Our essential responsibility is to make sure that available organs are used in the most responsible and effective way possible.

State and federal law governs the process of donation in the United States.  Any change to the current voluntary nature of donation, whether that would involve preferred consent, financial incentives, preferred status or other means, would involve a public initiative to amend the law.  UNOS, as a corporation, has declared its support of careful study of potential incentives, financial or non-financial, that would encourage donation while respecting individuals’ freedom of choice.  Such study may involve legislative efforts to suspend the law to allow examination of the results.  As a federal contractor for the OPTN, UNOS cannot develop policies not supported by the law or expend limited resources lobbying for legislative changes beyond the OPTN’s mandate.

One of the fundamental questions UNOS is seeking to answer has to do with the potential number of persons who could qualify for deceased organ recovery.  Our Center for Transplant System Excellence is conducting a Deceased Donor Potential Study. This study will identify the total number of medical cases in which persons could be deceased organ donors regardless of issues of consent. The results of this study will provide a better understanding of what is possible. The merits of whether a system based on altruism is the best approach could then be understood in the context of what is possible. It may well be that the number of medically suitable cases as currently defined is not adequate in any circumstance.

Many people are convinced that the delicate nature of donation may be adversely affected by negative connotations or perceptions generated by controversy over debates about changes to the underlying legal system such as presumed consent. That being the case, it is prudent to pursue the DDP Study to learn what the potential might be before considering whether to advocate for a fundamental change.

Among key strategic goals for the OPTN are increasing the number of transplants performed and optimizing post-transplant survival.  Even with the current supply of donated organs, we can increase utilization of organs and enhance survival by better matching available organs with candidates who are the best long-term match.  In promoting organ donation, we actively support efforts such as those of Donate Life America, which has recently announced more than 100 million Americans have formally registered their wish to donate organs and tissues and has set an ambitious goal of 20 million new donor commitments this year.

We all agree a higher rate of donation is essential to save lives and relieve suffering of men, women and children anxiously awaiting an organ transplant.  UNOS and the OPTN are dedicated to helping save and enhance lives through organ allocation.  Whether society may be ready to adopt a new model for the process of organ donation is an important discussion that would involve society as a whole and active support of state and national lawmakers.

Walter Graham

CEO

Bob Aronson of Bob’s Newheart is a 2007 heart transplant recipient, the founder of Facebook’s nearly 2,500 member Organ Transplant Initiative and the author of most of these donation/transplantation blogs.

You may comment in the space provided or email your thoughts to me at bob@baronson.org. And – please spread the word about the immediate need for more organ donors. There is nothing you can do that is of greater importance. If you convince one person to be an organ and tissue donor you may save or positively affect over 60 lives. Some of those lives may be people you know and love.

Please view our video “Thank You From the Bottom of my Donor’s heart” on http://www.organti.org This video was produced to promote organ donation so it is free and no permission is needed for its use.

If you want to spread the word personally about organ donation, we have another PowerPoint slide show for your use free and without permission. Just go to http://www.organti.org and click on “Life Pass It On” on the left side of the screen and then just follow the directions. This is NOT a stand-alone show, it needs a presenter but is professionally produced and factually sound. If you decide to use the show I will send you a free copy of my e-book, “How to Get a Standing “O” that will help you with presentation skills. Just write to bob@baronson.org and usually you will get a copy the same day.

Also…there is more information on this blog site about other donation/transplantation issues. Additionally we would love to have you join our Facebook group, Organ Transplant Initiative The more members we get the greater our clout with decision makers.

Ethicist Needs Ethics Transplant


In an op-ed piece on MSNBC Arthur Caplan a University of Pennsylvania bioethicist suggested that Vice President Dick Cheney received a heart transplant because he was rich and influential.  Caplan implied, too, that Cheney at 71 was too old for a transplant and that the heart should have gone to a younger person.  I responded with this comment.

Up until today I had some respect for Dr. Caplan but upon reading his uninformed and arrogant musings on Vice President Cheney’s heart transplant and senior citizens, I not only lost all respect I find him pathetic and in need of an ethics transplant. 

I am a long time Democrat, a very vocal opponent of Mr. Cheney and everything he stands for and a transplant recipient who got a heart at age 68 and I’m neither rich nor influential yet I believe the former Vice President got his heart in the same fair and balanced manner in which I got mine.  In that sentence I just negated all of Caplan’s arguments.

Had Arthur Caplan taken a little bit of time to understand the donation/transplantation process he might have a different story.

As much as I dislike Dick Cheney he got his heart fairly and am convinced that his wealth and influence had nothing to do with it. The only discriminatory factor that prevailed is that you must be able to pay for a transplant whether privately or through insurance. Yes, that leaves a lot of people out of the mix but that’s another argument.  He was insured just as I was. Had we matched bank accounts I would have come out on the short end but it was insurance that paid not private wealth.

The United Network for Organ (UNOS) Sharing in Richmond, Virginia (a site I’ve visited many times, has Caplan?) is a U.S. government subcontractor that coordinates all organ transplants in the United States.  It has done so since its establishment under the National Organ Transplant Act (NOTA) in 1984.  Its computer system tracks and continually updates the national transplant list which includes nearly 114,000 Americans.  It is a very sophisticated process and it is blind.  The information in the system does not contain anyone’s name or rank or social standing or wealth it has medical information and the location for each patient.

Having been on the national waiting list I think I’m familiar with the process of how you get there and it is not easy.  First you must see a specialist in your disease at a transplant center where you are subjected to battery of tests to determine two things 1) are you a legitimate candidate for a transplant and 2) is it likely you’ll survive after the surgery.  If the physician determines you meet those criteria he or she presents your case to a hospital’s transplant committee and, if they agree, the patient’s information is sent to UNOS for listing.  Please note, you cannot get on the list unless a specialist physician certifies that you are dying, that a transplant is a last resort to save your life and that you will survive the surgery.

In the United States there are 58 Organ Procurement Organizations (OPOs) they are the federally mandated groups that work with transplant centers  and UNOS to identify potential donors and then with families and hospitals to coordinate the recovery of the organ and its transportation to the site of the recipient.  They have no knowledge at any time of who the recipient is.

Once it is clear that there will a donor organ the process begins to match blood type, tissue, size and other factors.  The match must be as close as possible to in order to limit rejection of the organ by the host body (once transplanted rejection is further limited by powerful drugs). While the intent is to get the organ to the sickest patient, it doesn’t always work out that way because sometime the sickest patient is not a good match for the available organ.

Here’s an example.  I had my transplant done at the Mayo Clinic in Jacksonville, Florida.  My heart came from South Carolina.  I don’t know all the details but here’s what likely happened.  First the heart was offered within the immediate area served by the OPO but there were apparently no good matches.  Then it was made available to outlying areas and they found me in an area that was in the jurisdiction of a different OPO altogether.  I was not the sickest (wasn’t even hospitalized) and certainly at age 68 was not the youngest, and I know I was not the richest but I was a match and I got the heart.  It is just as likely that the same thing could have happened for Mr. Cheney. 

It is also likely that had Cheney not gotten the heart, no one would because it wasn’t a match.  I doubt that someone else was deprived of an organ because Mr. Cheney got it.  Also, there is the question of distance.  An organ will only survive for a limited amount of time once removed from a body.  It must be transplanted as soon as possible.  Mr. Cheney was likely the best candidate within the range of the survivability of the organ. 

 And finally.  It may not be important to Dr. Caplan that those of us over 65 have a chance at getting a transplant and living several more years but it is to us.  How dare he imply that we seniors aren’t worth the time, money and effort to save.  His arrogance and lack of compassion reflects poorly on his ethical character.  How can the ethicist say that a certain segment of the population is “disposable.”  Is that ethical behavior?   Better unlock that ivory tower door Dr. Caplan.  Let some fresh air in.

Bob Aronson, a 2007 heart transplant recipient is the founder of Facebook’s 1700 member Organ Transplant Initiative and the writer of 110 blogs on donation/transplantation issues on Bob’s Newheart on WordPress. 

You may comment in the space provided or email your thoughts to me at bob@baronson.org. And – please spread the word about the immediate need for more organ donors. There is nothing you can do that is of greater importance. If you convince one person to be an organ and tissue donor you may save or positively affect over 60 lives. Some of those lives may be people you know and love.

 Please view our video “Thank You From the Bottom of my Donor’s heart” on http://www.organti.org This video was produced to promote organ donation so it is free and no permission is needed for its use.

If you want to spread the word personally about organ donation, we have a PowerPoint slide show for your use free and for use without permission.  Just go to http://www.organti.org and click on “Life Pass It On” on the left side of the screen and then just follow the directions.  This is NOT a stand-alone show, it needs a presenter but is professionally produced and factually sound.

 Also…there is more information on this blog site about other donation/transplantation issues. Additionally we would love to have you join our Facebook group, Organ Transplant Initiative The more members we get the greater our clout with decision makers.

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