Neediest Patients Should Get Organ Donations

14 April 2000

By Stentor Danielson

More than 4,000 people die each year waiting for an organ transplant. While much of this problem can be linked to an unfortunate scarcity of donors, the process of organ allocation has also come under scrutiny.

Last month, a mandate from the Department of Health and Human Services (HHS) targeted inefficient organ distribution by instituting a new system of determining which patients receive available organs.

The House of Representatives passed a bill earlier this month that would block such action by HHS and put sole control of organ distribution policy in the hands of the United Network for Organ Sharing (UNOS), the organization charged with overseeing organ distribution in the United States. The bill's implicit endorsement of the current geographical system runs counter to the intended purpose of organ donation.

Under the system currently used by UNOS, organs are first offered to patients in a small local area. HHS has instructed UNOS to offer each organ to the most needy case in a much larger region. This need-based system is more consistent with the best interests of the patients and the humanitarian intention of donors.

Organ donation is the ultimate charitable act. Because the buying and selling of organs is prohibited, the decision to become a donor can bring one no benefits other than the satisfaction of having done a good deed. At the same time, it costs the donor nothing, unlike other good deeds -- for example, donating to help stop world hunger or giving blood -- that take up the time or money of the donor.

It seems logical, then, that a person would join the distressingly small sector of the population made up of organ donors because he or she wants to save someone else's life. But opponents of HHS's decision have shifted the focus away from this basic motivation.

The foremost argument made against HHS is that the government has no place interfering in organ transplants. Rep. Michael Bilirakis, R-Fla., the House sponsor of the bill, suggested that organ donation is too important to trust to politicians.

However, this logic misses two key points about the situation. First, UNOS is an agent of the government. While it is still a private organization, UNOS was created in response to the National Organ Transplant Act of 1984, which authorized the formation of a national network to regulate organ allocation. The contract granted to UNOS gives it a sort of monopoly over organs. A monopoly of any kind should bear close scrutiny because of the inefficiency of such organizations.

Second, UNOS is not the sole voice of the medical community. A report issued last year by the highly respected National Institute of Medicine concluded that a more need-based system of organ distribution would be beneficial. UNOS should not be allowed to have the monopoly on the donor industry that Bilirakis' bill would give it.

Furthermore, giving HHS a say does not put all the power of organ allocation in the hands of the bureaucrats. HHS only mandates that organs be given first to those deemed -- by the physicians -- to be most needy.

Along with the political power struggle inherent in HHS's attempt to tell UNOS what to do, people disagree over whether the current geographical system or the need-based system mandated by HHS is better.

Proponents of the geographical system cite a variety of advantages. For starters, some contend that keeping organs in the area encourages people who would not otherwise donate to do so. They argue that changing the system would decrease the organ supply.

These arguments do not hold up under the National Institute of Medicine study, which indicated that there would be no significant drop in donation if organs were distributed to a wider area. After all, most Americans are ignorant as to where their organs go. This makes sense -- I do not recall that the potential destination of my organs ever being mentioned -- by person or pamphlet -- when I got the "organ donor" designation put on my driver's license.

Supporters of Bilirakis' bill also contend that the need-based system seems biased toward large organ distribution centers. As there is more demand for organs at larger centers, supporters of Bilirakis' bill fear that these centers will siphon organs away from smaller centers. Such occurrences would have economic consequences because where organs go, transplant fees follow.

While this may be true, the alternative is denying organs to the neediest patients. By taking a financial component into account, Bilirakis' supporters are placing money above the medical establishment's commitment to saving lives.

In line with this argument is the assertion that the current system rewards "good" states that have invested in organ donor education. Increased spending leads to more organs donated, which leads to improved health. But when organs are distributed more widely, states that have invested less can reap the rewards earned by their neighbors. For example, Wisconsin fears that its efforts to increase donation may not pay off if its organs begin to be shipped to organ-hungry Chicago.

The fundamental question raised here is: Should organs be given to the states who deserve them or the people who need them? I know that I, for one, signed up to donate my organs to dying people, not the state of Pennsylvania.

The purpose of a national organ donation coordinating body is to save the lives of the many people awaiting transplants. Donations are made to aid the medical community in saving lives. The aim of saving the most lives must, therefore, be of the greatest concern when creating organ distribution policies.

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