April 18, 2024


The United States, like other nations, is facing a huge shortage of organs. At the moment, there are 92, 400 Americans waiting for organs — mostly kidneys — but only 14,500 people donated them last year. People are waiting up to five years for a match — longer than the median survival rate in many cases. Bad as this news is, prospects for the future look worse. One result of the so-called obesity epidemic is that the number of patients with kidney failure as a result of diabetes and high blood pressure will probably soar. The crisis is already provoking discussion of radical solutions. Some of these were raised at the World Transplant Congress in Boston last month.

Since most donors are dead, an obvious solution is to enlarge the pool of dead people. Most potential donors and their relatives believe that doctors take organs only from brain-dead people. However, redefining death as what happens when your heart beat stops, not when your brain waves flatline, will increase the number of American bodies available for organ harvesting by 22,000. This is an option backed by the US Institute of Medicine in a report earlier this year. Strong support from the British government has increased the number of "donors after cardiac death" by six-fold in the last 15 years. Not all doctors agree with this. Like Lazarus, some patients do recover after their breathing and heartbeat have stopped. However, more and more hospitals are using this definition — and even expanding it. Just to make sure that the patient is really dead, transplant surgeons used to wait 10 minutes. This interval is dropping to 5 minutes, and three American centres are using a two-minute interval.

There are other options, too — all highly controversial. The Institute of Medicine baulked at paying organ donors, but a number of bioethicists, libertarians and free-market conservatives contend that this is the only way to meet the shortage. "I resisted all market mechanisms because of the risk of injustice," says Robert Veach, of Georgetown University. "I think we’ve waited long enough. There are too many people dying. I think it’s time to begin limited experiments with cash payments." Sally Satel, a doctor and well- known conservative pundit, wrote in the New York Times earlier this year that repugnance at selling body parts is outdated. Markets for human eggs, sperm and surrogate mothers already exist and are no longer controversial, she argued. What’s different about organs?

Other contentious ideas have also been mooted. These include classifying patients in permanent vegetative states or unconscious comas as dead, including high-risk donors such as intravenous drug users or homosexuals, and allowing committed donors to go higher on waiting lists. Some patients cut waiting times themselves by buying organs on the black market in developing countries. With the gap between patients and donors widening, there will be increasing pressure to implement some of these schemes, however far-fetched they now seem.