Better care for accidents victims, increased seat belt use and tougher drunken driving laws have saved more lives, but not without a cost -- fewer organ donors for patients needing transplants.
Because the number of typical donors of the past -- the 18- to 35-year-old accident victims -- is decreasing, officials at Johns Hopkins Hospital are stepping up efforts to find more people willing to donate organs and are considering elderly donors who might not have been candidates before.
The hospital's efforts to increase public awareness about the need for organ donors includes an education program for religious leaders to inform them about ways they can spread the word among their congregations.
"A lot of things have happened that have decreased the donor pool," said Greta Cuccia, Hopkins' new donor advocate.
"The seat belt laws, kids safety seat laws, drunk driving laws, the 55 mles per hour speed limit and better trauma care increasing the survival rate of patients -- all of these things have affected the donor pool," she said.
Combine the lack of available organs with increased public knowledge about transplants as a medical option, and it means a need for more education about organ donation -- both by the general public and those in medicine, Ms. Cuccia said.
In 1988, state legislators adopted the federal Required Request Law, which said that the next of kin of anyone who died would be presented the option of organ donation. That doesn't always happen, she said.
"Sometimes it is difficult for the health care professional to deal with grieving families," she said. "Losing a patient can be difficult for a physician. They sometimes feel a conflict of going to someone and saying, 'Sorry you lost your son, but will you donate an organ for transplant?' "
If families are not offered the donor organ option, "then you are making that decision for the family already," Ms. Cuccia said.
Hopkins, which serves most of the transplant patients in the Baltimore area, currently has 282 people in the Baltimore metropolitan area on waiting lists for heart, liver, pancreas-kidney, heart-lung and kidney transplants.
Charles Riegger, a 32-year-old former Towson State football player, was on one of those lists, waiting for a heart transplant. Doctors discovered last summer that Mr. Riegger developed cardiomyopathy, a chronic heart muscle disorder that often leads to heart failure. Mr. Riegger was luckier than many, in that his wait was only four months. But his need was critical, and that October morning when doctors told him they had a donor came none too soon.
"My heart had stopped beating three times while I was on the waiting list, and they had to revive me," said Mr. Riegger, a Parkville electronics parts salesman and the father of three daughters.
"I was given last rites a couple of times when I was in Hopkins," hesaid. He had been put on an experimental device that helped pump his heart for nearly two months before he received his transplant. Two other patients at Hopkins had used the device, but had died before a suitable donor could be found.
Mr. Riegger said the experience has given him a new perspective on life. "It has made me appreciate waking up in the morning and being able to see daylight and breath normally," he said.
Mr. Riegger has been recovering at home, going in every few weeks for biopsies and otherwise monitoring his vital signs to make sure the body does not reject the organ. So far, so good. "I'm getting stronger by the week," he said. He plans on going back to work in mid-January.
He is a soldier now in the campaign to increase donor awareness. "It's the ultimate way to help your fellow human beings," he said.
Dr. Martin Donner has several perspectives on organ donation. He is a doctor who is also awaiting a heart transplant. The former head of radiology at Hopkins, Dr. Donner has been waiting more than five months for a suitable donor.
After his transplant, Dr. Donner, a native German, hopes to became an educator to stress the need for organ donations. "In some parts of Europe, there is presumed consent that all people are organ donors unless the families specify differently," Dr. Donner said. "Here it is just the opposite."
Because of the donor shortage, Ms. Cuccia said doctors are expanding their pool for potential donors.
"Eight years ago, they wouldn't look at anyone past 35 or 40 years old," she said. "Now they are considering donors 70 years old and older." However, organs from older donors are often limited because of medical unsuitability, she said. "Usually it's the kidneys or liver, depending on the health of the donor."
The biggest hope is to improve public awareness and increase education in the health care community about organ donation, Ms. Cuccia said. "Hopkins is making it a priority to make donations a normal everyday standard of care," she said.
The campaign will include working with religious leaders about organ donation and its implications, Ms. Cuccia said.
"Religious leaders have asked to be educated about donations so they can make their own decisions to teach their congregations," she said.