Compensating organ donors

November 16, 1998|By Froma Harrop

DANIEL CANAL is the 13-year-old who, since May, has had 12 organs transplanted into his body. He's now out of the medical woods and eating his first solid food -- chicken tenders and French fries from Burger King.

Not long ago, transplanting a kidney from one body into another was an awesome event. Today, however, it's a fairly routine procedure: 11,000 kidneys were transplanted last year. Unfortunately, as the number of lives that can be saved by organ transplants continues to rise, so do the number of people who die because an organ cannot be found in time. This need not be. And it would not be if our society could accept some system of compensating donors or their families for their kindness.

The truth of the matter is that there is no shortage of suitable organs for transplant. There just aren't enough organ donors -- the good people who sign agreements to make a gift of their organs for transplantation at the time of their deaths. In the United States, there are only 21 donors per million population. Right now, some 60,000 Americans linger on waiting lists for organs. About 4,000 of them will die over the next year waiting.

A painful shortage

Meanwhile, federal regulators write contorted policies to make the shortage less painful. Last month, the Department of Health and Human Services finished work on a regulation that would make the availability of organs less an accident of geography. The highest priority would go to the sickest people on the waiting lists.

That change should help families like the Canals. They belong to a nomadic tribe of Americans living out of suitcases in the hope that an organ will be found in a far-off medical center. The Canals moved three times -- from California to Washington, D.C., to Miami -- so that they could increase Daniel's chances of reaching the top of a waiting list. However, changes in rules for allocating scarce commodities tend to create imbalances elsewhere. The federal government rule has intensified a turf war between smaller transplant programs and the large centers where the neediest patients are often located.

Again, our society could sweep away today's baroque system for allocating organs if it would offer some financial incentives for organ donation. Those who oppose allowing any transfer of money for organ donations do offer compelling arguments. They fear that it would produce a frightening market for body parts. The prospect of people getting killed for their organs -- or simply being allowed to die unnecessarily -- is indeed gruesome. And there are scary stories: impoverished people selling organs; dictatorships accelerating executions of criminals to obtain valuable livers, hearts and kidneys.

Driver's license fee

Clearly, any system for compensating donors must be carefully designed. But that can be done. One suggestion is to waive the driver's license-renewal fee of any motorist who agrees to become an organ donor.

This incentive amounts to just a few dollars but would sway lots of Americans who would like to participate in the program but need a little extra push to actually sign the donor's card. Another proposal is to help pay the funeral expenses of someone whose organs had been taken at time of death. The money would go directly to the funeral home. Note that neither idea promotes direct payment for organs. There is no benefit for hastening anyone's death.

The miraculous story of Daniel Canal shows how far organ-transplant technology has progressed. A patient at the University of Miami's Jackson Children's Hospital, Daniel was given a new liver, pancreas, small intestine and stomach last May.

After the transplant, his small intestine stopped working, and he almost died. In June, he received another set of the four organs, but his body rejected them. Last month, doctors tried again, giving him his third liver/pancreas/small intestine/stomach transplant. These seemed to take.

Routine operations

Many of us remember waiting breathlessly as Dr. Christian Barnard performed the first heart-transplant operation in 1967. Last year, more than 2,000 hearts were transplanted with little fanfare in the United States alone.

Transplants are no longer a novelty and more people can benefit from them. But as long as our society relies solely on the generous few who agree to make a gift of their organs, the supply is unlikely to catch up with the demand. As a result, many people will needlessly die.

Froma Harrop is a Providence Journal editorial writer and columnist.

Pub Date: 11/16/98

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