Although most of us give little thought to organ donation, an extraordinary system orchestrates the transfer of life to someone in desperate need.
Megan Slough and Geoffrey Kabat
Renewing your driver’s license at the DMV is one of those mundane chores modern life imposes on us. We wait for our number to be called, to have our eyes checked, and verify our address. Only at the last step of the process are we confronted with a question that is of a very different order – one that opens out from our circumscribed life to thinking about others. We are asked whether we want to register as an organ donor or, if we have registered in the past, to continue as a donor. There is no time for reflection or for a tutorial on organ donation, so we respond to this question based on what we already know or don’t know, and on deep-seated emotions.
Few of us think about the implications of the decision that we are being asked to make. And most people have very limited knowledge about the organ donation system. For many of us, our information comes from T.V. and the movies. Unless you yourself, or a loved one, have had your life turned upside-down, and are now in need of an organ transplant to continue living, and unless you are on that donor list waiting for the call, you are unlikely to think about it.
This is hardly surprising, given our reluctance to think about our own demise and the use our organs would be put to after we’re gone.
Since the organ transplantation program is such a vital resource, bringing together recipients and donors, it’s important to have a basic understanding of how the system works.
Even though surveys indicate that 95% of adults in the U.S. support organ donation, only 54% are registered. And that number varies dramatically depending on which state you’re in. For example, in Washington State, 85% of residents and in Montana 89% of residents are registered, whereas in New York only 26% of residents are registered. Why is the response rate so low in New York and some other states? And what factors influence whether one signs up to be a donor?
It is likely that many factors influence registration rates. However, one factor that has been identified as a contributor is mistrust of doctors. People fear that the surgeon who treats you will not wait until there is a complete, irreversible loss of brain function, thereby cutting your life short. As understandable as this fear is, in truth, health care professionals are motivated to save every life that comes into the emergency room, regardless of whether a person is on the donor list or not. That is their job, and it is instilled in them with the Hippocratic Oath.
Since the nation-wide organ transplantation system was established in the mid-1980s, the number of transplants performed each year has increased, reaching 34,800 in 2017. Sixteen thousand four-hundred donors were the source of the transplanted organs. The most commonly transplanted organs are: kidney, liver, heart, lungs, pancreas, and intestines. Even more people receive other tissues, corneas restoring sight, bones, skin, and heart valves. Up to 8 people’s lives can be saved by just one donor, and up to 50 people can benefit from one donor.
After someone’s organ starts to fail and that person needs a transplant in order to survive, a thorough evaluation is done at a transplant center. If the person is a good candidate, she/he will be put on the national transplant waiting list. Another fear some people have is that the list can be manipulated, and individuals who are wealthy and well-connected can move up on the list, as we see in some TV shows. However, this is not the case in the U.S. The integrity of the list is scrupulously maintained, and the only factors that are used to find a match are blood type, body size, how sick the patient is, tissue type, and the time spent on the waiting list. Organs are never matched based on race, gender, income, or social status.
Once a recipient is put on the list, all that is left is to wait for a donor. Unfortunately, there is a growing gap between the number of people placed on the list and the number registering as donors. In 2017, the number of people in need of a lifesaving organ transplant was 115,400, and, of these, 75,000 were active waiting list candidates. Thus, only one-third to one-half of those on the waiting list end up receiving a transplant in a given year. On average, 18 people on the waiting list die each day for lack of a needed organ.
Most organ transplants come from deceased donors. A typical scenario involves a person brought to the hospital with a life-threatening brain injury due to a car accident, stroke, or oxygen deprivation. Whether the person is on the list or not, which is not even considered, the doctors will work hard to save the life. If their efforts fail, the patient is proclaimed both clinically and legally dead. This is the pivotal moment at which one’s registration as a donor can transform the end of a life into the possibility of extending someone else’s life.
But now, time is of the essence. Most organs only last about 8 hours outside the body; the kidneys can last a little longer, from 24 to 36 hours. A separate team of surgeons is in charge of the organ transplantation. Recovering first the life-saving organs and other tissues, they check the waiting list for a match, and someone is given a second chance at life.
In view of the unforgiving arithmetic governing transplants, the best way to help more people is to increase donor registration. If we increased the proportion of registered donors nationally by just 10% (from 54% to 64%), we could perform an additional 6,400 transplants per year, bringing the yearly total to over 41,000.
There is no age limit on who can donate. In the U.S., the oldest donor so far was a 92-year-old man, who donated his liver to save a 69-year-old woman.
Organ transplants prolong life, but do not last forever. Of the 115,000 people on the waiting list, 83% of them are waiting for a kidney. Even with the majority of the donations coming from deceased donors, after 1 year around 93% of transplanted kidneys are still working, after 3 years 86%, and, after 10 years, only 54% of transplants are working. Heart and liver success rates are similar with around 70-75% of transplants still in good working condition after 5 years. Tissue transplants, such as corneas, have a very high success rate, and recipients rarely need re-transplant. With enough donors, people can keep extending their lives, even after their first transplant is done.
If you are inspired and want to save a life, it is very easy to register to become a donor. Some states even allow you to specify which organs you want to donate. You don’t even need to wait the 2 hours at the DMV. You can sign up right now online, at https://organdonor.gov or simply go to your state’s motor vehicle website, where you can update your status.
In a society in which almost everything has a price, the decision to donate your organs in order to save, or enhance, the life of someone you will never know reminds us that we share a deep connection with others and have the ability to bestow an invaluable gift.
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Megan Slough is a graduate student in the Department of Microbiology and Immunology at the Albert Einstein College of Medicine. Geoffrey Kabat is a cancer epidemiologist in the Department of Epidemiology and Population Health, also at Einstein.
