Organ Insurgents vs. Organ Bureaucrats

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One of the
biggest stories in organ-donation circles these days is the rise
of private efforts to increase the supply of organs for transplant
operations. The organ bureaucracy is trying to stop them, but the
law is on the side of the organ insurgents.

The organ insurgents
are acting because the organ bureaucracy seems to have run out of
strategies to reduce the organ shortage. Over 6,000 Americans die
every year waiting for transplants, and the shortage continues to
get larger with no end in sight. Every year, about 40,000 new names
are added to the transplant waiting list. Millions of dollars have
been spent trying to convince Americans to donate their organs when
they die. These efforts have not reduced the shortage, even with
the addition of live organ donation to the equation. Live organ
donors now provide about half of the organs transplanted in the
United States every year.

The 90,000
Americans now on the national transplant waiting list are literally
staring death in the face. About 60% of them will die before they
get one. The waiting list has become a "waiting to die"

Unwilling to
consign their fate to a system that seems destined to fail them,
more and more Americans have been taking the search for life-saving
organs into their own hands.

Todd Krampitz
of Houston needed a kidney transplant. He advertised for a directed
donation from a deceased donor. His billboards attracted national
press coverage. He got the kidney he needed, and he also kick-started
a trend. A growing number of families are making public solicitations
for donations to their loved ones through the Links
For Life web site.

Bob Hickey
of Denver needed a kidney transplant. He advertised for a live donor
on a web site called
He received several offers, and eventually a kidney from Rob Smitty
of Chattanooga. has since arranged several more
transplants, and hundreds of people are now advertising for live
donors on the site.

People who
don't yet need organs are also trying to improve their odds of getting
one if they ever need one. Over 3,500 people have joined LifeSharers,
a non-profit organ donation network. LifeSharers is based on the
idea that people who are willing to donate their own organs when
they die should be the first to receive an organ if they need one
to live. LifeSharers members promise to offer their organs first
to other members, using a form of directed donation that is legal
in all 50 states and under federal law. Anyone, regardless of their
current medical condition, can join LifeSharers
for free.

All of these
efforts are legal, and they all increase the supply of organs and
public awareness of the need for more organ donors. But they've
all attracted the opposition, not the support, of the organ bureaucracy,
which says it's not fair to try to increase your odds of getting
an organ transplant.

Critics of
Mr. Krampitz' efforts said he got an unfair advantage by advertising
because not everybody who needs a transplant could afford to do
so. Similar charges were leveled at Mr. Hickey, and
was criticized for making him pay for his listing on their web site.
A common complaint about LifeSharers is that it introduces non-medical
considerations into the organ allocation system, a complaint also
leveled against efforts like those of Mr. Krampitz, Mr. Hickey,

These complaints
don't pass the "common sense" test.

First, it's
absurd to say people shouldn't use their financial resources to
increase their odds of getting a transplant. People use money to
get on the transplant waiting list. They use it to pay for transplant
operations. They use it in countless ways to improve the health
of their family members. It makes no sense to put this one area
off limits. It's offensive to tell people they should just sit back
and let a family member die rather than use whatever resources they
have to save their life.

Second, it's
ridiculous to say non-medical considerations shouldn't play a part
in allocating organs. They already do. Money, race, age, geography,
and time spent waiting are just some of the non-medical factors
now used to decide who gets available organs.

Rather than
criticizing private efforts to increase the supply of organs, the
transplant bureaucracy should embrace them. Instead, it's trying
to stop these efforts by making it illegal for Americans to direct
the donation of their organs to non–family members. In other
words, they want to stop you from deciding who gets your organs.
How bizarre! If bureaucrats tried to stop you from deciding who
gets your home when you die, you'd think they were crazy.

The transplant
bureaucracy seems too focused on how to distribute the limited number
of organs available. It should focus more on how to increase the
number of organs available to distribute.

The easiest,
and fairest, way to do this is to give organs first to registered
organ donors. If this simple change was implemented as national
policy, millions of people would register and we would make a big
dent in the organ shortage. Today, Americans donate only about half
of the organs that could save lives and reduce suffering. They bury
or cremate the rest. If people knew that they'd go to the back of
the transplant waiting list if they didn't agree to donate their
organs when they died, this senseless and tragic waste of life-saving
organs would be significantly reduced, and thousands of lives would
be saved every year.

Several other
ideas for increasing the supply of organs have been advanced by
thoughtful professionals. These ideas include an options market
for cadaveric organs, "rewarded gifting" payments to donors'
families, and presuming that everyone has consented to being an
organ donor in the absence of evidence to the contrary. Each of
these ideas would save thousands of lives each year. None of these
ideas has attracted the support of the organ bureaucracy.

donation is an inherently good thing. It is something to be encouraged,
applauded, and rewarded. The organ bureaucracy should lead the efforts
to increase the number of organ donors, not oppose them.

2, 2006

Cohen [send him mail] (right)
is professor of law at the George Mason University School of Law.
David J. Undis [send
him mail
] (left) is Executive Director of LifeSharers.

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