Organ Insurgents vs. Organ Bureaucrats

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" list.

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, and

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.

Organ 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.

January 2, 2006