|
 |
|
|
 As
the head of Mid-America Transplant Services (MTS) sees it, the organ
transplant economy is a victim of its own success.
Medical advances in recent years have produced more and more transplant
candidates, creating a demand curve that just grows higher and higher
each year. But, unlike most businesses that can expand production
to meet demand, MTS and other organ clearinghouses around the country
must make do with an organ supply that remains stubbornly static.
And the imbalance between supply and demand can be downright cruel.
“Despite advances in modern medicine and, ironically, largely because
of those advances, the odds of someone dying on the organ waiting
list are greater than they were 15 years ago,” says Dean F. Kappel,
president and CEO of MTS, a not-for-profit organization that coordinates
the procurement of vital organs, tissues and eyes throughout eastern
and southern Missouri, southern Illinois and northeastern Arkansas.
Kappel, who commands a staff of 70 employees who call on 120 hospitals
within the sprawling MTS service area, explains that a combination
of longer life expectancies, improved transplant technology, and
better anti-rejection drugs have combined to greatly increase the
pool of transplant candidates.
"Despite
advances in modern medicine and, ironically, largely
because of those advances, the odds of someone dying
on the organ waiting list are greater than they were
15 years ago.”
|
Dean
F. Kappel
president and CEO
MTS
|
|
|
In the case of heart transplants, for instance, Kappel says that
people older than 50 or 55 were 10 years ago never considered for
new hearts. Nowadays, heart transplants are routinely performed
on people into their 60s, he says. That means more and more people
with bad tickers are waiting for new hearts or, in many cases, new
heart valves.
And it can be a long wait. While organ supplies—most notably the
heart, liver and kidneys but also lungs, pancreas, skin, bones,
bone marrow, and corneas—have never equaled demand, the transplant
gap just gets worse. While 14,000 patients across the country were
awaiting transplantation in 1998, more than 80,000 are on waiting
lists (about 1,700 in the St. Louis region) today. The grim reality
is that more than 5,000 people die each year while waiting for an
organ.
In the region served by MTS, the number of organ donors has actually
dropped since a record of 124 donors in 1998. MTS processed 107
donors in 2001 and won’t reach 100 for 2002, Kappel says.
“Anything that we can do to increase supply would be beneficial,”
Kappel pleads.
“Our
best hope, though, is that we continue with broad
public education beginning at the elementary and high
school level and continuing through all phases of
adult life.”
|
Martin
D. Jendrisak
transplant surgeon,
Washington University School of Medicine
|
|
|
One thing that might increase supply is to compensate families for
organ donations, maintains Ronald Munson, a professor of science
and medicine philosophy at the University of Missouri—St. Louis.
Munson, author of Raising the Dead: Organ Transplants, Ethics
and Society, says he supports a system of compensation within
a regulated market.
“It’s not in the best interests of anyone to have organs sold on
e-Bay,” Munson says. “My own view is that there is some degree of
hypocrisy in passing legislation in our country where we don’t provide
people with the funds they may need to pay for an organ transplant
while keeping them from selling another organ to pay for it.”
The legislation referred to by Munson is the 1984 National Organ
Transplant Act that made selling organs illegal in the U.S. while
creating the Organ Procurement and Transplantation Network, including
MTS, to equitably distribute organs among transplant patients. Before
the legislation, organs were sometimes sold to the highest bidder,
according to 1998 congressional testimony of then-U.S. Health and
Human Services Director Donna E. Shalala.
Munson says that most organ procurement organizations now “shy away
from the concept of selling organs as if you made an indecent proposal...they
are afraid that the whole system might collapse.”
Not so, Kappel says. “Our organization has for a number of years
been in favor of trying to do a pilot (compensation) program. We
don’t know if the concept is good or bad, but we’ll never know if
it works or not if we don’t try it under some controlled circumstances.”
Would a compensation system increase organ supply? Munson and Kappel
say that study results are mixed. “Whether it would increase donation,
I don’t know,” Kappel says. But he notes that others within the
transplant system are compensated. “Everybody in the system gets
paid. I get paid; my staff gets paid; surgeons get paid; hospitals
get paid. You have to be careful that organs aren’t available to
the highest bidder, but there can be some incentive.”
Kappel and others suggest reasonable compensation might take the
form of helping families pay the funeral expenses associated with
a death and subsequent cadaver organ donation opportunity.
“Once a month, we’re approached by a family member asking for assistance
with funeral expenses,” Kappel says. “I don’t know what would be
wrong with that.”
Martin D. Jendrisak, a transplant surgeon with Washington University
School of Medicine, suggests that a so-called “presumed consent”
law could be enacted to spur donations. Under such legislation,
authorities would presume that a deceased person is a willing organ
donor unless that person “opts out” by registering his or her opposition.
“In several countries people make it a community responsibility
to support organ donation, and they have implied consent for donation,”
Jendrisak says. “The rate of opting out is apparently under 10 percent,
and these countries such as Denmark don’t see the degree of shortages
we see in this country.”
“It’s
not in the best interests of anyone to have organs
sold on e-Bay.”
|
Ronald
Munson
professor of science and
medicine philosophy,
University of Missouri–St. Louis
|
|
|
While Munson says presumed consent for organ donations is controversial
and carries with it questions of due process and other constitutional
issues, Jendrisak notes that states have the right to perform autopsies
under certain conditions and over the objections of family members.
“Our best hope, though, is that we continue with broad public education
beginning at the elementary and high school level and continuing
through all phases of adult life,” Jendrisak believes.
To increase organ supply, Kappel suggests that area businesses help
educate employees through various workplace initiatives for which
MTS can provide assistance, such as informational payroll stuffers.
Individuals, he adds, can obtain organ donor information through
MTS. Once a decision to donate is made, potential donors should
make their intentions known to family members and register their
intent through the Missouri or Illinois Department of Revenue, both
of which maintain a donor registry.
William V. Poe is principal of Poe Communications, a St. Louis
advertising and marketing communications firm.
|
|
|
|
|
-
- - - - - - - - - -
- - - - - - -
-
- - - - - - - - - -
- - - - - - -
-
- - - - - - - - - -
- - - - - - -
-
- - - - - - - - - -
- - - - - - -
|
