by Gregory Tyson, PhD student
In 1950 Dr. Richard Lawler performed the first human kidney transplant in Chicago. This was the first of many pioneering procedures that led to transplantation of livers, hearts, and other organs into human patients. As immunosuppressive drugs were developed and the techniques required for successful transplants were mastered, it was thought that no one needing an organ would be left waiting. Sadly, even as we have progressed into the 21st century, this has not been the case.
Due to such issues as congenital defects, hypertension, and diabetes, organs can stop functioning properly. Modern science has resulted in the invention of dialysis machines, which filter the blood and eliminate waste as functioning kidneys are supposed to do. However, these and other products designed to prolong life are only temporary fixes that do not fully replace the function of healthy organs. As a result, transplantations are needed, which allow the replacement of a failing organ with a functioning one from a living or deceased donor. These transplantations save lives, as half of transplant recipients live at least ten years after receiving a new organ.
Unfortunately, organs cannot be transplanted from any one person to another. Instead, donors and recipients must be matched based on blood type and other genetic factors. If the donated organ is not matched properly, the recipient’s immune system recognizes the transplanted organ as foreign and rejects it. This results in destruction of the organ and sometimes death of the patient. Even well-matched organs need to be transplanted with caution, as rejection can still occur and immunosuppressive drugs are usually required. Despite these risks and difficulties, however, organ donations save a considerable number of lives.
Over 120,000 people are currently waiting for organs in the U.S. As just 28,000 transplants are performed annually and over 50,000 people are added to the list each year, the number of people waiting has skyrocketed. This led to the deaths of over 6,500 people waiting for organs last year, and an additional 5,000 people were removed from the transplant list because they became too sick to receive an organ. With so few organs available, the average wait time for a transplant is now over three years.
What has caused this organ shortage? It’s simple: there are not enough people donating. One of the reasons is that people have to opt-in to become organ donors, which requires filling out paperwork or signing up online. This requirement likely contributes to the U.S. having an organ donor consent rate of just 40%. The problem is compounded by the fact that when someone’s donation status is unknown, by default they are not organ donors. Switching to an opt-out system, where people are presumed to be organ donors, could drastically increase the donation rate. People would still have the right to choose their donation status, but the default option has a strong pull on a person’s decision to become an organ donor. In fact, all of the European countries that have implemented an opt-out system have organ donor consent rates of at least 85%, whereas those with opt-in policies have consent rates below 30%. In addition, switching to an opt-out system would not require large changes to the current organ donation system that prioritizes need, match of organ, and wait time for organ recipients.
Although switching to an opt-out system would increase the number of available organs, it may not be enough to overcome the current organ shortage. One potential solution would involve permitting a regulated organ trade to increase donation rates among living donors. Family members are rarely matches to their loved ones who require organs, but they would donate if they could. This fact could be used to help willing donors donate to another family in need. The recipient’s family could then donate to the original donor’s family, with these combined donations saving two lives. Due to the complications of organ donor matching, it is unlikely that two families could mutually donate. Nonetheless, computer algorithms could determine if a network of ten people and their relatives could all donate to each other and therefore save ten lives in the process (Figure 1). Although this approach has not been tried in other countries, it could be a practical and safe alternative to the growing black market selling of organs.
In summary, the current organ supply in the U.S. is extremely limited, leaving thousands dying and many others barely clinging to life. Switching to an opt-out donation system and creating a regulated organ trade could immediately increase the organ supply, but these are only short-term answers. As the demand for organs continues to climb, government investment into long-term solutions is needed. These include stem cell research to grow organs in vitro, or limiting rejection from poorly matched donors. Given the current status of the system, we have to hope such scientific advances can help the 21st century solve for millions what the 20th century could only do for a few.
 Centers for Disease Control and Prevention
Cover Photo by Pixabay via Pexels: Creative Commons