This question- or is that this argument- comes up for discussion routinely.  Why are we not transplanting more organs?  How can we more adequately provide organs across the USA?  Other countries of the world?

So, the first thing one must recognize is that the US considers it a crime to sell one’s organs.  Even if that organ is a kidney, where we have two and one could grant life to another soul.

In the US, we have some 115K folks on transplant waiting lists.  Thankfully, only 33 such folks die daily.  But, that does not make the problem less of an issue.

There’s the real fact we die in places where the organ can’t  be harvested for transplantation.  In the streets, in cars, etc.   We die before arriving to the hospital where harvesting can be done.  Or, we have incurable infections or die from cancerous growths.

UNOS, the United Network for Organ Sharing, tries desperately to match the most needy patient with the right organ.  But, sometimes the distance is way too great- the organ would be non-viable by the time the needed patient received it.  So, a less-likely recipient is chosen, which may mean long-term viability is a risk factor.

Besides the dearth of organs, there are other problems.  Many surgeons refuse to accept organs that are legally donated because the patient donor (or is that the brain-dead donor?) is infected with a disease.

Like hepatitis C.  (Heretofore called non-A, non-B hepatitis.)  But, other clinicians remind us that hepatitis C is no longer a deadly disease.  We have the means to cure the patient infected with hepatitis C (albeit at a $ 100K cost)- so why not accept that organ and give the needy patient the chance?

It’s presumed that the rationale for this is because transplant specialists are rated on the one-year survival rate for those they transplant.  With no penalties to their ratings should the patient die will still awaiting that perfect transplant donor.

I also think that $ 100K therapeutic regimen that will be needed to eradicate hepatitis that now must be added to the already expensive transplantation costs leads to some of this reticence, as well.

But, what about taking an organ from an IV drug user?  Or, prostitutes (male or female)?  Many of the clinicians looking to increase the potential donor pool think these may be avenues to pursue.

Therein lies another major problem.  If one of the organ procurement organizations (OPO) removes an organ for transplant and no one uses it, there is no revenue to offset the procurement process. (That happened almost 5,000 times last year- about 1/8 of all harvested organs.) Or, if that less valuable organ is harvested (say it has hep C), the OPO has additional costs in harvesting and maintaining the viability of the organ, increasing its costs.

One of the suggestions that I often hear is the reason why I pulled myself off the Virginia Donor’s registry.  To allow clinicians to cull organs from folks who are not brain-dead.   (In other words, remove organs from someone before that person is legally dead.)  That way they can increase the number of donors by 40%.

Really???  Instead of waiting for their souls to depart the body, clinicians will simply harvest organs while the brain is functional.

My children will make the choice when it’s time to donate my organs.  They know the rules and will follow them.  Because I can’t trust the clinicians.