Stipulations Placed on Organ Donation

Purpose

The Policy Memorandum (PM) provides guidance to United Network for Organ Sharing (UNOS) and Organ Procurement and Transplantation Network (OPTN). This policy memorandum is to discuss the status of those who have been ineligible for the transplant list due to existing health problems that should be considered for transplantation, creating a better system for increased donor availability through better education and creating an opt-out system. This memorandum is to revise previous policies that have created to prevent those who need a transplant and alternatives that should be considered to solve this increasing problem.

Background

Since the creation of the ability to donate organs, thousands of lives have been saved from this medical advancement. However, there are those who do not fall within the qualifications of the organ donation list, that has been created by United Network of Organ Sharing. This group has strict guidelines that for many they are condemned to a life on dialysis, ventilator dependence, medication treatments that are sometimes worse than the actual disease.

There are 115,000 Americans waiting on an organ transplant, 22 people die daily in the United States due to waiting on an organ to be donated (). Despite this growing need for organs there are many who are eligible to donate due and choose not to. If they chose to donate or their families elect to donate their organs, they can save upwards of 8 lives from their major organs, 2 people would be able to see again and if they chose to donate their tissue and bone it would help many heal from being in an accident, burns or cancer.

While being on the organ transplant list myself for a kidney, I was told that due to my blood type it would be close to 7 to 10 years before I would get the get of life from a new kidney. While those who have an O blood type their wait time is generally longer as they can only receive an O blood type donor. For these patients many wait upwards of 10 years or longer.

I urge UNOS and OPTN to consider creating a push for donation for living donors if the patient has the ability to get an organ. Many citizens do not know that there are organs that they can donate while they are alive. The liver is an amazing organ, that when you remove one third it will regenerate over time and you only need one functioning kidney to live. Creating an initiative for living donation would decrease the list extensively. I would also urge them to look at their guidelines, if there are medical treatments that would make the patient eligible for donation that they should exhaust those options before denying them from the list.

While almost 95,000 people in the United States are waiting for a life-saving kidney transplant. But thousands of other Americans aren't on the list simply because they are not perceived as having enough support from family and friends, one of the national criteria for determining who gets an organ transplant of any kind (McNeil, 2018). I find this an alarming fact as many transplant hospitals have a transplant house, with a nurse who will come daily and check on the patients and draw labs if they didn't have an appointment in clinic. They would also have transportation to and from the hospital for them to get to their post-op visits or further imaging studies. The criterion means that transplant centers often require patients to bring their social support- friends or relatives- to medical appointments and be available and with the patients round-the-clock after the transplant for anywhere from four to six months. In other areas of health care, we do not exclude patients from life-saving treatment merely because they do not have friends or family said Karen Ladin (McNeil, 2018). If this is the case, we need to make an action plan to help those who have little support have their best chance to have a more quality of life. Who is to say that they are any less qualified to receive an organ than the rest of us. It could be due to multiple facts ranging from where they live in relation to family or friends and where they live from the actual transplant facility. This can be solved on multiple accounts have more facilities who can offer services to have someone to look in on them after transplant.

The next topic for discussion is the procurement of the organs and how they are distributed from the organ transplant list. Currently, in the United States there is a growing disparity between the organ donor list and the organ transplant waiting list. The statistics are clear, 95% of United States adults support organ donation, but not nearly enough sign up to be donors (Phillip, 2018). If you were to go to your local Department of Motor Vehicles you can elect to be an organ donor, by doing this it will go on your physical driver's license. Having elected to be an organ donor doesn't mean for certain that you will be able to donate that will all depend on the nature of death. Being a donor, the donor must be kept on artificial life support until all organs can be allocated to a recipient and teams are in place for the procurement. Majority of donors are from cardiac or brain death from strokes to suicides or a sudden death that we are able to sustain body function while the process of placing these organs is done. The other aspect of this is that the family member of the potential donor can elect to remove them from being a potential donor. In the United States it is currently not required for those who are healthy to be automatically placed on the organ donation list. While in many countries this is a policy and also a law their citizens must follow.

While the list of possible donors decreases in the United States the list of those needing an organ transplant continues to grow daily. The stipulations that UNOS places on those who are trying to get on the list must fall within very strict guidelines. There have been cases where the patient was considered healthy but needed assistance keeping an underlying medical condition that wouldn't affect the organ is taken off the list. There are patients whom may have needed to be hospitalized due to the condition they are trying to receive an organ to cure them from are removed from the list. All while they may be able to receive a living donor and bypass the list aren't made aware of this due to the lack of education. It is very interesting after going through an organ transplant twice that the first time I was able to get on the national list when my native kidneys failed. However, once the first transplant failed, I was denied from the list due to the nature of my kidney disease. Being a young woman in my mid-twenties to a life on dialysis who has a bachelor's in nursing and being forced to leave a job they love.

No matter how one frames the issues, the supply of organs is not meeting the demand (Cohen & Crowe, 2006). It is sad that there are other countries who are working so hard to solve this growing problem. There is widespread interest in finding novel ways to boost the organ supply- ranging from modest reform of the current system, such as better education about the benefits of organ donation, to more radical proposals, such as organ markets, the redefinition of death, and the retrieval of organs from decreased individuals without prior consent (Cohen & Crowe, 2006). I don't necessarily agree with the thought of an organ market as it would be hard to regulate how the organ was procured and the current health of the donor which would ultimately put the recipient at an increased risk. I however agree with the idea of a redefinitions of death as it can be a determining factor in which organs are able to be taken. In a hospital within my area there was a young patient who had attempted to commit suicide and the family would not consider brain death as a clinical diagnosis of death as they still saw that their family member had a heart beat and was breathing with assistive devices. Due to this when it came time to procure the organs his young healthy heart wasn't able to be placed with a recipient who could have been waiting in the wings for that very heart. There are cases where the patient will elect to have their organs donated and when the time came the family would say no to the donation. This is where the system of retrieval without prior consent would be a good option to consider. House Resolution 794, which was presented on May 3, 2006, recognizes the 17th anniversary of the massacre in Tiananmen Square. It describes China's policy of harvesting organs from executed prisoners as barbaric. It calls for the Chinese government to end organ harvesting and ensure that its organ donor programs proceed only on a purely transplant, voluntary, and non-commercial basis (Cohen & Crowe, 2006). Before doing research on this policy I was unaware at how extensive this has been going on around the world not only in the prison system but in other countries where they can profit from the selling of organs. 95% of organs transplanted in China were from executed criminals, with the other 5% coming from living donors (Cohen, Crowe, 2006). I would revise this policy in that those inmates who are of good health and would qualify for donation could opt for this to happen that way their life would have meaning to their families, that yes bad things happened in the end, but their family member was able to save lives.

Spain is widely perceived in the transplant community as having one of the best organ donation programs in the world, and many analysts believe that its presumed consent law accounts for part of its success. Spain has a weak presumed consent law, where hospital staff members always approach the surviving family members- not to request permission to procure organs, but to see if they would prefer not to allow procurement to proceed as it normally would (Cohen & Crowe, 2006). The United States currently uses an opt-in system where it is all voluntary for citizens to sign up to be an organ donor. Our organ donation shortage could be cut shorter if we were to follow the model that Spain uses and as more families may be more willing to donate their loved one's organs. Knowing the extent on how many lives could be saved in return of donation.

Conclusion

To implement an improved policy for organ donation would require switching to an opt-in system. Create better education for the general public regarding living donation, and that you do not have to die to have lives. Finally, to work with patients in whatever their specific needs are to give them the best quality of life. With implementing these policies, we can put the United States on top of organ transplantation worldwide, showing other countries how our policies have improved outcomes.

References

Crowe, S., & Cohen, E. (2006, September). Organ Transplant Policies and Policy Reform. Retrieved from https://bioethicsarchive.georgetown.edu/pcbe/background/crowepaper.html

McNeil, T. (2018, July 19). Restricting Who Gets an Organ Transplant. Retrieved November 11, 2018, from https://now.tufts.edu/articles/restiricting-who-gets-organ-transplant

Organ, Eye, and Tissue Donation Registration. (n.d.). Retrieved from https://www.donatelife.net/

Phillip. (2018, March 16). Organ Donation - The Shortage Around the World. Retrieved from https://ontheknow.com/organ-donation-the-shortage/

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