 | 
| |
|
| |
As the practice of transplantation makes great advances, patients who, a few years ago, would have been declared hopeless are given a new lease on live. However, the list of prospective transplant recipients has grown tremendously. As of November 5, 1997, 55,899 people were waiting for organs. An overwhelming 37,724 were waiting for kidneys, while the rest were in need of liver, heart, lung, pancreas, or intestine transplants (some are also waiting for combination transplants). In 1996 only 19,410 transplants were performed. This significant gap between supply and demand has created serious global problems.
A number of questions have developed around this issue:
Who should be placed on transplant lists?
Not all patients in need of stronger hearts are immediately placed on transplant lists. The overall likelyhood of the patient’s survival chances is taken into consideration. Aside from such objective factors as age and strength, some people have been advocating a more subjective analysis of the patient’s transplant worthiness. For example, should an alcoholic get a liver over someone who was in an accident? Should a smoker who shows no inclination to kick the habit get a lung over a smoker who wants to quit? If donor recipients do not demonstrate the ability to take care of their transplants, should they be considered?
Who should be able to donate organs?
If every eligible donor was allowed to donate his or her organs, the number quoted above would be a lot smaller. So why do we have restrictions on who can donate? The restrictions are in place to prevent the transformation of organ donation into profitable venture of sorts. India, for example, is fighting an organ black market where organs are harvested from the poor for a pittance and sold to the highest bidder. Consent in donation is another important consideration in terms of who can donate. Legislators in some states have proposed a policy of "presumed consent," where brain dead patients are presumed to be willing donors unless they file a non-donor card. Physicians recommend against such policies because of the possible risks associated with such laws (see Related Links).
How can we guarantee a fair chance to everyone who needs a transplant?
Since the Larry Hagman and Mickey Mantle transplants, the public has been clamoring for assurances of fairness in the transplant waiting list procedures. Admittedly, certain factors do bump people up in the waiting lists. If a patient is in critical need of an organ, he or she is given priority. While this policy works to most patients’ benefit, some have been known to take advantage of it. Hospitals have been known to move non-critical children into ICU’s to increase their priority in the list. Because of similar loopholes, we cannot completely guarantee a fair waiting list. Of course, the United Network for Organ Sharing (UNOS) vigorously denies that celebrities (or anyone else, for that matter) get special treatment.