Organ Donation Often Off-Limits Topic

The allegations of favoritism that surrounded Mickey Mantle’s recent liver transplant are a powerful reminder that there are far more people waiting for transplants than there are organs to give them. The question is: With so many people dying who might be able to provide needed organs, why are there so few organs available for transplant?

Almost 5,000 people were waiting for liver transplants when Mantle got his. In all of 1994, 3,500 liver transplants were performed.

Since more than 25,000 people die each year from liver failure, the list of those waiting could be even longer if there were more organs to use.

The same dismal story of people dying for want of organs can be told about the tens of thousands of Americans currently awaiting kidney, pancreas, heart or lung transplants.

The largest source of organs for transplantation comes from those who are declared brain dead while on life-supporting technologies. While many die each year under circumstances that would permit them to be used as organ donors, relatively few organs are obtained. Why?

A team at the University of Pittsburgh led by Laura Siminoff, Robert Arnold, Beth Virnig and I published a two-year study in the Annals of Internal Medicine that provides the answer.

The reason is simple but dismaying: Many families simply do not give their consent when asked.

We found that, while the possibility of organ donation was relatively rare, nearly every case where someone might have been a donor was identified by someone in the hospital where the person died. Moreover, laws mandating inquiries about donation are being followed. Most families were asked. But, sadly, only 48 percent of those asked said yes. The percentage of those willing to say yes to tissue donation such as skin or bones, or to corneas was far lower.

The numbers are surprising, because opinion polls conducted by many organizations in recent years have shown widespread public support for organ donation and transplantation. Some surveys report that about 65 percent of those asked say they would donate their organs or allow donation from a deceased relative. So where is all this apparent altruism when it is needed most?

The reasons families object hinge on a lack of faith and trust. Many families express religious reservations about organ donation. Some talk about their fears about harming the deceased or mutilating the body of their loved one. Some simply do not trust the medical system, worrying that their relatives will be allowed to die prematurely if permission to donate is given; are ambivalent because of the belief that there are gross inequities in how organs are used to save lives; or are just angry at what they perceive to be insensitive requests.

Some argue that what we need to do to get more organs and tissues for transplant is to create a market in body parts. Others maintain that we should pass laws presuming that individuals consent to donation and put the burden on those who are opposed, having them carry a card or inform their relatives.

The study shows that neither of those approaches would work. The most important reason people do not donate has nothing to do with money or with selfishness. They do not donate because they find the subject distasteful, they feel their religious beliefs will be compromised, they are not asked in a respectful manner or they do not believe the system is fair.

Until those issues are resolved, the gap between those who need a transplant to live and those who take their organs with them to the grave will never be bridged.

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The following fields overflowed: CREDIT = Art Caplan King Features Syndicate