The organ transplant and procurement system is poorly designed, poorly managed and benefits some at the expense of others. I have often written about it, including here, here and here. Indeed, The New York Times reports that the organ transplant system is in chaos as Waiting Lists are ignored.
For decades, fairness has been the guiding principle of the American organ transplant system. Its bedrock, a national registry, operates under strict federal rules meant to ensure that donated organs are offered to the patients who need them most, in careful order of priority.
But today, officials regularly ignore the rankings, leapfrogging over hundreds or even thousands of people when they give out kidneys, livers, lungs and hearts. These organs often go to recipients who are not as sick, have not been waiting nearly as long and, in some cases, are not on the list at all, a New York Times investigation found.
In an earlier article, Senator Ron Wyden (D-Ore.) told the Washington Post,
“For too long, it’s been clear that UNOS has fallen short of the requirements for this contract and the expectations of Americans waiting for a transplant.” His colleague and frequent collaborator, Senator Charles Grassley (R-Iowa), said “The system is rife with fraud, waste and abuse, corruption, even criminality.”
The Times article goes on to say that last year organ transplant officials skipped over the waiting lists 20% of the time. This may sound like a travesty, but the reality is more complicated. The Times writers go on to add that a primary reason waiting lists are sometimes ignored is because the federal government pressured procurement organizations to stop wasting organs. In other words, while trying to be fair, and find the most deserving recipients, organs expired while waiting for that perfect recipient.
Under government pressure to place more organs, the nonprofit organizations that manage donations are routinely prioritizing ease over fairness. They use shortcuts to steer organs to selected hospitals, which jockey to get better access than their competitors.
Estimates vary across regions but around 20% to 30% of donated organs are wasted. Organs expire while waiting for the recipient, waiting on the recipients’ doctors or waiting for transportation to the recipient thousands of miles away. One estimate puts the total number of wasted organs at 28,000 annually. It is easy to dismiss the number until you realize that represents an equal number of people waiting desperately for an organ transplant.
The sickest patients are supposed to get priority for lifesaving transplants. But more and more, they are being skipped over.
Sometimes the sickest patients do not always get the organs because they are considered too sick to benefit. Maybe both patient and the organ are marginal. Even getting on a waiting list is difficult, not uniformly administered, nor particularly fair. About 90,000 people are waiting for a kidney. More than 100,000 people are on a waiting list and untold thousands more were not allowed to be on the list for various reasons.
When a potential match occurs, the recipient’s doctor is notified, but the doctor often says “no” for reasons including donor’s age and organ size. The Times reports this happens 200 times a day. Each time an organ is offered to a donor, his or her doctor has to evaluate their patient for compatibility. If a doctor declines the organ believing it is not a good match, it is offered to the next person on the list, whose doctor has to evaluate it for compatibility. This can occur numerous times before a match is found. While an organ makes the rounds of numerous doctors, each having to decide if it is a good match the organ is expiring. It makes sense that organ procurement systems are simultaneously evaluating other, readily available patients for potential matches. If a match is available locally, while another match is thousands of miles away requiring air transport, it makes sense to stay local, especially if time is ticking away. The Times worries this is happening with increased frequency.
The organ donation and procurement system is convoluted, and made more complicated by the artificial scarcity of organs. The solution is to make organs plentiful by allowing families to sell their dying loved one’s organs at time of death. Only then will fewer valuable, life-saving organs get buried with their original owners.
Read more at New York Times: Organ Transplant System ‘in Chaos’ as Waiting Lists Are Ignored.
Goodman Health Blog: