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Moving the needle on organ donation

For the thousands of people on organ donation lists, news of an available heart, or lungs, or liver can’t come soon enough. But many don’t get that call in time. According to a new feature on The Atlantic’s website, 21 people die waiting for a transplant every day. That works out to more than 7,600 patients every year.

Unfortunately unless you’re personally touched by the issue... you don’t really think about it

Although many people say they support organ donation, in many countries, only a minority actually register as organ donors. (“Unfortunately unless you’re personally touched by the issue, unless you have a child that gets a virus and suddenly needs a new heart, you don’t really think about it,” one expert says in the piece.) It’s a paradox many people in the field are trying to unravel. The reasons they’ve uncovered so far include mistrust of medical professionals: Some people believe that if a medical team finds out that you're an organ donor, they won't work as hard to save your life, in order to harvest your organs. And how much TV a person watches can influence how much he or she trusts doctors. One study found that people who watched more of the TV series Grey’s Anatomy were more likely to mistrust doctors and nurses.

Religion also influences the picture, probably because of concepts of bodily integrity in the afterlife. Catholics are less likely to donate their organs, even though the Vatican officially supports organ donation.

So what can be done about the organ shortage? Some groups are working on solutions, as highlighted in the piece:

"What we’re trying to do in New York is move the cultural needle on the issue,” says Aisha Tator, executive director of the New York Alliance for Donation. “Organized tissue donation should be a cultural norm like we did with bike helmet and seatbelt interventions.” Her organization isn’t the only one. Throughout the United States there have been a smattering of recent educational campaigns and studies on their efficacy. Campaigns have targeted the young, the oldnursesDMV employees, and ethnic minorities who tend to donate less than white Americans or white Brits.

Another, more drastic change is to shift the U.S.’s current opt-in system to one that requires people to opt-out. Many experts point to Spain, which has an opt-out system - and one of the highest rates of organ donation. But the logistics of such a system would probably be difficult, best, to implement.

Giving priority to people who donate, or have a relative who has donated, is another approach being explored in Israel:

The transplant system in Israel is a case study for how these ideas can be systematized. A change of law in 2010 that prioritizes patients with a history of donation—if a family member donated his or her organs or the patient himself made a living donation or if the patient has been on the donor list for at least three years—has incentivized a significant portion of the population to register as donors.

Preliminary results, published last year, show that the annual deceased organ-donation rate increased from 7.8 organs per million people in 2010 to 11.4 organs per million people in 2011. The number of new registrations per month more than doubled and the total number of candidates waiting for a transplant fell for the first time ever.

At a recent Stanford Health Policy forum in August, the option of compensating donors was debated. Whatever the solution in the U.S. turns out to be, it will require a sea change in how we, administer and even think about organ donation.

Previously: Stanford Health Policy forum on organ-donation crisis now available online, Physicians more likely to become organ donors, Canadian study finds and Students launch Stanford Life Savers initiative to boost organ donation
Photo by Tiiu Sild

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