Editing Organ donation (section)

==Organ shortfall==
[[File:Patient receiving dialysis 03.jpg|thumb|left|Patient receiving dialysis]]
The demand for organs significantly surpasses the number of donors everywhere in the world. There are more potential recipients on organ donation waiting lists than organ donors.<ref>{{cite journal |last1=Howard |first1=David H |title=Producing Organ Donors |journal=Journal of Economic Perspectives |date=July 2007 |volume=21 |issue=3 |pages=25–36 |doi=10.1257/jep.21.3.25 |pmid=19728420 }}</ref> In particular, due to significant advances in [[Kidney dialysis|dialysis]] techniques, patients with end-stage renal disease (ESRD) can survive longer than ever before.<ref>{{cite journal |last1=Massey |first1=E. K. |last2=Hilhorst |first2=M. T. |last3=Nette |first3=R. W. |last4=Smak Gregoor |first4=P. J. H. |last5=van den Dorpel |first5=M. A. |last6=van Kooij |first6=A. C. |last7=Zuidema |first7=W. C. |last8=Zietse |first8=R. |last9=Busschbach |first9=J. J. V. |last10=Weimar |first10=W. |title=Justification for a home-based education programme for kidney patients and their social network prior to initiation of renal replacement therapy |journal=Journal of Medical Ethics |date=November 2011 |volume=37 |issue=11 |pages=677–681 |doi=10.1136/jme.2011.042366 |pmid=21613647 |s2cid=35300096 }}</ref> Because these patients do not die as quickly as they used to, and as kidney failure increases with the rising age and prevalence of high blood pressure and diabetes in a society, the need especially for kidneys rises every year.<ref>{{cite journal|last1=Kaufman|first1=Sharon R.|last2=Russ|first2=Ann J.|last3=Shim|first3=Janet K.|title=Aged bodies and kinship matters: The ethical field of kidney transplant|journal=[[American Ethnological Society#American Ethnologist|American Ethnologist]]|date=February 2006|volume=33|issue=1|pages=81–99|doi=10.1525/ae.2006.33.1.81|pmid=18461150|pmc=2373268}}</ref>

{{As of|March 2014}}, about 121,600 people in the United States are on the waiting list, although about a third of those patients are inactive and could not receive a donated organ.<ref name=unostrendstable>{{cite web |url=http://www.unos.org/ |at=Transplant Trends |publisher=United Network for Organ Sharing | title=UNOS | access-date=March 8, 2014 |quote=Waiting list candidates as of today 2:24pm}}</ref><ref name=washingtonpost>{{cite news |url=https://www.washingtonpost.com/wp-dyn/content/article/2008/03/21/AR2008032102981_pf.html |title=A Third of Patients On The Transplant List Are Not Eligible |newspaper=[[The Washington Post]] |url-status=live |archive-url=https://archive.today/20130209011604/http://www.washingtonpost.com/wp-dyn/content/article/2008/03/21/AR2008032102981_pf.html |archive-date=February 9, 2013 |access-date=October 31, 2016 |date=March 22, 2008 |first=Rob |last=Stein }}</ref> Wait times and success rates for organs differ significantly between organs due to demand and procedure difficulty. {{As of|2007}}, three-quarters of patients in need of an organ transplant were waiting for a kidney,<ref>{{cite web | url=http://www.ctdn.org/resources_public.php#Statistics |at=Waiting List Statistics | title=Resources – General Public | publisher=California Transplant Donor Network | access-date=March 31, 2011 | archive-date=August 19, 2010 | url-status=usurped | archive-url=https://web.archive.org/web/20100819174225/http://www.ctdn.org/resources_public.php}}</ref> and as such kidneys have much longer waiting times. As stated by the Gift of Life Donor Program website, the median patient who ultimately received an organ waited 4 months for a heart or lung—but 18 months for a kidney, and 18–24 months for a pancreas because demand for these organs substantially outstrips supply.<ref>{{cite web|url=http://www.donors1.org/patient/waitinglist/|title=Understanding the Organ Transplant Waiting List – Gift of Life Donor Program|website=www.donors1.org|access-date=February 17, 2018|archive-url=https://web.archive.org/web/20180521160101/http://www.donors1.org/patient/waitinglist/|archive-date=May 21, 2018|url-status=dead}}</ref> An increased prevalence of [[self-driving car]]s could exacerbate this problem: In the US, 13% of organ donations come from car crash victims, and autonomous vehicles are projected to reduce the frequency of car crashes.<ref>{{cite journal|doi=10.1146/annurev-publhealth-040119-094035|title=Autonomous Vehicles and Public Health|year=2020|last1=Rojas-Rueda|first1=David|last2=Nieuwenhuijsen|first2=Mark J.|last3=Khreis|first3=Haneen|last4=Frumkin|first4=Howard|journal=Annual Review of Public Health|volume=41|pages=329–345|pmid=32004116|doi-access=free|hdl=10230/52903|hdl-access=free}}</ref>

In Australia, there are 10.8 transplants per million people,<ref>{{cite web|url=http://www.donatewest.health.wa.gov.au/documents/ReflectionsWinter_2005.pdf |title=Organ & Tissue Donation Western Australia (WA) |publisher=DonateLife in Western Australia |access-date=March 31, 2011 |url-status=dead |archive-url=https://web.archive.org/web/20070927225555/http://www.donatewest.health.wa.gov.au/documents/ReflectionsWinter_2005.pdf |archive-date=September 27, 2007}}</ref> about a third of the Spanish rate. The [[Lions Eye Institute]], in Western Australia, houses the [[Lions Eye Bank]]. The Bank was established in 1986 and coordinates the collection, processing and distribution of eye tissue for transplantation. The Lions Eye Bank also maintains a waitlist of patients who require corneal graft operations.
About 100 corneas are provided by the Bank for transplant each year, but there is still a waiting list for corneas.<ref>{{cite web |url=http://www.lei.org.au/go/lions-eye-bank |title=Lions Eye Institute: Lions Eye Bank |publisher=Lei.org.au |date=June 30, 2011 |access-date=May 19, 2012 |url-status=dead |archive-url=https://web.archive.org/web/20100107205639/http://www.lei.org.au/go/lions-eye-bank |archive-date=January 7, 2010 }}</ref> "To an economist, this is a basic supply-and-demand gap with tragic consequences."<ref name=Dubner2006>{{cite news|url=https://www.nytimes.com/2006/07/09/magazine/09wwln_freak.html|title=Flesh Trade|newspaper=New York Times|date=July 9, 2006 |first1=Stephen J.|last1=Dubner|first2=Steven D.|last2=Levitt}}</ref> Approaches to addressing this shortfall include:
* Donor registries and "primary consent" laws, to remove the burden of the donation decision from the legal next-of-kin. Illinois adopted a policy of "mandated choice" in 2006, which requires driver's license registrants to answer the question "Do you want to be an organ donor?" Illinois has a registration rate of 60 percent compared to 38 percent nationally.<ref name=nytimes2009>{{cite news |last1=Thaler |first1=Richard H. |title=Opting in vs. Opting Out |url=https://www.nytimes.com/2009/09/27/business/economy/27view.html |work=The New York Times |date=September 26, 2009 }}</ref> The added cost of adding a question to the registration form is minimal.
* Monetary incentives for signing up to be a donor. Some economists have advocated going as far as allowing the sale of organs. ''The New York Times'' reported that "Gary Becker and Julio Jorge Elias argued in a recent paper<ref>{{cite journal |last1=Becker |first1=Gary S |last2=Elías |first2=Julio Jorge |title=Introducing Incentives in the Market for Live and Cadaveric Organ Donations |journal=Journal of Economic Perspectives |date=Summer 2007 |volume=21 |issue=3 |pages=3–24 |doi=10.1257/jep.21.3.3 |pmid=19728419 }}</ref> that 'monetary incentives would increase the supply of organs for transplant sufficiently to eliminate the very large queues in organ markets, and the suffering and deaths of many of those waiting, without increasing the total cost of transplant surgery by more than 12 percent.'"<ref name="Dubner2006"/> Iran allows the sale of kidneys and has no waiting list.<ref name=Ghods2006>{{cite journal |last1=Ghods |first1=Ahad J. |last2=Savaj |first2=Shekoufeh |title=Iranian Model of Paid and Regulated Living-Unrelated Kidney Donation |journal=Clinical Journal of the American Society of Nephrology |date=November 2006 |volume=1 |issue=6 |pages=1136–1145 |doi=10.2215/CJN.00700206 |pmid=17699338 |doi-access=free }}</ref> [[Organ futures]] have been proposed to incentivise donation through direct or indirect compensation. The primary argument against such proposals is a moral one; as the article notes, many find such a suggestion repugnant.<ref name="Dubner2006"/> As the National Kidney Foundation puts it, "Offering direct or indirect economic benefits in exchange for organ donation is inconsistent with our values as a society. Any attempt to assign a monetary value to the human body, or body parts, either arbitrarily, or through market forces, diminishes human dignity."<ref>{{cite web | url=http://www.kidney.org/news/newsroom/positionpaper03.cfm | title=Financial Incentives for Organ Donation | archive-date=May 17, 2013 | archive-url=https://web.archive.org/web/20130517121252/http://www.kidney.org/news/newsroom/positionpaper03.cfm| date=August 12, 2014 }} ''After May 2013, this page was no longer available for archiving; in March 2014, searches of the kidney.org site did not reveal a comparable statement in current online materials.''</ref>
* An opt-out system ("dissent solution"), in which a potential donor or his/her relatives must take specific action to be excluded from organ donation, rather than specific action to be included. This model is used in several European countries, such as Austria, which has a registration rate eight times that of Germany, which uses an opt-in system.<ref name="nytimes2009"/>
* Social incentive programs, wherein members sign a legal agreement to direct their organs first to other members who are on the transplant waiting list. One historical example of a private organization using this model is LifeSharers, which is free to join and whose members agree to sign a document giving preferred access to their organs.<ref>{{cite journal |last1=Undis |first1=David J. |title=LifeSharers: Increasing Organ Supply Through Directed Donation |journal=The American Journal of Bioethics |date=July 2005 |volume=5 |issue=4 |pages=22–24 |doi=10.1080/15265160500194600 |pmid=16109688 |s2cid=34441333 }}</ref> "The proposal [for an organ mutual insurance pool] can be easily summarized: An individual would receive priority for any needed transplant if that individual agrees that his or her organs will be available to other members of the insurance pool in the event of his or her death. … The main purpose [of this proposal] is to increase the supply of transplantable organs in order to save or improve more lives."<ref name=Schwindt1998>{{cite journal |last1=Schwindt |first1=Richard |last2=Vining |first2=Aidan |title=Proposal for a Mutual Insurance Pool for Transplant Organs |journal=Journal of Health Politics, Policy and Law |date=October 1998 |volume=23 |issue=5 |pages=725–741 |doi=10.1215/03616878-23-5-725 |pmid=9803360 }}</ref>
* Encouraging more people in palliative care to become donors. Researcher suggests that 46% of patients in palliative care are eligible, but only 4% are approached to consider eye donation.<ref>{{Cite journal |last1=Long-Sutehall |first1=Tracy |last2=Bracher |first2=Mike |last3=Mollart |first3=Sarah |last4=Wale |first4=Jane |date=November 2, 2023 |title=Eye donation from palliative and hospice care contexts: the EDiPPPP mixed-methods study |url=https://www.journalslibrary.nihr.ac.uk/hsdr/KJWA6741/ |journal=Health and Social Care Delivery Research |language=EN |volume=11 |issue=20 |pages=1–159 |doi=10.3310/KJWA6741|doi-access=free |pmid=37929829 }}</ref><ref>{{Cite journal |date=April 16, 2024 |title=Hospice and palliative care services could encourage eye donation |url=https://evidence.nihr.ac.uk/alert/hospice-and-palliative-care-services-could-encourage-eye-donation/ |journal=NIHR Evidence|doi=10.3310/nihrevidence_62809 }}</ref>
[[File:ABO blood type.svg|thumb|right|410px|Blood type (or blood group) is determined, in part, by the ABO blood group antigens present on red blood cells.]]
* Technical advances allows the use of donors that were previously rejected. For example, [[hepatitis C]] can be knowingly transplanted and treated in the organ recipient.<ref>{{cite news |last1=Harris |first1=Richard |title=Hepatitis C Not A Barrier For Organ Transplantation, Study Finds |url=https://www.npr.org/sections/health-shots/2019/04/03/709533047/hepatitis-c-not-a-barrier-for-organ-transplantation-study-finds |access-date=December 14, 2020 |work=[[NPR]] |date=April 3, 2019}}</ref>
In hospitals, organ network representatives routinely screen patient records to identify potential donors shortly in advance of their deaths.<ref name=NewZeal>{{cite news |last1=Stein |first1=Rob |title=New Zeal in Organ Procurement Raises Fears |url=https://www.washingtonpost.com/wp-dyn/content/article/2007/09/12/AR2007091202681.html |newspaper=The Washington Post |date=September 13, 2007 }}</ref> In many cases, organ-procurement representatives will request screening tests (such as [[blood typing]]) or organ-preserving drugs (such as [[Antihypertensive|blood pressure drugs]]) to keep potential donors' organs viable until their suitability for transplants can be determined and family consent (if needed) can be obtained.<ref name=NewZeal/> This practice increases transplant efficiency, as potential donors who are unsuitable due to infection or other causes are removed from consideration before their deaths, and decreases the avoidable loss of organs.<ref name=NewZeal/> It may also benefit families indirectly, as the families of unsuitable donors are not approached to discuss organ donation.<ref name=NewZeal/>

Doctors and patients are sometimes hesitant to accept organs from people who  died of brain tumours. However, an analysis of the UK donor registry found no evidence of cancer transmission across more than 750 donations, including people with high-grade tumours. This suggests that it may be safe to increase the use of organs from people who died of a brain tumour, which could help reduce organ shortfall.<ref>{{cite journal |last1=Greenhall |first1=George H. B. |last2=Rous |first2=Brian A. |last3=Robb |first3=Matthew L. |last4=Brown |first4=Chloe |last5=Hardman |first5=Gillian |last6=Hilton |first6=Rachel M. |last7=Neuberger |first7=James M. |last8=Dark |first8=John H. |last9=Johnson |first9=Rachel J. |last10=Forsythe |first10=John L. R. |last11=Tomlinson |first11=Laurie A. |last12=Callaghan |first12=Chris J. |last13=Watson |first13=Christopher J. E. |title=Organ Transplants From Deceased Donors With Primary Brain Tumors and Risk of Cancer Transmission |journal=JAMA Surgery |date=May 2023 |volume=158 |issue=5 |pages=504–513 |doi=10.1001/jamasurg.2022.8419 |doi-access=free |pmid=36947028 |pmc=10034666 }}</ref><ref>{{Cite journal |date=September 7, 2023 |title=Organs from people who died of a brain tumour may be safe to transplant |url=https://evidence.nihr.ac.uk/alert/organs-from-people-who-died-of-a-brain-tumour-may-be-safe-to-transplant/ |journal=NIHR Evidence|doi=10.3310/nihrevidence_59694 |s2cid=261628146 }}</ref>