Organ Donor Debate

National Organ Donor Registry

Each day, about 74 people receive an organ transplant. However, 17 people die each day waiting for transplants that can't take place because of the shortage of donated organs. We propose the development of a national incentive-based Advance-Directive Organ Registry, in which all adults are encouraged to register their advance directive regarding organ donations. Those individuals agreeing to permit usable organs to be taken at the time of death would receive priority for organs generated by the program, should a transplant become necessary when there is a shortage of organs (Better Health Information, 2004).

The proposed system would allow individuals to exercise autonomy in deciding whether or not to participate. We believe that in the event of a shortage of organs, it is reasonable that priority be given to those willing to advance the public good by participating in the responsibility for organ donation (Carolyn, 2003).

People die today because of a shortage of organs. By increasing the supply, the proposed system decreases the total number of people who die. The proposed system is firmly founded on the principles of patient autonomy, beneficence, and justice. Autonomy is served by the voluntary registration of an advance directive that will likely be honored. The welfare of those who need transplants is served by increasing the supply of cadaver donor organs, while reducing the need for living organ donation, with its potential risks as well as ethical and psychological conflicts advances the welfare of their family members. Justice is also served when more persons who need transplants get them (Carolyn, 2003).

A problem with the current system by which donor organs are rationed is that it takes no account of, indeed it encourages, the 'free rider': the individual who hopes to benefit from the cooperation of others even though he does not himself contribute to the socially desired end. Although it is in each individual's interest that donor organs should be available, it is in nobody's interests to make his/her own organs available: the choice to donate postmortem is an entirely altruistic one. We therefore have the current situation where demand is not matched by supply, and individual patients who could benefit from a transplanted organ are denied that treatment owing to a lack of suitable organs available for transplant (Horning, 2005).

One of the more popular programs that provide incentives for becoming an organ donor is the preferred status program. People would be added to the registry and receive preferred status. The concept of preferred status involves the rewarding of organ donors by providing them with a modest but definite recognition, in kind, for their willingness to participate in the system. A precedent to some degree is credit to blood donors should they need blood in the future. Individuals who have signified their intention to be organ/tissue donors, or perhaps, to a lesser degree, first degree relatives of those who have signed up or have actually been donors, would receive points or other value that would somewhat facilitate their likelihood of receiving an organ, should they need it in the future (Horning, 2005).

The impact on the system would depend strongly on the Perception of society and the transplant community as to the ethical worth of preferred status, and this would involve mainly the degree to which the process was deemed to be fair. A net ethical good from this point of view would accrue from an increased perception that organ donation is important to all, transplants are successful, and the system works without barriers to the disadvantaged segments of society (Osorio, 2004).

One of the most important aspects of the preferred status concept is its potential to provide recognition for those opting into the system without the unfairness and tawdriness intrinsic to any form of financial incentive or recognition. If the definition of a modest but definite benefit is optimal, preferred status has the potential to maximize fairness in the system, in excess of that at present. In general, the value or points awarded should be sufficient to be tiebreakers. The value should probably not be sufficient to place an elective case with a short time on the list ahead of one who is about to die, or who has been waiting for years. Given this aim, it seems possible that preferred status would help facilitate a change from the present general sense of personal un-involvement to a majority that agree to opt in (Osorio, 2004).

As a corollary to this, those in society that are disadvantaged in general, and therefore in terms of access to medical care, would be dealt with most fairly by the possibility of preferred status. Because the life-giving organ represents a benefit that transcends money, its value is the same to a very poor disadvantaged person as to a wealthy one, unlike a monetary consideration. It would be hoped that the disadvantaged, now particularly likely to view organ donation and transplantation with suspicion, might realize a sense of democracy in their rightful access to the same option (that of preferred status) as any other citizen. This could be particularly important in the case of kidneys for Blacks, who have a particular need at present, in view of their higher incidence of kidney failure, since it would encourage donation by this segment of the population that is particularly likely to also need the availability of a transplant (Delmonico, 2004).

Forward approaches involve offering some type of incentive for people to become part of an organ donor registry so that if they die under circumstances where they can donate, their organs will be recovered. Registering as an organ donor would give you a better chance of getting an organ if you ever needed one. Deciding not to register would reduce

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