WASHINGTON, April 21 (UPI) -- The widening gap between patients needing transplanted organs and the number of persons willing to give them is prompting some experts to call for new -- and often radical -- ways to spur donations.
The suggestions range from loosening current restrictions on who can donate to far more drastic measures, including "organ conscription" requiring donations from all persons who die with adequately healthy body parts.
Some experts are even calling for debate on altering the legal definition of death so that patients in permanent comas or vegetative states can become candidates for donation.
Matters of life and its protections are dangerous political ground in the United States, and policy makers are not likely to entertain the more radical ideas for boosting donations. Still, the calls for a new approach to transplant donation are shedding light on a the alarming number of Americans who die while waiting for others to give the organs that could save their lives.
Transplant list wait times have increased drastically in the United States over the last decade. More than 90,500 persons were on U.S. waiting lists as of December 31, 2005, which is more than 4.5 times the number waiting a decade earlier, according to the United Network for Organ Sharing, the non-profit group that oversees organ allocation in the United States.
Longer life expectancy has given average Americans more time to live to see their organs fail, while rising rates of obesity and diabetes make that more likely to happen.
Despite the demand, numbers of donations have risen only slightly. Just over 28,000 Americans donated organs last year, up from 19,000 a decade ago, according to the network.
The shortage has led some experts to call for new incentives to encourage donations. One option would let prospective recipients move up on wait lists if members of their family donate. Another would require citizens to make an affirmative choice of whether or not they wish to donate before receiving a driver's license.
Federal law bans money or other inducements from changing hands in exchange for organs. But policy makers should consider altering the law to allow for new incentives, says Robert Veatch, of the Kennedy Institute of Ethics at Georgetown University.
Veatch refers to an organ conscription policy as the "nuclear option". But he has called for experimentation with policy that many officials consider nearly as radical: cash payments for organs. Veatch says he opposed payments for decades because of their potential to exploit poor people in need of money. Now, he's changed his mind.
"There are too many people dying. I think its time to begin limited experiments with cash payments," he told the President's Council on Bioethics this week.
Veatch is backed by libertarian thinkers, some of whom argue that a law taking all incentive out of donating while demand continues to rise makes no economic sense.
"Do not get yourself into the illusion that there is something so unique about the question of organ or body parts ... that the general rules of economics do not apply," said Richard Epstein, director of the law and economy program at the University of Chicago School of Law.
A system of cash payments for organs are strongly opposed by both liberal and conservative ethicists, and also by a host of medical groups. Francis Delmonico, a transplant surgeon, warned that groups including the National Kidney Foundation, the American Society of Transplant Surgeons, and the United Network for Organ Donation, which he heads, would offer "staunch opposition" to any congressional attempt to legalize a market in human organs.
"That list is growing because of inadequate medical care and its not just solvable by buying organs," Delmonico said.
Others warn that placing a market value on human organs would undermine human dignity. "Isn't there really something disquieting about entering in to a society in which certain parts of the body are treated as alienable things like automobiles?" said council member Leon Kass, a University of Chicago ethicist who is also a vocal opponent of embryonic stem cell research.
Still, Veatch predicted that a combined policy of limited payments, forced donation decisions, and waiting list incentives could boost U.S donations by up to 75 percent.
He also called for new policy that would let very ill patients choose to receive transplants from donors now deemed too high-risk to donate, including injection drug users and men who have sex with men, who both have high rates of HIV and hepatitis.
Daniel Foster, a member of the panel and a professor of internal medicine at the University of Texas Southwestern Medical Center pointed out that more than 65,000 Americans are waiting for kidney transplants, most of whom will die before a match is found.
"I think we have to do something radical about it," he said.
