Donation: A Difficult Choice for the
By Ridgely Ochs
August 20, 2002
How do you get more Americans to bequeath their organs?
Currently 80,269 critically ill people are waiting for organ
transplants, according to the United Network for Organ Sharing, a
nonprofit, federally funded organ procurement group. But last year,
only 6,081 organs came from cadavers -- a number that has remained
essentially flat for a decade, despite attempts to increase public
The issue is "whether we can identify a noncoercive technique for
increasing the number” of such donated organs, said Dr. Frank Riddick,
chairman of the American Medical Association's council on ethical and
Under consideration are such proposals as paying small fees to donors'
survivors, awarding a congressional medal of honor -- or even
presuming someone is a donor unless he or she has stated otherwise.
In New York and most other states, an eligible donor must be declared
brain-dead in a hospital and his or her organs viable and free of
disease. In the New York Organ Donor Network -- New York City and six
counties, including Nassau and Suffolk -- there were about 62,000
deaths last year. Of those, only about 600 were potential organ
donors, according to Martin Woolf, a spokesman for New York Organ
Donor Network. And only 199 ended up being donors, Woolf said.
In the past two years, several bills in Congress have tried to address
ways to increase donations, including a bill by Sen. Charles Schumer
(D-N.Y.) to create a database encompassing donor information from
state registries to speed the donor-recipient matchup.
Sen. Bill Frist (R-Tenn.) is a former lung and heart transplant
surgeon whose 1996 legislation required information about organ
donation on tax return envelopes. He has sponsored a bill that would
honor donors with congressional medals of honor and has introduced
another to allocate $18 million aimed at increasing donations.
Two bills call for giving a donor's family a $10,000 tax credit or a
$2,500 tax refund. But in a recent issue of the New England Journal of
Medicine, Dr. Frank Delmonico, a member of the Health and Human
Services advisory panel on transplantation, argues that those "are in
reality merely forms of payment.” And the National Organ Donation Act
of 1985 forbids any form of payment for an organ.
Nevertheless, Delmonico supported studying whether covering funeral
expenses might increase donations. And in its June meeting, the AMA's
House of Delegates approved a report calling for studies aimed at
identifying what motivates families, including "the use of modest
financial incentives,” according to the AMA's Riddick.
One approach that hasn't seemed to gain congressional support is
"presumed consent.” Several countries, including Spain, Belgium and
Austria, have laws that presume someone is a donor unless that person
has stated otherwise. But such an approach "stands to contradict a
profound respect a majority of Americans reserve for the value of
individualism,” according to a UNOS document -- a view supported in
the New England Journal article.
In Sweden and Denmark, citizen must state whether they will or won't
be organ donors, a practice called "mandated choice” or "required
response.” The UNOS document found that feasible, but Delmonico said
it ran counter to "the expectation of autonomy on the part of most
families” and said it hasn't been studied in this country.
Others argue that not knowing what Americans want is no reason to
reject it out of hand. "The presumption is that Americans want their
choices. They don't want to be told what to do,” said Alan Berger, a
fierce xenotransplantation critic and advocate of mandated choice.
"But you've never given them a chance.”
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