Have a Heart : How to Expand the Organ Harvest

3D anaglyph of the human heart. Image from 3D-image.net.

Israel’s new approach:
Donor cards and organ transplants

By Ted McLaughlin / The Rag Blog / March 16, 2010

For years now, doctors have been able to save lives and prolong lives by performing organ transplants. Hearts, livers, kidneys, lungs, etc. can be taken from those who’ve died and preserved long enough to replace defective organs in a person who needs a new organ to survive. This is a big step forward for medicine.

There is only one problem. The only source for these replacement organs is people who have authorized their organs to be harvested before they died, and this has created a serious shortage of available organs. There are waiting lists for every kind of organ transplant. It is hoped that someday medical science will be able to grow new organs (possibly from stem cells), but that is still a long way from happening.

In most Western nations, about 30% of the population have authorized the harvesting of their organs after death. This is not a bad percentage, but still leaves long lists of people who are waiting for organs. Some of them even die while waiting for an appropriate organ.

Medical professionals have been searching for a way to boost the quantity of available organs, and up until now there have only been two solutions — neither of which is free from ethical problems. And an unethical solution may well be worse than no solution at all.

First, is the buying and/or selling of organs. This distasteful method is not approved in any civilized country. This is because of a couple of thorny questions. Should the rich get preference in receiving available organs because they can outbid those poorer than they are? Should the poor be pressured into giving their organs (or those of their loved ones) because of their poverty? Any moral and ethical person would quickly answer no to both questions.

The second solution is for doctors to assume they have permission to harvest organs unless the donor had specifically left written instructions denying them that privilege. This also presents an ethical dilemma. Just because a person has not left a written denial does not mean he/she gave his/her permission.

It is not uncommon in modern society for someone to delay doing something he or she really intended to do until it was too late. Just look at the many people who die without leaving a will. You cannot assume that all of them meant not to leave a will. In fact, I’ll bet that many of them simply procrastinated too long and died unexpectedly. Making assumptions about what a person wanted is like walking through an ethical minefield — it could blow up on you at any time.

Israel is in an even worse position than most Western countries. That is because only about 10% of Israelis have authorized the harvesting of their organs after they die. This has made their waiting lists much longer than those of other developed countries, making it far more likely that a patient would die while waiting for a suitable organ.

Israel was in bad need of a way to boost organ donations, and because they are a very religious nation, neither of the two ethically-suspect solutions would be appropriate for them to use. What were they to do? Simply urging the public to sign donor cards had only gotten them to 10%, and further government pleas were unlikely to significantly improve upon that.

The Israeli government has devised a new solution that’s never been tried before — it’s simple, ingenious, and devoid of the ethical problems attached to other solutions. They have passed a law that gives priority for organ transplants to those who signed donor cards before they became ill. These people would be put ahead of those who had not signed donor cards if they needed a transplant.

They have not yet implemented the new law, and it might not work for some reason unknown now, but I think it’s a good idea. Why shouldn’t those willing to give be the first to get? And it’s fair to everyone — black or white, rich or poor, male or female, young or old, religious or atheist. Anyone can (and should) sign a donor card. I believe this simple law will significantly increase the number of donors and save many lives.

There are those who say this would not be a big advantage, because soon the list of those waiting who had signed donor cards would be very long. I don’t buy this argument. Even if the list is long, we must remember there will be a lot more available organs. Therefore those waiting will not have to wait as long as they do now to get their transplant. I believe the law will provide a good chance to save a lot of lives that are now being lost.

The United States, Canada, and Europe should watch closely to see what happens when Israel implements the new law. If it significantly increases the number of donors and the number of lives saved, then it should be implemented in other developed nations.

Someday in the future, we might not have the need for human donors of organs. Maybe science will find a way to create new organs by harvesting them from the dead. But until then, the goal should be to save lives. I believe Israel’s new law will do that.

[Rag Blog contributor Ted McLaughlin also posts at jobsanger.]

The Rag Blog

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14 Responses to Have a Heart : How to Expand the Organ Harvest

  1. Richard says:

    Ted,
    You misrepresented one point. Organs are “harvested” from live people not dead people, just people some greedy doctor declares “gonna be dead pretty soon” or to make the judgment that the life isn’t worth living. This is a class question, which class gets to give…the poor, which class gets the organs…the rich.

    Maybe the Isralis will harvest the organs of the West Bank citizens they murder, of course after carefully passing a “law.”

    Anyway you made me think, I will have “No organ harvest” tatooed on my ass.

  2. Ted — I think this is, as you say, an ingenious approach, and it will be interesting to see what develops. Right now, although “no civilied country” approves of the practice, there is apparently quite a thriving black market in illegally harvested organs, unethically (to say the least) obtained.

    However, I’m curious about Israel’s low starting percentage of willing donors — 10% is really down there, especially, one might think, in a war-torn nation where young, healthy people have a higher chance of being killed, yet leaving, perhaps, some useable spare parts behind. I wonder if the low percentage has to do with the specific religious beliefs of Israelis? I know that Orthodox Judaism, at least, prohibits cremation of the dead; are there prohibitions, does anyone know, against organ transplants? What asbout Islam? I have the impression that, around here, it is the Apocalyptic Christians who are least likely to sign a donor card, because they don’t want to have some evil person’s heart put into them; it may screw them up on Judgment Day.

    Richard, good grief; how do you feel about the Blood Bank? Worried it’s been contaminated with vampire blood?

    I don’t think it will be very long, really, once the lid is off stem cell research, for organs to be grown specifically tissue-matched to the recipient. Medical Science can already grow a human external ear on a mouse’s ass. And blood (untainted, type A, B, AB, or O on order, Rh + or -) in California rice fields. It’s not the future; it is happening now.

  3. Mariann-
    There is a religious element. At least one ultra-orthodox group allows it’s members to receive transplants, but not to donate their organs. The group is about 100,000 strong.
    Frankly, if this approach fails it will probably be due to religious beliefs. However, the government believes the number of the religious groups opposed to organ donation is small and won’t affect the program. I hope they are right.

    Richard-
    With an attitude like yours, you deserve to be at the bottom of any list to receive an organ. I hope for your sake you never need a transplant.

  4. Mariann says:

    Ted —- not sure what you mean by that crack about Richard. Do you think that current organ recipients have been tested for their “attitude” by some medical attitude testing board? Do you think that individuals should not have the right to “opt out” of organ donation and/or receipt? Or do you think he’s wrong in saying that right now more organs surely come from poor people and go to rich people?

    I get really nervous when anyone starts talking about who “deserves” health care and who does not. Who “deserves” an education, employment, or decent housing? Who decides?

    Again, I thought this was a very interesting and provocative article, and look forward to hearing how the story develops!

  5. Mariann,

    Eduction and Housing are goods not rights. Goods have to be earned. Earned by who? By the individual of course. “deserve” has nothing to do with it, choice has everything to do with it. That means anyone can acquire goods if they choose to do so.

  6. Mariann-
    I was referring to his “ass” tattoo.

  7. Anonymous says:

    Extremist – I wish you would choose to live just one week as a homeless person, talking with them, living with them, gaining an understanding of who they are and what they face daily. Your attitude about ‘choice’ is misguided at best.

  8. Anonymous says:

    Does anyone know how the proposed solution “give & ye shall be more likely to get” might handle children and legally incompetent adults?

  9. How does a child “earn” the right to be educated?

  10. Mariann says:

    Great review in today’s Austin American-Statesman of “Repo Men”, a near-future sci fi flic about repossessing organs that have not been paid for. The hard-ass protagonist experiences a literal “change of heart”, then finds himself on the side of the homeless, the outlaws, and all those who want to keep on keepin’ on even if they can’t cough up the monthly payment on their liver.

    Interesting…

  11. Anonymous says:

    Ted – I’ll guess Extremist thinks parents should earn/pay the wherewithal for their children’s education, healthcare, and everything else; those who choose not to do so raise ignoramuses, have higher rates of maternal and infant death, etc. The poor are poor due to their own lack of initiative; there are no extenuating circumstances. This is what passes in our unenlightened times as a “Darwinian” approach.

  12. I received a kidney transplant over a year ago. At the time, both native kidney’s had been removed due to (Polycystic Kidney Disease)and I had been on dialysis for two years.

    I live now because of the organ donation from a young man who left behind a wife and a young child.

    The decision to donate is to make the gift of life.

    To receive such a gift is a most humbling experience.

    I hear epithets, dogma and political beliefs thrown around in any health care debate, but the crucial issue is the miracle and the quality of life itself.

    If anyone is interested, I have told my story on my blog: Surviving PKD on blogspot.com.

  13. Richard says:

    Anon, “The poor are poor due to their own lack of initiative;”

    You might note that right now there are 153,214,000 workers and about 134,000,000 jobs, that leaves 19.2 million out of luck. This is what is known as the “surplus labor pool” an absolute necessity to the functioning of Capitalism. I hope your people were poor and raised an ignoramus and it is not by your choice. Good choice to comment anonymously.

  14. Pat Cuney says:

    Through an unfortunate set of circumstances, this information recently came to my attention.

    If you are willing to donate an organ at death, you cannot just sign the back of your driver’s license and expect it to happen. NO, NO, NO! You MUST be actually registered on your state’s organ donor registry list, otherwise it just doesn’t count!!!!! So, if you care about this, as I do, do it, and do it now, and tell your friends and family. The driver’s license is not enough. You must be proactive.

    For Texas: https://www.donatelifetexas.org/TXDear_Secure/Confirmation.aspx

    If you are not in Texas, search Google for organ donor donation and I’m sure you will find the info there.

    Pat Cuney

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