RESEARCHERS HUNT FOR ANSWERS TO GROWING ORGAN SHORTAGE
BY BOB REEVES -- Lincoln Journal Star

    Twelve of the 73,000 Americans waiting for heart, lung, liver, kidney, pancreas or intestine organ transplants die each day.
    Fewer than 22,000 transplants are performed in the United States each year. Organs for those are harvested from fewer than 6,000 cadavers and fewer than 5,000 living donors.
    Filling that gap is one of the main reasons researchers at the University of Nebraska Medical Center in Omaha and elsewhere are studying the potential of xenotransplantation - transplanting organs from one species to another.

Alan Langnas

    But critics argue not nearly enough is being done to increase the number of human donors.
    In an editorial column, Drs. Murry Cohen and Andrew Breslin of the Physicians Committee for Responsible Medicine suggested that commercials promoting organ donor awareness should be run during the Super Bowl instead of ads for fast food and beer.
    "Each and every day in the United States, 6,000 bodies full of human organs are buried or burned," said Cohen. "That's 2 million each year, many times the number of organs required for all types of transplants."
    But physicians and others in the field are quick to point out that most bodies are unsuitable for transplants.
    "Even if we could triple the number of donors, it still wouldn't meet the needs of 60,000 to 80,000 people waiting for transplants," said Dr. Alan Langnas, chief of transplantation at UNMC.
    A major effort to increase donations is led by the Richmond, Va.-based Coalition on Donation. Its national public service campaign runs 6,000 TV spots each month urging potential donors to let family members know their wishes.
    Surveys show 80 percent of Americans support organ donation, but only 28 percent have signed organ-donor cards; fewer than half who sign let immediate family members know their wishes.
    Even if they do, the wishes of the family take precedence, said coalition spokesman Bob Spieldenner.

Andrew Jameton, bioethicist, Medical Center

    Since 1994, Pennsylvania has had a "first-person consent" law allowing physicians to honor the wishes of a patient even if the family objects. That same year, Pennsylvania began requiring hospitals to report every death or imminent death to the local organ procurement organization, which is linked with a nationwide organ donor network.
    The number of donations per year has increased 40 percent, said Brian Broznick, executive director of the Center for Organ Recovery and Education in Pittsburgh.
    Virginia recently passed similar legislation, and Louisiana is considering it. And, since 1997, Medicare regulations require all American hospitals to report every death to the donor network.
    In Nebraska, which has an average of 34 organ donors per year, the body becomes the possession of the next of kin, said Karen Risk, Director of the Nebraska Organ Retrieval System, which coordinates transplants in Nebraska.
    In most cases, she said, "if the family knows you want to donate, they'll do it."
    The notion that people who have signed organ donor cards will be allowed to die is a myth, Risk said. The National Organ Transplant Act of 1984 states that transplant surgeons cannot be involved in the treatment of potential organ donors, she noted.
    Several European countries have enacted "presumed consent" laws, which assume people consent to donate organs unless they have signed documents saying otherwise. That has increased donations, but many doctors still honor the wishes of family members who oppose organ donation, said William Beschorner, chief of the xenotransplant team at UNMC.
    The Nebraska Heart Institute has transplanted more than 100 hearts since 1986 and about 20 lungs since 1992. Its president, Dr. Deepak Gangahar of Lincoln, said presumed consent laws may work in Europe, but they will not fly here. "Americans are too independent," he said.
    "The tragedy is that 10,000 to 20,000 people each year lose their lives in their homes, on the highways and in hospitals, who could become potential organ donors," said Gangahar. "But either people don't think about it during their lifetime, or they don't convey that information to family members.

Deepak Ganghar

    "Family physicians need to bring it up, pastors in church. It needs to be talked about at the dinner table."
    Medical Center ethicist Dr. Andrew Jameton said a presumed consent law might work in a state like Nebraska, where he says physicians have "high integrity." But he fears that in the wrong hands, the law could lead to "people being hauled off the streets and organs being sold."
    Selling organs is illegal in the United States.
    "It's too close to buying and selling human beings," said Jameton.
    Added Langnas: "It's a big leap to take a normal healthy person and put them through an operation. It's putting your own life at risk."
    Some promoters of organ donation have suggested paying funeral expenses or otherwise compensating the donor's family.
    "Everyone else makes money. Why not the family that actually donates the organ?" asked Langnas.
    But Beschorner believes both paying for organs and presumed consent undermine an essential characteristic of organ donations: that they are gifts.
    "Most families donate organs because they want to help somebody out, and also perhaps to improve the dignity of the deceased. I think the whole dynamics of that would change if it became commonplace to pay someone $5,000 for an organ.
    Reach Bob Reeves at 473-7212 or breeves@journalstar.com.