Too Alone in Our Luck: A New Organ Transplant Paradigm

 We’re lucky, Tamar and I. We both, though twenty years apart, are renal transplant donor recipients. Her first anniversary comes in early October
 
 As to my experience, I knew, like thousands of Americans, that I’d need a new kidney. I’m far luckier than most, though, for I also knew what most Americans don’t:

          . I never had to do dialysis. (Neither did Tamar have to be dialysed.)
 
          . I’d never be on a list. (Nor was she.)

          . My sister and I would have an ease of planning, over time, when and where we’d have the switch-out done. We did it on 3 July 1998, having arranged it well in advance. The sense of control in an otherwise unsettling time was palpable and welcome. The overwhelming number of people needing new kidneys never have the luxury we had.

 As you likely know, a world-wide black market in all sorts of organs flourishes. Most often, in that market, ‘donors’ are from poor nations and, here, from very poor American neighborhoods. These people typically receive a pittance after organ extraction under, often, remarkably filthy conditions. Infection and/or death often follow.
 
 There’s no comprehensive solution on the horizon, yet Dr. Sander Florman of Mt. Sinai in New York offers an idea, a new and interesting route that may help deal with the awful supply-demand transplant-organ reality. He points out that we use an opt-in donor model. That is, if you want your organs to survive you, you check that off on your license. Dr. Florman argues that we, here, must do what an increasing number of nations do. We must, he says, go to an opt-out donor model.

 Under the opt-out model your consent is presumed unless you opt-out (and anyone may opt-out without having to explain the reasons for opting out). All healthy citizens, on this paradigm, are presumed to be donors.

 While most Americans in survey upon survey support the idea of organ-donation, donation rates remain very low. In countries with opt-out laws, roughly only 5% opt out. And while there’s no guarantee that world-wide presumed-consent would eliminate the wait-lists and the global black-market, the record does show that in the nations with it, the legitimate availability of healthy organs has increased significantly. Lives are saved and far fewer poor people are exploited. Many more transplantees and donors return to their families and work, and the emotional and economic health of those nations are bettered.

 Long before I knew for certain I’d need a renal transplant I followed the medical and legal and medical debates including the prosecutions of those Americans who would (you’ll excuse the term) gouge the poor as they realize enormous profits from the torn bodies of the voiceless.  
 
Opt-out is the first ray of decency I’ve seen (and, again, anyone genuinely may opt-out under the plan; it simply reverses the current presumption). Under the current opt-in system too many Americans die for lack of transplantable organs, and many organs (after, for example, deadly car accidents) just get tossed. We must be willing to try new, well thought-out models.                                                       *

Not everyone with bum kidneys has the close family, the gem of a sister I have. Not everyone, as Tamar did, was able to find a solid match in a longstanding family friend. 

We all can, though, regard new approaches seriously, perhaps by supporting small-scale, opt-out test-programs in several states or in large cities.
 
 Tamar and I are far too alone in our luck.

 

 

 

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