Organ Donation: Too Important for Opt In 20091219

(10 pm. – promoted by ek hornbeck)

Organ donation is a topic not thought about very much, but it should be.  Since the first successful kidney transplant in the 1950s, the technology has improved by a huge margin, so now most transplanted organs function within design parameters.  Sounds great, right?

The problem is that there are many fewer organs available than required.  We shall discuss some the the scientific and logistical problems, and then a, in my estimate, viable solution.  Please keep with me here, because it is important.

I will not bore you with the statistics, but let it be sufficient to say that many thousands of people die needlessly every year in the United States for lack of organs or tissue that they need to live.  The same situation applies to most of the other developed nations.  This is unnecessary.

I am, and have been, an organ and tissue donor since it became a checkoff on a driver’s license issue.  But I made the conscious choice to do so.  Unfortunately, most of mine are old and wrinkly now, so would not be of much use to others.  That is a joke, and I admit a poor one.

People do not know how much good to others that organ and tissue donation.  Imagine for a minute (I know that this is not comfortable) that you have recently died.  Those organs and tissues will not do you a bit of good, because you are, well, dead.  But if kept viable, those organs and tissues can be of tremendous help to others who have a good chance of life with quality except that something terrible has happened to them.

We shall go from the top.  Obviously, brain transplants would change the recipient into you, but the brain dies after only a few minutes without oxygen, so those are not much of an issue within the parameters of this discussion.  However, the corneae of the eyes, donated, could allow two people, blind from cornea damage.  Two for the price of one is not a bad bargain for a horrible condition.

Now, we are all covered with skin.  Skin transplants, just a little from each donor, can help folks who have been burnt to recover.  Many burn patients are children, and I can not think of any better use for my skin if I do not need it any more than to help little kids get better.

Now for the heart.  Even if yours is not perfect, the valves often are.  Transplanted to a person with bad ones, they can have excellent quality of life for a long time.  For those of you much younger than me, the entire heart can replace a defective one for decades, allowing the person receiving it excellent quality of life.

We now have the technology to transplant lungs along with the heart, or just individually.  That gift for a child with cystic fibrosis might make her or him live for many decades with near to or normal life quality.

The same can be said for the liver (those transplants are extremely successful), and for several other organs.

Bone transplants are another very successful procedure.  Just a little bone, properly transplanted, can stimulate the recipient to produce new osocytes (bone cells), and replace missing tissue.

There are scores of other transplant procedures, but they all depend on either tissue provided by the patient (skin grafts for burn patients are notable there), or from others (that includes all of whole organ transplants).

Here are the negatives.  Host graft rejection is the largest threat, if the surgeon did a proper job hooking up the vascularity.  Modern anti-rejection drugs, such as cyclosporin, mitigate this in most cases.  However, except for very recent research findings, those drugs have to be taken for life to prevent it.  Good tissue typing reduces the need for the anti-rejection drugs, and if the donor population were larger, better matches could be found.  Right now, we use the best tissue matches that we can find, and they are not that good because of a small donor pool.

Expense is another problem.  When an organ is found that is a good enough match, it often has to be removed immediately and flown thousands of kilometers to reach the recipient.  Additionally, the surgery is expensive on its own, but moving a useful organ to the point of need is very expensive.  My dad always told me that a job can be done in three ways, and you can choose two of the three:  Fast, Right, and Cheap.  Cheap and right takes a long time for adequate results, cheap and fast makes for poor results, and fast and right is EXPENSIVE.  But fast and right is necessary for organ transplantation.

Thus my thesis for this essay.  Organs need to be removed and preserved IMMEDIATELY after a person is declared brain dead.  My thought is that, without other arrangements, that the medical profession should presume that people have donated their organs.  I have to carry a card that says that I did.  I maintain that I should have to carry a card that says that I did NOT.

I appreciate the fact that some folks have religious reasons not to donate.  That is fine.  I also appreciate the fact that some folks just do not want to do it.  That, also, is fine.  Finally, some folks have family that want a “whole” body to bury (a waste of good land), and I appreciate that as well.  But most of us do not fall into those categories.

Thus, it should be an opt out situation to donate organs or tissue.  If you do not want to do so, then sign a driver’s license that says that you do NOT want to donate, not one the the says that you DO want to donate.  This way many more organs and much more tissue would be available to those who, in our death, we could save.  Certainly there would be some organs that were not usable, but the increase in compatible tissue matches would mean that the recipients could use lower doses of a very expensive drug (that has serious side effects) and, perhaps with better matches, the elimination of taking the drug for life.  Folks, it is up to us.  I donate, and it does not cost one cent.  Please consider it, and talk it over with your family.  This is probably the most important topic about which I have ever posted, because it really affects lives in a very real way.

Any thoughts on this subject would be appreciated.

Warmest regards,

Doc

Crossposted at dailykos.com