By Armita Hamedi and Katarina Zorcic
The total number of organ donations in the United States and Canada is rapidly increasing compared to previous years. The amount of people who are deciding to become deceased organ donors is increasing more than ever before, and there has been a record-breaking number of organ transplants performed in the past year. According to the Organ Procurement and Transplantation Network (OPTN), 14,903 deceased individuals were organ donors in 2022 and 42,888 organ transplants were performed, setting a national record for the highest number of organ transplants (OPTN, 2023).
Although these statistics and records are exciting to hear, there is still a large number of patients that never get matched with an organ. According to UNOS, there were 104,060 candidates on the organ recipient list in 2022 and 6,466 people who were living organ donors (UNOS, 2023). This means that the amount of deceased and living organ donors made up less than 50% of the patients on the recipient list in the past year. The problem stems from the fact that there was a large decrease in the number of organ donors after the COVID-19 pandemic; professionals are hoping that these numbers will begin to skyrocket now that the fear behind the pandemic is dying down.
There have been certain initiatives, such as the organ priority rule (OPR), which have been suggested to increase the number of organ donors. However, there is controversy around the OPR’s effectiveness and fairness. The OPR states that registered organ donors have priority for organs over non-registered patients. A paper published by Chandler et al. looked into the idea of organ reciprocity to hopefully increase the number of registered organ donors. The paper concluded that there is hope for the OPR and its success in increasing the number of donor registrations in countries like the United States or Canada, but it is important to note that it may not be as fair as it seems (Chandler et al., 2012).
Medical coercion comes into play when considering the OPR since becoming an organ donor may not be something an individual wants to pursue originally but they may become one in order to have a higher chance of getting an organ if ever needed. What needs to be taken into consideration is the idea of free will. In medicine, there should be no incentive to do or make any certain type of decision, especially if your life can be on the line.
The OPR may also take away from the “altruistic motive” of becoming an organ donor (Burkell et al., 2013). Canadian and American culture runs on the idea of altruism but this does not necessarily mean that incorporating reciprocal altruistic ideologies within medical legislation may be the best idea for increasing organ donations.
Another viewpoint opposing the OPR is that if someone is a registered organ donor, they should not be given priority for an organ as their body is more “useful” when considering how many lives they may save once deceased. This is not an ethical way of thinking when talking about people’s lives, but it does bring up a good point about the goal of organ donations. If we want to save as many lives as possible, would it be more beneficial to save the life of one person or to allow the organ donor to have priority?
Many ethical questions come into play when trying to figure out a system that works for everyone, especially in so-called “melting pot” countries where many different cultural and personal viewpoints clash. Christopher De Luca brought up a good point on reciprocal altruism in his article published in December. He mentioned that based on the findings from Li et al., participants in Canada and the US were shown to be more likely to become registered organ donors if they expected something in return (Li et al., 2013). The OPR does seem like a possible fix for the organ donor shortage, but there may be better options for the future.
Presumed organ donation may be the permanent fix to the organ donation shortage. Countries such as Spain and France have enforced presumed organ donations since 1979 and 2017, respectively, and Spain was the top country in 2021 for the highest rate of deceased organ donors (Mendoza, 2022). This system allows anyone who is not interested in becoming an organ donor to opt-out of becoming an organ donor. This system increases the number of organ donors as it requires more effort from people to not become an organ donor than to become an organ donor.
Although the OPR has the potential to become a successful system, there are still fundamental issues that need to be addressed and the best initiative needs to be put in place that will benefit the greater good.
2022 organ transplants again set annual records; organ donation from deceased donors continues 12-year record-setting trend – OPTN. Organ Procurement and Transplantation Network. (2023). https://optn.transplant.hrsa.gov/news/2022-organ-transplants-again-set-annual-records-organ-donation-from-deceased-donors-continues-12-year-record-setting-trend/.
Burkell, J. A., Chandler, J. A., & Shemie, S. D. (2013). Attitudes toward reciprocity systems for organ donation and allocation for transplantation: Table 1. Journal of Health Politics, Policy and Law, 38(5), 957–986. https://doi.org/10.1215/03616878-2334674.
Chandler, J. A., Burkell, J. A., & Shemie, S. D. (2012). Priority in organ allocation to previously registered donors: Public perceptions of the fairness and effectiveness of priority systems. Progress in Transplantation, 22(4), 413–422. https://doi.org/10.7182/pit2012324.
Li, D., Hawley, Z., & Schnier, K. (2013). Increasing organ donation via changes in the default choice or allocation rule. Journal of Health Economics, 32(6), 1117–1129. https://doi.org/10.1016/j.jhealeco.2013.09.007
Mendoza, J. (2022). Organ transplant waiting list in Spain 2021. Statista. https://www.statista.com/statistics/538386/number-of-patients-active-on-organ-transplant-waiting-list-in-spain/.UNOS data and transplant statistics: Organ Donation Data. UNOS. (2023). https://unos.org/data/.