Public Policy Governing Organ and Tissue Procurement in the United States

Results from the National Organ and Tissue Procurement Study

A shortage of organs and tissues for transplantation has been present throughout most of the history of transplantation. As of 31 January 1995, 37 873 patients in the United States were awaiting solid-organ transplantation ([1]). It has been estimated that about one third of patients with heart or liver failure die before a transplantable organ is found ([2]). Other types of transplants are also scarce. On average, 3500 patients are awaiting corneal transplantation during any given month, and many more are awaiting transplants of bone, skin, and other tissues ([3]).

The shortage will probably worsen as transplantation becomes more successful and is offered to sicker and older patients ([3], [4]). The number of organ donors is unlikely to keep pace with this increased demand. Although the largest source of potential organ donors are persons who have been declared dead according to neurologic criteria (“brain dead”), estimates of this potential pool of donors have been revised downward from a high of 32 000 to between 6000 and 10 000 potential donors annually. This downward revision is due to overly optimistic initial estimates and improved public health measures such as the use of seat belts and motorcycle helmets ([5], [6]).

Given the limited number of potential donors, there is a constant effort to increase the efficiency of the procurement system. The current system is based on the voluntary decisions of patients or their families to donate organs to help others. This emphasis on voluntariness is consistent with the value of respecting individual autonomy and the dignity of the body after death. Supporters of the current system of organ donation argue that altruism must be the overriding factor in the decision to donate ([7], [8]).

Education campaigns are designed to make the public aware of the good …