America Needs an Opt-Out Organ Donation Policy

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To address the nation's critical organ donation shortage and improve the organ matching and placement process, the U.S. Congress passed the National Organ Transplant Act (NOTA; P.L. 98-507) in 1984. The act established the Organ Procurement and Transplantation Network (OPTN) to maintain a national registry for organ matching. The act also called for the network to be operated by a private, non-profit organization under federal contract.

United Network for Organ Sharing (UNOS) was awarded the initial OPTN contract on September 30, 1986, and continues to administer the OPTN today.

Our current system is an opt in system, where a decedent or his/her family can opt in to donate the decedents' organs to others in need.  Part of the problem, at least in my home state of Indiana is that your remaining living relatives can choose against your wishes to donate and there is a terrible organ shortage in the United States.

According to organdonor.gov, there are 119,000 people waiting for an organ transplant in the United States.  In 2015, we transplanted only 30,970 persons.  22 people on the waiting list, die waiting for an organ.  95% of Americans support organ donation, yet only 48% are registered as organ donors.  Every 10 minutes, another person is added to that list.  Only 3 in 1000 die in such a way that permits organ donation.  Each year the number of people on the waiting list continues to grow! One donor can save up to 8 lives.  https://www.organdonor.gov/statistics-stories/statistics.html

Not to forget about my fellow kidney patients, according to the NKF:

"There are currently 121,678 people waiting for lifesaving organ transplants in the U.S. Of these, 100,791 await kidney transplants. (as of 1/11/16)
The median wait time for an individual’s first kidney transplant is 3.6 years and can vary depending on health, compatibility and availability of organs.
In 2014, 17,107 kidney transplants took place in the US. Of these, 11,570 came from deceased donors and 5,537 came from living donors.
On average:
Over 3,000 new patients are added to the kidney waiting list each month.
13 people die each day while waiting for a life-saving kidney transplant.
Every 14 minutes someone is added to the kidney transplant list.
In 2014, 4,761 patients died while waiting for a kidney transplant. Another, 3,668 people became too sick to receive a kidney transplant." https://www.kidney.org/news/newsroom/factsheets/Organ-Donation-and-Transplantation-Stats

 

My co-author, Heather Bahr (Brave Blake's Mom), has reminded my that Spain, Austria, Belgium and as of January 1, 2017 France are currently using the opt out system!  http://r.search.yahoo.com/_ylt=A0LEVyHOdZ9YC6gApSVXNyoA;_ylu=X3oDMTBydWNmY2MwBGNvbG8DYmYxBHBvcwM0BHZ0aWQDBHNlYwNzcg--/RV=2/RE=1486874190/RO=10/RU=http%3a%2f%2fwww.parliament.wa.gov.au%2fpublications%2ftabledpapers.nsf%2fdisplaypaper%2f3813336a792bbc8b9d40d54248257896000a9a44%2f%24file%2f3336.pdf/RK=0/RS=N4ueRV9PHQ7nNNtGT4DYiNRfRA4-(Austria);   http://in-training.org/organ-donation-to-opt-in-or-opt-out-637 (Germany and Spain); http://www.nbcnews.com/id/52138385/t/why-we-should-have-opt-out-organ-donation-policy/#.WJ93LX9SrIU(Belgium); and https://www.theguardian.com/society/2017/jan/02/france-organ-donation-law (France).

Social psychologists Shai Davidai, Tom Gilovich, and Lee Ross set out to understand the psychology behind these different organ donation rates. The researchers first asked Americans to consider what it means to donate one’s organs in opt-in countries versus opt-out countries. The researchers discovered that Americans view organ donation in opt-in countries as extraordinary altruism—more like leaving 50% of your estate to charity than leaving 5%. Yet in opt-out countries, what’s extraordinary is not donating your organs—more like skipping your child’s graduation than skipping your child’s baseball game. Americans also liken organ donation in opt-in countries to costly acts like going on a hunger strike, but see organ donation in opt-out countries as less consequential—more like letting someone go ahead in line.

The researchers then probed the beliefs of participants who live in countries with opt-in or opt-out policies. In Germany, an opt-in country, participants consider organ donation an ethically meaningful and costly action. But in Austria, an opt-out country, participants consider organ donation an ethically trivial and inconsequential action.

Based on these findings, the researchers conclude that changing policies so that the United States became an opt-out country, rather than an opt-in country, would change organ donation from a meaningful and costly action to a trivial and inconsequential one. This change in meaning, in turn, would lead to an increase in organ donations." https://sparq.stanford.edu/solutions/opt-out-policies-increase-organ-donation; Davidai, S., Gilovich, T., & Ross, L. (2012). The meaning of default options for potential organ donors. Proceedings of the National Academy of Sciences, 15201-15205.

"Researchers from the University of Nottingham, University of Stirling and Northumbria University in the UK analyzed the organ donation systems of 48 countries for a period of 13 years - 23 using an opt-in system and 25 using an opt-out system.
The study authors measured overall donor numbers, numbers of transplant per organ and the total number of kidneys and livers transplanted from both deceased and living donors.

They found that countries using opt-out systems of organ donation had higher total numbers of kidneys donated - the organ that the majority of people on organ transplant lists are waiting for. Opt-out systems also had the greater overall number of organ transplants."  http://www.medicalnewstoday.com/articles/282905.php

An article by Karen Hill on CNN's website may be instructive, "Clearly, the United States is approaching organ donation all wrong. Of course, as the recipient of a donated organ, I am probably biased. But the sheer numbers of people waiting in the United States suggest we could learn from countries like Wales, the most recent country to implement the new "opt-out" policy, meaning consent is presumed for anyone who does not formally decline being and organ donor.
 

The truth is that adopting the opt-out policy in America could potentially save tens of thousands of lives as the donor pool is given a massive boost. The 2003 report "Do Defaults Save Lives?" suggested that European countries that had implemented the presumed consent principle saw as much as 99% of their populations registered as donors, compared with about 30% with the opt-in approach." http://www.cnn.com/2015/12/28/opinions/hill-organ-donor-rules/; 21 NOVEMBER 2003 VOL 302 SCIENCE www.sciencemag.org page 1338-1339.

We believe the time has come for an opt out system here in America.  There are other options to consider such as the artificial kidney or lab grown or 3D printer versions, but as of the writing of this petition, they may be too far away for many people to wait.  Too many of us are lost while waiting.  https://www.ncbi.nlm.nih.gov/pubmed/18261540

 

 

 

 

 



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