Organ donation

"Organ donor" redirects here. For the song by DJ Shadow, see Endtroducing......

Organ donation is the donation of biological tissue or an organ of the human body from a living or dead person to a living recipient in need of a transplantation. Transplantable organs and tissues are removed in a surgical procedure following a determination, based on the donor's medical and social history, of which are suitable for transplantation. Such procedures are termed allotransplantations, distinguish them from xenotransplantation, the transfer of animal organs into human bodies. As of June 21, 2013, there are 118,617 people waiting for life-saving organ transplants in the U.S. Of these, 96,645 await kidney transplants. While views of organ donation are positive there is a large gap between the numbers of registered donors compared to those awaiting organ donations on a global level.

The youngest organ donor was a baby with anencephaly, born in 2015, who lived for only 100 minutes and donated his kidneys to an adult with renal failure.[1] In the same year, researchers from the Ganogen Research Institute transplanted human fetal kidneys from therapeutic abortions, including from fetuses with anencephaly, into animals for future transplantation into human patients.[2] The animals were able to survive on the human kidney alone, demonstrating both function and growth of the human organ.[3]

Legislation and global perspectives

The laws of different countries allow potential donors to permit or refuse donation, or give this choice to relatives. The frequency of donations varies among countries.

Consent process

The term consent is typically defined as a subject adhering to an agreement of principals and regulations; however, the definition becomes difficult to execute concerning the topic of organ donation, mainly because the subject is incapable of consent due to death or mental impairment.[4] One way organizations are attempting to gain more donors. There are two types of consent being reviewed; explicit consent and presumed consent. Explicit consent consists of the donor giving direct consent through proper registration depending on the country.[5] The second consent process is presumed consent, which does not need direct consent from the donor or the next of kin.[5] Presumed consent assumes that donation would have been permitted by the potential donor if permission was pursued.[5] Of possible donors an estimated twenty-five percent of families refuse to donate a loved one’s organs.[6] Consent is defined as adhering to an agreement of principals. However, this definition is hard to enforce in accordance with organ donation because, in most cases, organs are donated from the deceased, and can no longer provide consent for themselves.

Opt-in versus opt-out

See also: Mandated choice

There are two main methods for determining voluntary consent: "opt in" (only those who have given explicit consent are donors) and "opt out" (anyone who has not refused is a donor). Opt-out legislative systems dramatically increase effective rates of consent for donation (the so-called default effect).[7] For example, Germany, which uses an opt-in system, has an organ donation consent rate of 12% among its population, while Austria, a country with a very similar culture and economic development, but which uses an opt-out system, has a consent rate of 99.98%.[7][8]

Opt-out consent, otherwise known as "deemed" consent, refers to the notion that the majority of people support organ donation, but only a small percentage of the population are registered. For this reasons, countries, such as Wales, have adopted a "soft opt-out" consent, meaning if a citizen has not clearly made a decision to register, than they will be treated as a registered citizen and participate in the organ donation process. Likewise, opt-in consent refers to the consent process of only those who are registered to participate in organ donation. Currently, the United States has an opt-in system, but studies show that countries with an opt-out system save more lives due to more availability of donated organs. Registering to become an organ donor heavily depends on the attitude of the individual; those with a positive outlook might feel a sense of altruism towards organ donation, while others may have a more negative perspective, such as not trusting doctors to work as hard to save the lives of registered organ donors. The UK has several different laws and policies for the organ donation process, such as consent of a witness or guardian must be provided to participate in organ donation.

However, because of public policies, cultural, infrastructural and other factors, this does not always translate directly into increased effective rates of donation. In terms of effective organ donations, in some systems like Australia (14.9 donors per million, 337 donors in 2011), family members are required to give consent or refusal, or may veto a potential recovery even if the donor has consented.[9] Some countries with an opt-out system like Spain (36 effective donors per million inhabitants[10]) or Austria (21 donors/million) have high donor rates and some countries with opt-in systems like Germany (16 donors/million) or Greece (6 donors/million) have lower effective donation rates. The president of the Spanish National Transplant Organisation has acknowledged Spain's legislative approach is likely not the primary reason for the country's success in increasing the donor rates, starting in the 1990s.[11]

United States

Over 121,000 people in need of an organ are on the U.S. government waiting list.[12] This crisis within the United States is growing rapidly because on average there are only 30,000 transplants performed each year. More than 6,000 people die each year from lack of a donor organ, an average of 19 people a day. Between the years 1988 and 2006 the number of transplants doubled, but the number of patients waiting for an organ grew six times as large.[13] It has been estimated that the number of organs donated would double if every person with suitable organs decided to donate. In the past presumed consent was urged to try to decrease the need for organs. The Uniform Anatomical Gift Act of 1987 was adopted in several states, and allowed medical examiners to determine if organs and tissues of cadavers could be donated. By the 1980s, several states adopted different laws that allowed only certain tissues or organs to be retrieved and donated, some allowed all, and some did not allow any without consent of the family. In 2006 when the UAGA was revised, the idea of presumed consent was abandoned. In the United States today, organ donation is done only with consent of the family or donator themselves.[14] In some cases doctors are reportedly removing pieces of tissue from already dead patients without consulting the patient of their families' consent. This is completely legal procedure. According to economist, Alex Tabarrok the shortage of organs has increased the use of so-called expanded criteria organs, or organs that used to be considered unsuitable for transplant.[15] Due to the lack of donation it is leading some countries to try unconventional practice, creating a lot of controversy and loss of money. The University of Maryland's School of Medicine there were five patients that received kidney transplants that obtained cancerous or benign tumors that were withdrawn from the organ. This raised many questions for the head surgeon, Dr. Michael Phelan who explained that "the ongoing shortage of organs from deceased donors, and the high risk of dying while waiting for a transplant, prompted five donors and recipients to push ahead with the surgery."[15] Doctors are becoming desperate and are having to use organs from patients who are over the age of 60. These donors have had multiple medical problems, and their organs are more likely to fail than those of a younger healthier donor. The certainty remains true that are more than 100,000 people waiting for a transplant. The number of recipients is growing faster than there are donors.

Several organizations such as the American Kidney Fund are pushing for opt-out organ donation in the United States.[16]

Financial reward

In 1994 a bill was signed into law in Pennsylvania which proposed an idea that would increase the supply of organs for everyone. They decided to start paying $300 towards room and board and $3,000 to go towards funeral expenses to a donor’s family. Officials went back and forth for eight years before deciding on this program. It is the first of its kind. Procurement directors and surgeons across the nation are now looking at Pennsylvania’s program and watching for success.[17] Some are already planning to follow in its footsteps if this new incentive proves itself. There has already been at least nineteen families that have signed up for the benefit and there are more expected to come. There are people out there who oppose this plan fundamentally. One argument is it will disproportionately affect the poor.[18] The $300–3,000 reward will act as more incentive to the poor as opposed to the rich who may not find that amount of money to be worth it. Others may say that this new law in Pennsylvania violates the integrity of the self.

Europe

Map showing the coverage of 3 international European organ donation associations: Balttransplant, Eurotransplant and Scandiatransplant

Within the European Union, organ donation is regulated by member states. As of 2010, 24 European countries have some form of presumed consent (opt-out) system, with the most prominent and limited opt-out systems in Spain, Austria, and Belgium yielding high donor rates.[19] In the United Kingdom organ donation is voluntary and no consent is presumed. Individuals who wish to donate their organs after death can use the Organ Donation Register, a national database. The government of Wales became the first constituent country in the UK to adopt presumed consent in July 2013.[20] The opt-out organ donation scheme in Wales went live on 1 December 2015 and is expected to increase the amount of donors by 25%.[21] In 2008, the UK discussed whether to switch to an opt-out system in light of the success in other countries and a severe British organ donor shortfall.[22] In Italy if the deceased neither allowed nor refused donation while alive, relatives will pick the decision on his or her behalf despite a 1999 act that provided for a proper opt-out system.[23] In 2008, the European Parliament overwhelmingly voted for an initiative to introduce an EU organ donor card in order to foster organ donation in Europe.

Landstuhl Regional Medical Center (LRMC) has become one of the most active organ donor hospitals in all of Germany, which otherwise has one of the lowest organ donation participation rates in the Eurotransplant organ network. LRMC, the largest U.S. military hospital outside the United States, is one of the top hospitals for organ donation in the Rhineland-Palatinate state of Germany, even though it has relatively few beds compared to many German hospitals. According to the German organ transplantation organization, Deutsche Stiftung Organtransplantation (DSO), 34 American military service members who died at LRMC (roughly half of the total number who died there) donated a total of 142 organs between 2005 and 2010. In 2010 alone, 10 of the 12 American service members who died at LRMC were donors, donating a total of 45 organs. Of the 205 hospitals in the DSO's central region—which includes the large cities of Frankfurt and Mainz—only six had more organ donors than LRMC in 2010.[24]

Scotland conforms to the Human Tissue Authority Code of Practice, which grants authority to donate organs, instead of consent of the individual.[25] This helps to avoid conflict of implications and contains several requirements. In order to participate in organ donation, one must be listed on the Organ Donor Registry (ODR). If the subject is incapable of providing consent, and is not on the ODR, then an acting representative, such as a legal guardian or family member can give legal consent for organ donation of the subject, along with a presiding witness, according to the Human Tissue Authority Code of Practice. Consent or refusal from a spouse, family member, or relative is necessary for a subject is incapable.

Austria participates in the "opt-out" consent process, and have laws that make organ donation the default option at the time of death. In this case, citizens must explicitly “opt out” of organ donation. "In these so-called opt-out countries, more than 90% of people donate their organs. Yet in countries such as U.S. and Germany, people must explicitly “opt in” if they want to donate their organs when they die. In these opt-in countries, fewer than 15% of people donate their organs at death."[1]

The Mental Capacity Act is another legal policy in place for organ donation in the UK. The act is used by medical professionals to declare a patients mental capacity. The act claims that medical professionals are to "act in a patient's best interest," when the patient is unable to do so.[25]

Japan

The rate of organ donation in Japan is significantly lower than in Western countries.[26] This is attributed to cultural reasons, some distrust of western medicine, and a controversial organ transplantation in 1968 that provoked a ban on cadaveric organ donation that would last thirty years.[26] Organ donation in Japan is regulated by a 1997 organ transplant law, which defines "brain death" and legalized organ procurement from brain dead donors.

India

India has a fairly well developed corneal donation programme however donation after brain death has been relatively slow to take off. Most of the transplants done in India are living related or unrelated transplants. To curb organ commerce and promote donation after brain death the government enacted a law called "The Transplantation of Human Organs Act" in 1994 that brought about a significant change in the organ donation and transplantation scene in India. [27][28][29][30] [31][32][33][34][35] Many Indian states have adopted the law and in 2011 further amendment of the law took place.[36][37][38][39] [40] Despite the law there have been stray instances of organ trade in India and these have been widely reported in the press. This resulted in the amendment of the law further in 2011. Deceased donation after brain death have slowly started happening in India and 2012 was the best year for the programme.

Map shows Indian states that have done Deceased Donation Transplantation in India
Table 1 - Deceased Organ Donation in India - 2012.
State No. of Deceased Donors Total no. of Organs Retrieved Organ Donation Rate per Million Population
Tamil Nadu 83 252 1.15
Maharashtra 29 68 0.26
Gujarat 18 46 0.30
Karnataka 17 46 0.28
Andhra Pradesh 13 37 0.15
Kerala 12 26 0.36
Delhi-NCR 12 31 0.29
Punjab 12 24 0.43
Total 196 530 0.16

Source: Indian Transplant News Letter of MOHAN Foundation (Vol 2 Issue No. 37 of 2013)

The year 2013 has been the best yet for deceased organ donation in India. A total of 845 organs were retrieved from 310 multi-organ donors resulting in a national organ donation rate of 0.26 per million population(Table 2).

Table 2 - Deceased Organ Donation in India – 2013
StateTamil NaduAndhra PradeshKeralaMaharashtraDelhiGujaratKarnatakaPuducherryTotal (National)
Donor 131 4035352725182313
* ODR (pmp) 1.80 0.471.050.311.610.410.291.60.26
Heart 16 260-01025
Lung 20 200-00022
Liver 118 3423232320160257
Kidney 234 7559534054294548
Total 388 11388766374464852

* ODR (pmp) – Organ Donation Rate (per million population)

In the year 2000 through the efforts of an NGO called MOHAN Foundation state of Tamil Nadu started an organ sharing network between a few hospitals.[41][42] This NGO also set up similar sharing network in the state of Andhra Pradesh and these two states were at the forefront of deceased donation and transplantation programme for many years.[43][44] As a result, retrieval of 1033 organs and tissues were facilitated in these two states by the NGO.[45] Similar sharing networks came up in the states of Maharashtra and Karnataka; however the numbers of deceased donation happening in these states were not sufficient to make much impact.

In 2008, the Government of Tamil Nadu put together government orders laying down procedures and guidelines for deceased organ donation and transplantation in the state.[46] These brought in almost thirty hospitals in the programme and has resulted in significant increase in the donation rate in the state. With an organ donation rate of 1.15 per million population, Tamil Nadu is the leader in deceased organ donation in the country. The small success of Tamil Nadu model has been possible due to the coming together of both government and private hospitals, NGOs and the State Health department. Most of the deceased donation programmes have been developed in southern states of India.[47]

The various such programmes are as follows-

In the year 2012 besides Tamil Nadu other southern states too did deceased donation transplants more frequently. An online organ sharing registry for deceased donation and transplantation is used by the states of Tamil Nadu (www.tnos.org) and Kerala (www.knos.org.in). Both these registries have been developed, implemented and maintained by MOHAN Foundation.

Organ selling is legally banned in Asia. Numerous studies have documented that organ vendors have a poor quality of life (QOL) following kidney donation. However, a study done by Vemuru reddy et al shows a significant improvement in Quality of life contrary to the earlier belief.[48] Live related renal donors have a significant improvement in the QOL following renal donation using the WHO QOL BREF in a study done at the All India Institute of Medical Sciences from 2006 to 2008. The quality of life of the donor was poor when the graft was lost or the recipient died.[48]

Sri Lanka

Organ donation in Sri Lanka was ratified by the Human Tissue Transplantation Act No. 48 of 1987. Sri Lanka Eye Donation Society, a non-governmental organization established in 1961 has provided over 60,000 corneas for corneal transplantation, for patients in 57 countries. It is one of the major suppliers of human eyes to the world, with a supply of approximately 3,000 corneas per year.[49]

Israel

Since 2008, signing an organ donor card in Israel has provided a potential medical benefit to the signer. If two patients require an organ donation and have the same medical need, preference will be given to the one that had signed an organ donation card. This policy was nicknamed "dont give, don't get". Organ donation in Israel increased after 2008.

Brazil

A campaign by Sport Club Recife has led to waiting lists for organs in north-east Brazil to drop almost to zero; while according to the Brazilian law the family has the ultimate authority, the issuance of the organ donation card and the ensuing discussions have however eased the process.[50]

New Zealand

New Zealand law allows live donors to participate in altruistic organ donation only. In 2013 there were 3 cases of liver donation by live donors and 58 cases of kidney donation by live donors.[51] New Zealand has low rates of live donation, which could be due to the fact that it is illegal to pay someone for their organs. The Human Tissue Act 2008 states that trading in human tissue is prohibited, and is punishable by a fine of up to $50,000 or a prison term of up to 1 year.[52]

New Zealand law also allows for organ donation from deceased individuals. In 2013 organs were taken from 36 deceased individuals.[53] Everyone who applies for a drivers license in New Zealand indicates whether or not they wish to be a donor if they die in circumstances that would allow for donation.[54] The question is required to be answered for the application to be processed, meaning that the individual must answer yes or no, and does not have the option of leaving it unanswered.[54] However, the answer given on the drivers license does not constitute informed consent, because at the time of drivers license application not all individuals are equipped to make an informed decision regarding whether to be a donor, and it is therefore not the deciding factor in whether donation is carried out or not.[54] It is there to simply give indication of the person's wishes.[54] Family must agree to the procedure for donation to take place.[54][55]

A 2006 bill proposed setting up an organ donation register where people can give informed consent to organ donations and clearly state their legally binding wishes.[56] However, the bill did not pass, and there was condemnation of the bill from some doctors, who said that even if a person had given express consent for organ donation to take place, they would not carry out the procedure in the presence of any disagreement from grieving family members.[57]

The indigenous population of New Zealand also have strong views regarding organ donation. Many Maori people believe organ donation is morally unacceptable due to the cultural need for a dead body to remain fully intact.[58] However, because there is not a universally recognised cultural authority, no one view on organ donation is universally accepted in the Maori population.[58] They are, however, less likely to accept a kidney transplant than other New Zealanders, despite being overrepresented in the population receiving dialysis.[58]

Iran

Only one country, Iran has eliminated the shortage of transplant organs - and only Iran has a working and legal payment system for organ donation. [54] It is also the only country where organ trade is legal. The way their system works is, if a patient does not have a living relative or who are not assigned an organ from a deceased donor, apply to the nonprofit Dialysis and Transplant Patients Association (Datpa). The association establishes potential donors, those donors are assessed by transplant doctors who are not affiliated with the Datpa association. The government gives a compensation of $1,200 to the donors and aid them a year of limited health-insurance. Additionally, working through Datpa, kidney recipients pay donors between $2,300 and $4,500.[15] Importantly, it is illegal for the medical and surgical teams involved or any ‘middleman’ to receive payment.[59] Charity donations are made to those donors whose recipients are unable to pay. The Iranian system began in 1988 and eliminated the shortage of kidneys by 1999. Within the first year of the establishment of this system, the number of transplants had almost doubled; nearly four fifths were from living unrelated sources.[59][55] This system has exhibited a way to stop organ shortage. Which is to reimburse living donors for their organs. Other countries need to observe this method in the hopes that they will be able to alleviate the lack of organ donors. Nobel Laureate economist Gary Becker and Julio Elias estimated that a payment of $15,000 for living donors would alleviate the shortage of kidneys in the U.S.[15]

Bioethical issues

Deontological issues

Certain groups, like the Roma (gypsies), oppose organ donation on religious grounds, but most of the world's religions support donation as a charitable act of great benefit to the community.[60] Issues surrounding patient autonomy, living wills, and guardianship make it nearly impossible for involuntary organ donation to occur.

From the standpoint of deontological ethics, the primary issues surrounding the morality of organ donation are semantical in nature. The debate over the definitions of life, death, human, and body is ongoing. For example, whether or not a brain-dead patient ought to be kept artificially animate in order to preserve organs for procurement is an ongoing problem in clinical bioethics. In addition, some have argued that organ donation constitutes an act of self-harm, even when an organ is donated willingly.

Further, the use of cloning to produce organs with an identical genotype to the recipient has issues all its own. Cloning is still a controversial topic, especially considering the possibility for an entire person to be brought into being with the express purpose of being destroyed for organ procurement. While the benefit of such a cloned organ would be a zero-percent chance of transplant rejection, the ethical issues involved with creating and killing a clone may outweigh these benefits. However, it may be possible in the future to use cloned stem-cells to grow a new organ without creating a new human being.

A relatively new field of transplantation has reinvigorated the debate. Xenotransplantation, or the transfer of animal (usually pig) organs into human bodies, promises to eliminate many of the ethical issues, while creating many of its own. While xenotransplantation promises to increase the supply of organs considerably, the threat of organ transplant rejection and the risk of xenozoonosis, coupled with general anathema to the idea, decreases the functionality of the technique. Some animal rights groups oppose the sacrifice of an animal for organ donation and have launched campaigns to ban them.

Teleological issues

On teleological or utilitarian grounds, the moral status of "black market organ donation" relies upon the ends, rather than the means. In so far as those who donate organs are often impoverished and those who can afford black market organs are typically well-off, it would appear that there is an imbalance in the trade. In many cases, those in need of organs are put on waiting lists for legal organs for indeterminate lengths of time — many die while still on a waiting list.

Organ donation is fast becoming an important bioethical issue from a social perspective as well. While most first-world nations have a legal system of oversight for organ transplantation, the fact remains that demand far outstrips supply. Consequently, there has arisen a black market trend often referred to as transplant tourism. The issues are weighty and controversial. On the one hand are those who contend that those who can afford to buy organs are exploiting those who are desperate enough to sell their organs. Many suggest this results in a growing inequality of status between the rich and the poor. On the other hand are those who contend that the desperate should be allowed to sell their organs and that preventing them from doing so is merely contributing to their status as impoverished. Further, those in favor of the trade hold that exploitation is morally preferable to death, and in so far as the choice lies between abstract notions of justice on the one hand and a dying person whose life could be saved on the other hand, the organ trade should be legalized. Conversely, surveys conducted among living donors postoperatively and in a period of five years following the procedure have shown extreme regret in a majority of the donors, who said that given the chance to repeat the procedure, they would not.[61] Additionally, many study participants reported a decided worsening of economic condition following the procedure.[62] These studies looked only at people who sold a kidney in countries where organ sales are already legal.

A consequence of the black market for organs has been a number of cases and suspected cases of organ theft,[63][64] including murder for the purposes of organ theft.[65][66] Proponents of a legal market for organs say that the black-market nature of the current trade allows such tragedies and that regulation of the market could prevent them. Opponents say that such a market would encourage criminals by making it easier for them to claim that their stolen organs were legal.

Legalization of the organ trade carries with it its own sense of justice as well[citation needed]. Continuing black-market trade creates further disparity on the demand side: only the rich can afford such organs. Legalization of the international organ trade could lead to increased supply, lowering prices so that persons outside the wealthiest segments could afford such organs as well.

Exploitation arguments generally come from two main areas:

The New Cannibalism is a phrase coined by anthropologist Nancy Scheper-Hughes in 1998 for an article written for The New Internationalist. Her argument was that the actual exploitation is an ethical failing, a human exploitation; a perception of the poor as organ sources which may be used to extend the lives of the wealthy.[71]

Economic drivers leading to increased donation are not limited to areas such as India and Africa, but also are emerging in the United States. Increasing funeral expenses combined with decreasing real value of investments such as homes and retirement savings which took place in the 2000s have purportedly led to an increase in citizens taking advantage of arrangements where funeral costs are reduced or eliminated.[72]

Brain death versus cardiac death

Brain death may result in legal death, but still with the heart beating, and with mechanical ventilation, all other vital organs may be kept alive and functional for a certain period of time. Given long enough, patients who do not fully die, in the complete biological sense, but who are declared brain dead will usually, either after a shorter or longer interval, depending upon the patient's case and the type and extent of trauma and their age and prior health, start to build up toxins and wastes in the body, and the organs (especially sensitive ones like the brain, nerves, heart, blood vessels, lungs, liver, intestines, and kidneys) eventually can dysfunction, have coagulopathies or fluid and electrolyte and nutrient imbalances, or even fail- partially, or completely and irreversibly. Thus, the organs will usually only be sustainable and viable for acceptable use up until a certain length of time (most organs that are transplanted fortunately have widely used and agreed upon parameters, that are measurable and reliable, when determining their welfare and level of function). This will depend on how well the patient is maintained, any other comorbidities, the skill of the medical, nursing, and surgical teams, and the quality of the care and the facilities- and once removed, the time and the mode of transport and how smoothly the transplant procedure (and the care before, during, and after the operation[s]), goes.[73] Given optimal care and oversight, and with the person's (through a directive or driver's license) and/or guardian or next of kin or power of attorney's informed consent, certain cases can provide optimal opportunities for organ transplantation. A major point of contention is whether transplantation should be allowed at all if the patient is not yet fully (biologically) dead, and if brain death is acceptable, whether the person's whole brain needs to have died, or if the death of a part of the brain (i.e., the cerebrum- which makes us human in our intellectual, and indeed all, conscious capacities; or the brain stem- which controls vital organic functions needed for life, like breathing and precise heartbeat regulation) is enough for legal and ethical and moral purposes.

Most organ donation for organ transplantation is done in the setting of brain death. However, in Japan this is a fraught point, and prospective donors may designate either brain death or cardiac death – see organ transplantation in Japan. In some nations (for instance, Belgium, Poland, Portugal and France) everyone is automatically an organ donor, although some jurisdictions (such as Singapore, Portugal, Poland, or New Zealand) allow opting out of the system. Elsewhere, consent from family members or next-of-kin is required for organ donation. The non-living donor is kept on ventilator support until the organs have been surgically removed. If a brain-dead individual is not an organ donor, ventilator and drug support is discontinued and cardiac death is allowed to occur.

In the United States, where since the 1980s the Uniform Determination of Death Act has defined death as the irreversible cessation of the function of either the brain or the heart and lungs,[74] the 21st century has seen an order-of-magnitude increase of donation following cardiac death. In 1995, only one out of 100 dead donors in the nation gave their organs following the declaration of cardiac death. That figure grew to almost 11 percent in 2008, according to the Scientific Registry of Transplant Recipients.[74] That increase has provoked ethical concerns about the interpretation of "irreversible" since "patients may still be alive five or even 10 minutes after cardiac arrest because, theoretically, their hearts could be restarted, [and thus are] clearly not dead because their condition was reversible."[74]

Political issues

There are also controversial issues regarding how organs are allocated to recipients. For example, some believe that livers should not be given to alcoholics in danger of reversion, while others view alcoholism as a medical condition like diabetes.

Faith in the medical system is important to the success of organ donation. Brazil switched to an opt-out system and ultimately had to withdraw it because it further alienated patients who already distrusted the country's medical system.[75]

Adequate funding, strong political will to see transplant outcomes improve, and the existence of specialized training, care and facilities also increase donation rates. Expansive legal definitions of death, such as Spain uses, also increase the pool of eligible donors by allowing physicians to declare a patient to be dead at an earlier stage, when the organs are still in good physical condition.

Allowing or forbidding payment for organs affects the availability of organs. Generally, where organs cannot be bought or sold, quality and safety are high, but supply is not adequate to the demand. Where organs can be purchased, the supply increases.[76]

Iran adopted a system of paying kidney donors in 1988 and within 11 years it became the only country in the world to clear its waiting list for transplants.
— The Economist

Healthy humans have two kidneys, a redundancy that enables living donors (inter vivos) to give a kidney to someone who needs it. The most common transplants are to close relatives, but people have given kidneys to other friends. The rarest type of donation is the undirected donation whereby a donor gives a kidney to a stranger. Less than a few hundred of such kidney donations have been performed. In recent years, searching for altruistic donors via the internet has also become a way to find life saving organs. However, internet advertising for organs is a highly controversial practice, as some scholars believe it undermines the traditional list-based allocation system.[77]

The National Transplant Organization of Spain is one of the most successful in the world, but it still cannot meet the demand, as 10% of those needing a transplant die while still on the transplant list.[78] Donations from corpses are anonymous, and a network for communication and transport allows fast extraction and transplant across the country. Under Spanish law, every corpse can provide organs unless the deceased person had expressly rejected it. Because family members still can forbid the donation,[79] carefully trained doctors ask the family for permission, making it very similar in practice to the United States system.[80]

In the overwhelming majority of cases, organ donation is not possible for reasons of recipient safety, match failures, or organ condition. Even in Spain, which has the highest organ donation rate in the world, there are only 35.1 actual donors per million people, and there are hundreds of patients on the waiting list.[75] This rate compares to 24.8 per million in Austria, where families are rarely asked to donate organs, and 22.2 per million in France, which—like Spain—has a presumed-consent system.

Prison inmates

In the United States, prisoners are not discriminated against as organ recipients and are equally eligible for organ transplants along with the general population. A 1976 U.S. Supreme Court case[81] ruled that withholding health care from prisoners constituted "cruel and unusual punishment". United Network for Organ Sharing, the organization that coordinates available organs with recipients, does not factor a patient's prison status when determining suitability for a transplant.[82][83] An organ transplant and follow-up care can cost the prison system up to one million dollars.[83][84] If a prisoner qualifies, a state may allow compassionate early release to avoid high costs associated with organ transplants.[83] However, an organ transplant may save the prison system substantial costs associated with dialysis and other life-extending treatments required by the prisoner with the failing organ. For example, the estimated cost of a kidney transplant is about $111,000.[85] A prisoner's dialysis treatments are estimated to cost a prison $120,000 per year.[86]

Because donor organs are in short supply, there are more people waiting for a transplant than available organs. When a prisoner receives an organ, there is a high probability that someone else will die waiting for the next available organ. A response to this ethical dilemma states that felons who have a history of violent crime, who have violated others’ basic rights, have lost the right to receive an organ transplant, though it is noted that it would be necessary "to reform our justice system to minimize the chance of an innocent person being wrongly convicted of a violent crime and thus being denied an organ transplant"[87]

Prisons typically do not allow inmates to donate organs to anyone but immediate family members. There is no law against prisoner organ donation; however, the transplant community has discouraged use of prisoner's organs since the early 1990s due to concern over prisons' high-risk environment for infectious diseases.[88] Physicians and ethicists also criticize the idea because a prisoner is not able to consent to the procedure in a free and non-coercive environment,[89] especially if given inducements to participate. However, with modern testing advances to more safely rule out infectious disease and by ensuring that there are no incentives offered to participate, some have argued that prisoners can now voluntarily consent to organ donation just as they can now consent to medical procedures in general. With careful safeguards, and with over 2 million prisoners in the U.S., they reason that prisoners can provide a solution for reducing organ shortages in the U.S.[90]

While some have argued that prisoner participation would likely be too low to make a difference, one Arizona program started by Maricopa County Sheriff Joe Arpaio encourages inmates to voluntarily sign up to donate their heart and other organs.[91] As of mid-2012, over 10,000 inmates had signed up in that one county alone.[92]

Religious viewpoints

There are several different religions that have different perspectives. Islamic has a conflicting viewpoint, half believe that it is against the religion. However, Muhammed claims his believers should seek medical atention when in need and saving life is a very important factor of the Islamic religion. Buddhism is mostly agianst the practice, because it disrespects the bodies of ancestors and nature. Christianity is the most leaniant on the topic of organ donation, and believe it is a service of life.[93]

All major religions accept organ donation in at least some form on either utilitarian grounds (i.e., because of its life-saving capabilities) or deontological grounds (e.g., the right of an individual believer to make his or her own decision). Most religions, among them the Roman Catholic Church, support organ donation on the grounds that it constitutes an act of charity and provides a means of saving a life, consequently Pope Francis is an organ donor. One religious group, The Jesus Christians, became known as "The Kidney Cult" because more than half its members had donated their kidneys altruistically. Jesus Christians claim altruistic kidney donation is a great way to "Do unto others what they would want you to do unto them."[94] Some religions impose certain restrictions on the types of organs that may be donated and/or on the means by which organs may be harvested and/or transplanted.[95] For example, Jehovah's Witnesses require that organs be drained of any blood due to their interpretation of the Hebrew Bible/Christian Old Testament as prohibiting blood transfusion,[96] and Muslims require that the donor have provided written consent in advance.[96] A few groups disfavor organ transplantation or donation; notably, these include Shinto[97] and those who follow the customs of the Gypsies.[96]

Orthodox Judaism considers organ donation obligatory if it will save a life, as long as the donor is considered dead as defined by Jewish law.[96] In both Orthodox Judaism and non-Orthodox Judaism, the majority view holds that organ donation is permitted in the case of irreversible cardiac rhythm cessation. In some cases, rabbinic authorities believe that organ donation may be mandatory, whereas a minority opinion considers any donation of a live organ as forbidden.[98]

Organ shortfall

The demand for organs significantly surpasses the number of donors everywhere in the world. There are more potential recipients on organ donation waiting lists than organ donors. In particular, due to significant advances in dialysis techniques, patients suffering from end-stage renal disease (ESRD) can survive longer than ever before. Because these patients don't die as quickly as they used to, and as kidney failure increases with the rising age and prevalence of high blood pressure and diabetes in a society, the need especially for kidneys rises every year.

As of March 2014, about 121,600 people in the United States are on the waiting list, although about a third of those patients are inactive and could not receive a donated organ.[99][100] Wait times and success rates for organs differ significantly between organs due to demand and procedure difficulty. As of 2007, three-quarters of patients in need of an organ transplant were waiting for a kidney,[101] and as such kidneys have much longer waiting times. At the Oregon Health and Science University, for example, the median patient who ultimately received an organ waited only three weeks for a heart and three months for a pancreas or liver — but 15 months for a kidney, because demand for kidneys substantially outstrips supply.[102]

In Australia, there are 10.8 transplants per million people,[103] about a third of the Spanish rate. The Lions Eye Institute, in Western Australia, houses the Lions Eye Bank. The Bank was established in 1986 and coordinates the collection, processing and distribution of eye tissue for transplantation. The Lions Eye Bank also maintains a waitlist of patients who require corneal graft operations. About 100 corneas are provided by the Bank for transplant each year, but there is still a waiting list for corneas.[104]

"To an economist, this is a basic supply-and-demand gap with tragic consequences."[105] Approaches to addressing this shortfall include:

In hospitals, organ network representatives routinely screen patient records to identify potential donors shortly in advance of their deaths.[111] In many cases, organ-procurement representatives will request screening tests (such as blood typing) or organ-preserving drugs (such as blood pressure drugs) to keep potential donors' organs viable until their suitability for transplants can be determined and family consent (if needed) can be obtained.[111] This practice increases transplant efficiency, as potential donors who are unsuitable due to infection or other causes are removed from consideration before their deaths, and decreases the avoidable loss of organs.[111] It may also benefit families indirectly, as the families of unsuitable donors are not approached to discuss organ donation.[111]

The Center for Ethical Solutions, an American bioethics think tank, is currently working on a project called "Solving the Organ Shortage," in which it is studying the Iranian kidney procurement system in order to better inform the debate over solving the organ shortfall in the United States.[112]

Distribution

The United States has two agencies that govern organ procurement and distribution within the country. The United Network for Organ Sharing and the Organ Procurement and Transplant Network (OPTN) regulate Organ Procurement Organizations (OPO) with regard to procurement and distribution ethics and standards. OPOs are non-profit organizations charged with the evaluation, procurement and allocation of organs whithin their Designated Service Area (DSA). Once a donor has been evaluated and consent obtained, provisional allocation of organs commences. UNOS developed a computer program that automatically generates donor specific match lists for suitable recipients based on the criteria that the patient was listed with. OPO coordinators enter donor information into the program and run the respective lists. Organ offers to potential recipients are made to transplant centers to make them aware of a potential organ. The surgeon will evaluate the donor information and make a provisional determination of medical suitability to their recipient. Distribution varies slightly between different organs but is essentially very similar. When lists are generated many factors are taken into consideration; these factors include: distance of transplant center from the donor hospital, blood type, medical urgency, wait time, donor size and tissue typing. For heart recipients medical urgency is denoted by a recipients "Status" (Status 1A, 1B and status 2). Lungs are allocated based on a recipients Lung Allocation Score (LAS) that is determined based on urgency and wait time. Livers are allocated using both a status system and MELD/PELD score (Model for End-stage Liver Disease/Pediatric End-stage Liver Disease). Kidney and pancreas lists are based on location, blood type, Human Leukocyte Antigen (HLA) typing and wait time. When a recipient for a kidney or pancreas has no direct antibodies to the donor HLA the match is said to be a 0 ABDR mismatch or zero antigen mismatch. A zero mismatch organ has a low rate of rejection and allows a recipient to be on lower doses of immunosuppressive drugs. Since zero mismatches have such high graft survival these recipients are afforded priority regardless of location and wait time. UNOS has in place a "Payback" system to balance organs that are sent out of a DSA because of a zero mismatch.

Location of a transplant center with respect to a donor hospital is given priority due to the effects of Cold Ischemic Time (CIT). Once the organ is removed from the donor, blood no longer perfuses through the vessels and begins to starve the cells of oxygen (ischemia). Each organ tolerates different ischemic times. Hearts and lungs need to be transplanted within 4–6 hours from recovery, liver about 8–10 hours and pancreas about 15 hours; kidneys are the most resilient to ischemia. Kidneys packaged on ice can be successfully transplanted 24–36 hours after recovery. Developments in kidney preservation have yielded a device that pumps cold preservation solution through the kidneys vessels to prevent Delayed Graft Function (DGF) due to ischemia. Perfusion devices, often called kidney pumps, can extend graft survival to 36–48 hours post recovery for kidneys. Recently similar devices have been developed for the heart and lungs, in an effort to increase distances procurement teams may travel to recover an organ.

Suicide

People committing suicide have a higher rate of donating organs than average. One reason is lower negative response or refusal rate by the family and relatives, but the explanation for this remains to be clarified.[113] In addition, donation consent is higher than average from people committing suicide.[114]

Attempted suicide is a common cause of brain death (3.8%), mainly among young men.[113] Organ donation is more common in this group compared to other causes of death. Brain death may result in legal death, but still with the heart beating, and with mechanical ventilation all other vital organs may be kept completely alive and functional,[73] providing optimal opportunities for organ transplantation.

Controversies

In 2008, California transplant surgeon Hootan Roozrokh was charged with dependent adult abuse for prescribing what prosecutors alleged were excessive doses of morphine and sedatives to hasten the death of a man with adrenal leukodystrophy and irreversible brain damage, in order to procure his organs for transplant.[115] The case brought against Roozrokh was the first criminal case against a transplant surgeon in the US, and resulted in his acquittal.

At California's Emanuel Medical Center, neurologist Narges Pazouki, MD, said an organ-procurement organization representative pressed her to declare a patient brain-dead before the appropriate tests had been done.[111]

In September 1999, eBay blocked an auction for "one functional human kidney" which had reached a highest bid of $5.7 million. Under United States federal laws, eBay was obligated to dismiss the auction for the selling of human organs which is punishable by up to five years in prison and a $50,000 fine.[116]

On June 27, 2008, Indonesian Sulaiman Damanik, 26, pleaded guilty in a Singapore court for sale of his kidney to CK Tang's executive chair, Mr. Tang Wee Sung, 55, for 150 million rupiah (US$17,000). The Transplant Ethics Committee must approve living donor kidney transplants. Organ trading is banned in Singapore and in many other countries to prevent the exploitation of "poor and socially disadvantaged donors who are unable to make informed choices and suffer potential medical risks." Toni, 27, the other accused, donated a kidney to an Indonesian patient in March, alleging he was the patient's adopted son, and was paid 186 million rupiah (US$21,000).

Social media

The United States Department of Health funded a study by the University of Wisconsin Hospital to increase efforts to increase awareness and the amount of registered donors by pursuing members of the university and their family and friends through social media.[117] The results of the study showed a 20% increase in organ donation by creating support and awareness through social media.[117]

Becoming a donor

Adding one's name to a statewide organ donor registry is the recommended method for ensuring the decision to become an organ, eye and tissue donor is honored. Methods to join the donor registry vary somewhat by state. The most common way to register is through the DMV (Department of Motor Vehicles) or similar agency, typically when renewing a driver's license or ID card.

Alternately, most states also have online portals to their donor registries, which can be accessed through Donate Life America or the U.S. Department of Health and Human Services.

Sharing one's decision to donate with family members is very important, also. Although most states honor First Person Authorization (through donor registries, signing the back of a driver's license, living wills, etc.), the family's cooperation is vital in order to obtain medical and social background information to help determine the health of the donor's organs and tissues. Family challenges to the donor's legally documented decision to donate can cause delays, and may mean fewer organs can be transplanted as the organs deteriorate in the time after death is declared. To be considered as a living organ donor a person should contact a hospital with a transplant center/program. If the desire is to donate to a particular patient, then that patient's transplant center is the one which should be contacted. A list of transplant centers can be found through the Organ Procurement and Transplantation Network.

In the United Kingdom, one signs up to be an organ donor through the NHS Blood and Transplant Service, or on an application for a driving license. This is shown on the photocard part of the license as a code (115).[118]

Public service announcements

There is a need for more participants in organ donation. Marketing for organ donation must walk a fine line between stressing the need for organ donation and not being too forceful.[119] If the marketing agent is too forceful, then the target of the message will react defensively to the request. According to psychological reactance theory, a person will perceive their freedom threatened and will react to restore the freedom. According to Ashley Anker, the use of transportation theory has a positive effect on target reactions by marketing attempts.[119] When public service announcements use recipient-focused messages, targets were more transported. Individuals who watched recipient-focused messages were more transported because potential donors experience empathy for the potential recipient. Future public service announcements should use recipient-focused stories to elicit relationship formation between potential donors and recipients.

Awareness about organ donation leads to greater social support for organ donation, in turn leading to greater registration. By starting with promoting college students’ awareness of organ donation and moving to increasing social support for organ donation, the more likely people will be to register as organ donors.[120]

Shortages

Currently more than 100,000 people are waiting for an organ transplant, yet there is a shortage of donors. Over the years people worldwide have stopped registering to be organ donors, resulting in the deaths of numerous people each year. The shortage often creates unethical situations where payments are made in return for the sale of the organs and donors often do not receive appropriate post-operative care. Although most organs may only be taken from donors that have been declared dead (brain-dead), kidneys have remained an exception with their potential for live donor transplants and as such are often the target of illegal harvesting and black market transactions. Many countries have now started to move towards a system of donation by default on death ("Opt Out" system) unless a signed objection is registered with the relevant authorities in order to relieve the burden being placed on the health care system at the moment.

See also

References

  1. 1 2 Weaver, Matthew (23 April 2015). "Parents of UK's youngest organ donor hope others will be inspired". The Guardian (London). Retrieved 2015-04-24.
  2. ↑ http://www.cbsnews.com/news/growing-human-kidneys-in-rats-sparks-ethical-debate/
  3. ↑ http://onlinelibrary.wiley.com/doi/10.1111/ajt.13149/abstract
  4. ↑ Vincent, A.; Logan, L. (2012-01-01). "Consent for organ donation". British Journal of Anaesthesia 108 (suppl 1): i80–i87. doi:10.1093/bja/aer353. ISSN 0007-0912. PMID 22194436.
  5. 1 2 3 D'Alessandro, Anthony; Peltier, James; Dahl, Andrew (27 November 2012). "Use of social media and college student organizations to increase support for organ donation and advocacy: a case report". Progress in Transplantation 22 (4): 436–41. doi:10.7182/pit2012920. PMID 23187063.
  6. ↑ Siminoff, Laura; Agyemang, Amma; Traino, Heather (28 February 2013). "Consent to organ donation: a review". Progress in Transplantation. doi:10.7182/pit2013801. PMID 23448829.
  7. 1 2 Johnson, Eric J.; Goldstein, Daniel G. (21 November 2003). "Do defaults save lives?" (PDF). Science 302 (5649): 1338–9. doi:10.1126/science.1091721. PMID 14631022. Retrieved 2012-05-19.
  8. ↑ Thaler, Richard H. (September 26, 2009). "Opting in vs. Opting Out". The New York Times. Archived from the original on March 8, 2014. Retrieved March 7, 2014.
  9. ↑ "Myth busting". DonateLife. Australian Government Organ and Tissue Authority. My family can overrule my decision to be a donor. Archived from the original on 22 May 2013. Retrieved 15 May 2013.
  10. ↑ http://www.thelocal.es/20150113/spain-tops-world-organ-transplant-rankings
  11. ↑ Organ Donation Taskforce (2008). "The potential impact of an opt out system for organ donation in the UK" (PDF). United Kingdom: Department of Health. p. 22. Retrieved 8 March 2014.
  12. ↑ "Organ Procurement and Transplantation Network". http://optn.transplant.hrsa.gov/. U.S. Department of Health & Human Services. Retrieved 11 October 2015. External link in |website= (help)
  13. ↑ "Need continues to grow". http://optn.transplant.hrsa.gov/. U.S. Department of Health & Human Services. Retrieved 11 October 2015. External link in |website= (help)
  14. ↑ Orentlicher, David (2009). "Presumed Consent to Organ Donation: Its Rise and Fall in the United States" (PDF). Rutgers Law Review 61 (2): 295–331.
  15. 1 2 3 4 Tabarrok, Alex (January 8, 2010). "The Meat Market". The Saturday Essay. The Wall Street Journal.
  16. ↑ Carney, Scott. "The Case for Mandatory Organ Donation". Wired. Conde Naste. Retrieved 13 February 2015.
  17. ↑ Wiggins, Ovetta. "Pa. organ donors get $300 boost It pays for food or lodging for them or their family. A bigger plan's rejection rankles some.". Philly.com. Philadelphia Media Network. Retrieved 28 February 2015.
  18. ↑ Krauthammer, Charles. "Yes, Let's Pay for Organs". Time. Time Inc. Retrieved 28 February 2015.
  19. ↑ Gormley, Michael (April 27, 2010). "New York To Be First Organ Donor Opt-Out State?". New York. The Huffington Post (New York City). Archived from the original on April 30, 2010. Retrieved March 7, 2014.
  20. ↑ "Organ donation opt-out system given go-ahead in Wales". BBC News. July 2, 2013. Archived from the original on March 7, 2014. Retrieved March 7, 2014.
  21. ↑ "Organ donation law 'revolution' starts in Wales". BBC. Retrieved 1 December 2015.
  22. ↑ "MEPs back Europe organ donor card". BBC News. 22 April 2008. Archived from the original on 2 August 2012. Retrieved 8 March 2014.
  23. ↑ "Come donare" [How to Donate] (in Italian). Ministry of Health (Italy). Archived from the original on 8 March 2014. Retrieved 13 January 2013.
  24. ↑ Jones, Meg (23 April 2011). "A Soldier's Death Gives Life to Another Man". United States: Pulitzer Center on Crisis Reporting. Archived from the original on 26 August 2013. Retrieved 8 March 2014.
  25. 1 2 Vincent, A.; Logan, L. (2012-01-01). "Consent for organ donation". British Journal of Anaesthesia 108 (suppl 1): i80–i87. doi:10.1093/bja/aer353. ISSN 0007-0912. PMID 22194436.
  26. 1 2 Wicks, Mona Newsome (25 April 2000). "Brain Death and Transplantation: The Japanese". Medscape Transplantation (Medscape). Retrieved 8 March 2014.
  27. ↑ Vyas, Hetel (January 14, 2013). "State goes slow on stiffer jail term for organ scamsters". The Times of India. Archived from the original on March 7, 2014. Retrieved March 7, 2014.
  28. ↑ Kurup, Deepa (January 4, 2013). "Expendable cogs in a well-oiled racket". The Hindu (India). Archived from the original on March 10, 2013. Retrieved March 7, 2014.
  29. ↑ "Govt amends Transplantation of Human Organs Act". Zee News (India). March 17, 2011. Archived from the original on March 7, 2014. Retrieved March 7, 2014.
  30. ↑ "National Workshop of transplant coordinators provides guidelines". The Hindu (India). March 7, 2013. Archived from the original on May 11, 2013. Retrieved March 7, 2014.
  31. ↑ Dhar, Aarti (19 December 2009). "Organ Transplant Bill tabled". The Hindu. Archived from the original on 8 March 2014. Retrieved 8 March 2014.
  32. ↑ The Transplantation of Human Organs (Amendment) Bill, 2011, Act No. 136-C of 2009. Retrieved on 8 March 2014.
  33. ↑ Sreeraman (23 November 2009). "Amendments in Transplantation of Human Organ Act, 1994". Medindia. Archived from the original on 8 March 2014. Retrieved 8 March 2014.
  34. ↑ Shroff, Sunil (Jul–Sep 2009). "Legal and ethical aspects of organ donation and transplantation". Indian J. Urol. 25 (3): 348–55. doi:10.4103/0970-1591.56203. PMC 2779960. PMID 19881131.
  35. ↑ Shroff, Sunil (2009). "Organ Donation and Transplantation in India – Legal Aspects & Solutions to Help With Shortage of Organs". J. Nephrol. Ren. Transplant. 2 (1): 23–34. ISSN 1918-0268.
  36. ↑ "Illegal organ transplant can attract 10-year jail". The Hindu. 13 August 2011. Archived from the original on 8 March 2014. Retrieved 8 March 2014.
  37. ↑ "Ann 4 THOA ACT 2011" (PDF). Organ Retrieval Banking Organization. Archived (PDF) from the original on 8 March 2014. Retrieved 8 March 2014.
  38. ↑ "Lok Sabha approves tougher organ transplant Bill". India Today. 13 August 2011. Archived from the original on 21 August 2013.
  39. ↑ "RS seal on amendment to human organs bill". The Times of India. 27 August 2011.
  40. ↑ Express News Service (August 13, 2011). "LS okays amendments to organ transplantation Bill". Archive. The Indian Express (India). Archived from the original on March 7, 2014. Retrieved March 7, 2014.
  41. ↑ Kannan, Ramya (22 January 2002). "Organ donation gains momentum". Southern States. The Hindu (India). Archived from the original on 8 March 2014. Retrieved 8 March 2014.
  42. ↑ Kannan, Ramya (28 February 2003). "High time to streamline organ transplants". Southern States. The Hindu (India). Archived from the original on 13 December 2013. Retrieved 8 March 2014.
  43. ↑ Raman, Usha (25 July 2002). "Living after death". Metro Plus Hyderabad. The Hindu (India). Archived from the original on 29 November 2010. Retrieved 8 March 2014.
  44. ↑ Joseph, Lison (28 January 2004). "Organ transplantation help at hand". Hyderabad. The Times of India. Retrieved 8 March 2014.
  45. ↑ "Cadaveric Organ Donation Figures". MOHAN Foundation. INOS Figures (2000 - 2009). Archived from the original on 2 January 2014. Retrieved 8 March 2014.
  46. ↑ Navin, Sumana (2008). "Government Orders on Organ Donation and Transplantation From Tamil Nadu Health Department". MOHAN Foundation. Archived from the original on 11 December 2013. Retrieved 8 March 2014.
  47. ↑ Srinivasan, Sandhya (2013). "Has Tamil Nadu turned the tide on the transplant trade?". BMJ (United Kingdom) 346: f2155. doi:10.1136/bmj.f2155. PMID 23585066.
  48. 1 2 Reddy, Sunil K. Vemuru; et al. (January–March 2011). "Live related donors in India: Their quality of life using world health organization quality of life brief questionnaire". Indian J. Urol. 27 (1): 25–9. doi:10.4103/0970-1591.78411. PMC 3114583. PMID 21716885.
  49. ↑ "Sri Lanka donates eyes to the world". Foxnews.com. Associated Press. 23 January 2012. Archived from the original on 23 January 2014. Retrieved 9 March 2014.
  50. ↑ Carneiro, Julia (1 June 2014). "How thousands of football fans are helping to save lives". BBC News Magazine.
  51. ↑ Organ Donation New Zealand "Number of transplant operations in New Zealand" http://www.donor.co.nz/statistics/number-of-transplant-operations-in-new-zealand
  52. ↑ "Human Tissue Act 2008". New Zealand Legislature. 1 July 2013. Public Act 2008 No 28. Retrieved 2015-08-10.
  53. ↑ "Number of deceased organ donors in New Zealand". Statistics. Organ Donation New Zealand. Archived from the original on 30 May 2014.
  54. 1 2 3 4 5 "Organ and tissue donation". Getting a license. NZ Transport Agency.
  55. ↑ "Kidney Donation". Nephrology Department, Christchurch Hospital, New Zealand. Canterbury District Health Board. October 2011. Archived from the original on 29 November 2014.
  56. ↑ New Zealand Parliament "Human Tissue (Organ Donation) Amendment Bill" http://www.parliament.nz/en-nz/pb/legislation/bills/00DBHOH_BILL7223_1/human-tissue-organ-donation-amendment-bill
  57. ↑ New Zealand Herald. "Doctors oppose organ donor bill" http://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=10379728
  58. 1 2 3 Mauri Ora Associates Limited. "Māori Pacific Attitudes Towards Transplantation: Professional Perspectives" https://www.health.govt.nz/system/files/documents/pages/maori-pacific-attitudes-towards-transplantation.pdf
  59. 1 2 Ghods, Ahad J.; Savaj, Shekoufeh (November 2006). "Iranian Model of Paid and Regulated Living-Unrelated Kidney Donation". Clinical Journal of the American Society of Nephrology. doi:10.2215/CJN.00700206. PMID 17699338.
  60. ↑ Easterbrook, Gregg. "Organ Donation: Where Your Religion Stands". BeliefNet. Archived from the original on 10 November 2013. Retrieved 9 March 2014. Despite popular misconceptions, there are almost no religious rules against donating organs or receiving transplants. A few denominations ban these practices, and a few others have rules that are not models of clarity. This is the first of two pages.
  61. ↑ Zargooshi, Javaad (2001). "Quality of life of Iranian kidney "donors"". J. Urol. 166 (5): 1790–9. doi:10.1016/S0022-5347(05)65677-7. PMID 11586226.
  62. 1 2 Goyal, Madhav; et al. (2002). "Economic and health consequences of selling a kidney in India". JAMA 288 (13): 1589–93. doi:10.1001/jama.288.13.1589. PMID 12350189.
  63. ↑ Sidner, Sara; Eastment, Tess (29 January 2008). "Police hunt for doctor in kidney-snatching ring". CNN. Archived from the original on 9 November 2012. Retrieved 8 March 2014.
  64. ↑ Matas, David; Kilgour, David (31 January 2007). "Bloody Harvest: Report into Allegations of Organ Harvesting of Falun Gong Practitioners in China" (PDF). Archived (PDF) from the original on 15 February 2014. Retrieved 8 March 2014.
  65. ↑ Adams, David (27 May 2003). "Organ trafficking suspected in mass murder case". The Times (United Kingdom). Retrieved 8 March 2014.
  66. ↑ Kelly, Annie (September 6, 2009). "Child sacrifice and ritual murder rise as famine looms". The Guardian (London). Archived from the original on February 14, 2014. Retrieved March 7, 2014.
  67. ↑ Carney, Scott (8 May 2007). "Why a Kidney (Street Value: $3,000) Sells for $85,000". Wired. Archived from the original on 29 July 2013. Retrieved 8 March 2014.
  68. ↑ Jan, Sadaqat (12 November 2006). "Poor Pakistanis Donate Kidneys for Money". The Washington Post. Associated Press. Retrieved 8 March 2014.
  69. ↑ Sarvestani, Nima (31 October 2006). "Iran's desperate kidney traders". BBC News. Archived from the original on 13 November 2013. Retrieved 8 March 2014.
  70. ↑ Carney, Scott (8 May 2007). "Inside 'Kidneyville': Rani's Story". Wired. Archived from the original on 23 June 2013. Retrieved 8 March 2014.
  71. ↑ Scheper-Hughes, Nancy. "The new cannibalism". Berkeley Digital Library SunSITE. University of California, Berkeley. Archived from the original on 3 May 2009.
  72. ↑ Stix, Gary (4 January 2011). "Donate Your Brain, Save a Buck". Scientific American 304 (1): 29. doi:10.1038/scientificamerican0111-29a. Retrieved 8 March 2014.
  73. 1 2 Heisler, Jennifer (29 June 2013). "Organ Donation After Brain Death". About.com. Retrieved 9 March 2014.
  74. 1 2 3 Sanford, John; Dubois, Gėrard (Spring 2011). "When Are You Dead?". Stanford Medicine Magazine. United States: Stanford University School of Medicine. Archived from the original on 15 November 2013. Retrieved 9 March 2014.
  75. 1 2 Bird, Shiela M.; Harris, John (2010). "Time to move to presumed consent for organ donation". Analysis. BMJ 340: c2188. doi:10.1136/bmj.c2188. PMID 20442244.
  76. ↑ R.M. (anonymous) (7 December 2011). "Organ sales: Paying to live" (blog). The Economist. London. Archived from the original on 19 June 2013. Retrieved 9 March 2014. Iran adopted a system of paying kidney donors in 1988 and within 11 years it became the only country in the world to clear its waiting list for transplants.
  77. ↑ Appel, Jacob (May–June 2005). "Organ Solicitation on the Internet: Every Man for Himself?". Hastings Cent. Rep. 35 (3): 14–15. doi:10.1353/hcr.2005.0052. PMID 16092393.
  78. ↑ "Trasplantes" [Transplants] (in Spanish). Spain: National Transplant Organization. Los españoles, un ejemplo imitado. Archived from the original on 6 January 2014. Retrieved 9 March 2014.
  79. ↑ Archived March 8, 2014, at the Wayback Machine.
  80. ↑ "More countries hope to copy Spain's organ-donation success". Canadian Medical Association. 29 September 2003. Archived from the original on August 28, 2009. Retrieved 2011-03-31.
  81. ↑ Estelle v Gamble 429 U.S. 97, 97 S. Ct. 285 50l Ed 2d251 [1976]
  82. ↑ "U.S. Statement On Prison Status and Organ Allocation". United Network for Organ Sharing. 2002-06-02. Archived from the original on September 26, 2006. Retrieved 2009-12-20.
  83. 1 2 3 Wiegand, Steve (January 25, 2002). "State inmate gets new heart; 'Medically necessary care' is required by law, an official says". The Sacramento Bee.
  84. ↑ Ingalls, Chris (8 April 2005). "Prison inmate awaits organ transplant" (PDF). KING-TV. Association of Washington Cities. Archived from the original (PDF) on 6 January 2009. Retrieved 20 December 2009.
  85. ↑ Attack of the Clones...And the Issue of the Clones, 3 Colum. Paul Lesko and Kevin Buckley – Sci. & Tech L. Rev. 1, 19 (2002)
  86. ↑ Killer in Need of a Kidney Starts Ethics Row, Lee Douglas – Chicago Tribune, May 29, 2003, at 10.
  87. ↑ Perry, David L. "Should Violent Felons Receive Organ Transplants?". Markkula Center for Applied Ethics. Retrieved 2009-12-20.
  88. ↑ Guidelines for Preventing HIV Through Transplantation of Human Tissue and Organs, CDC Recommendations and Reports, May 20, 1994 /43(RR-8); 1–17.
  89. ↑ O'Reilly, Kevin B. (9 April 2007). "Prisoner organ donation proposal worrisome". American Medical News. Archived from the original on 30 September 2013. Retrieved 8 March 2014.
  90. ↑ http://www.gavelife.org – Organization established to advocate for organ donations from prisoners.
  91. ↑ "Sheriff Teaches Inmates to "Have a Heart" By Volunteering To Give Up Theirs". Committee to Re-Elect Joe Arpaio 2008. 13 June 2007. Archived from the original on 14 January 2009. Retrieved 20 October 2008.
  92. ↑ http://www.msco.org – See Maricopa County's "I DO" program.
  93. ↑ "Organ Transplants" (PDF).
  94. ↑ "Inside the Kidney Cult". The Sydney Morning Herald. 30 March 2008. Archived from the original on 17 April 2012. Retrieved 8 March 2014.
  95. ↑ "(untitled)" (Microsoft PowerPoint). Give and Let Live. United Kingdom: NHS Blood and Transplant. Archived from the original on 8 March 2014. Retrieved 8 March 2014.
  96. 1 2 3 4 "Statements from Religions". American Red Cross. Jehovah's Witness. Archived from the original on 17 September 2008. Retrieved 22 July 2008.
  97. ↑ "Shinto: Organ donation". BBC. 16 September 2009. Archived from the original on 29 December 2013. Retrieved 8 March 2014.
  98. ↑ Sinclair 2003, p.242
  99. ↑ "UNOS". United Network for Organ Sharing. Transplant Trends. Retrieved 8 March 2014. Waiting list candidates as of today 2:24pm
  100. ↑ Stein, Rob (22 March 2008). "A Third of Patients On The Transplant List Are Not Eligible". The Washington Post. Retrieved 8 March 2014.
  101. ↑ "Resources - General Public". California Transplant Donor Network. Waiting List Statistics. Archived from the original on 19 August 2010. Retrieved 2011-03-31.
  102. ↑ "OHSU Transplant Program". Oregon Health & Science University. 16 March 2011. Retrieved 31 March 2011. Link redirects to page without the required information; original page has been excluded from Internet Archive.
  103. ↑ "Organ & Tissue Donation Western Australia (WA)" (PDF). DonateLife in Western Australia. Archived from the original (PDF) on September 27, 2007. Retrieved 2011-03-31.
  104. ↑ "Lions Eye Institute: Lions Eye Bank". Lei.org.au. 2011-06-30. Retrieved 2012-05-19.
  105. 1 2 3 Dubner, Stephen J.; Levitt, Steven D. (2006-07-09). "Flesh Trade". New York Times.
  106. 1 2 Thaler, Richard H. (2009-09-26). "Opting In vs. Opting Out". New York Times.
  107. ↑ Ghods AJ, Savaj S (2006). "Iranian model of paid and regulated living-unrelated kidney donation". Clin J Am Soc Nephrol 1 (6): 1136–45. doi:10.2215/CJN.00700206. PMID 17699338.
  108. ↑ "Financial Incentives for Organ Donation". Archived from the original on 17 May 2013. After May 2013, this page was no longer available for archiving; in March 2014, searches of the kidney.org site did not reveal a comparable statement in current online materials.
  109. ↑ "Lifesharers.org".
  110. ↑ Richard Schwindt and Aidan Vining (1998). "Proposal for a Mutual Insurance Pool for Transplant Organs". Journal of Health Politics, Policy and Law 23 (5): 725–41.
  111. 1 2 3 4 5 Rob Stein (2007-09-13). "New Zeal in Organ Procurement Raises Fears". The Washington Post (The Washington Post Company). Retrieved 2008-05-02.
  112. ↑ Solving the Organ Shortage. Center for Ethical Solutions. Retrieved on 2009-07-08. Archived April 13, 2009, at the Wayback Machine.
  113. 1 2 Figueiredo FM, Capaverde FB, Londero GG, et al. (March 2007). "Organ donation in suicides". Transplant. Proc. 39 (2): 344–5. doi:10.1016/j.transproceed.2007.01.015. PMID 17362725.
  114. ↑ Moraes BN, Bacal F, Teixeira MC, et al. (April 2009). "Behavior profile of family members of donors and nondonors of organs". Transplant. Proc. 41 (3): 799–801. doi:10.1016/j.transproceed.2009.02.043. PMID 19376356.
  115. ↑ Jesse McKinley (2008-02-27). "Surgeon Accused of Speeding a Death to Get Organs". The New York Time (The New York Times Company). Retrieved 2008-05-02.
  116. ↑ J.H. Huebert (1999-09-24). "Human Organs and Ebay: A Combination That Could Save Lives". The Collegian. Archived from the original on July 7, 2007. Retrieved 2009-11-17.
  117. 1 2 Peltier, James W., Anthony M. Allessandro, and Andrew J. Dahl. "Use of Social Media and College Student Organizations to Increase Support for Organ Donation and Advocacy: A Case Report." Progress in Transplantation (2012): 436-41.
  118. ↑ Gov.uk, Driving license codes, https://www.gov.uk/driving-licence-codes
  119. 1 2 Reinhart, A. M. and A. E. Anker (2012). "An Exploration of Transportation and Psychological Reactance in Organ Donation PSAs." Communication Research Reports 29(4): 274-284.
  120. ↑ Feeley, TH, Peltier, JW, D'Alessandro, AM, Dahl, AJ (2013). "A sequential decision framework for increasing college students’ support for organ donation and organ donor registration". Progress in Transplantation.

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