Talking Points: Allocation of Solid Organs
The US transplant network is operated by the United Network for Organ Sharing (UNOS) under contract with the federal government. They have been operating the system since it began in 1987. UNOS maintains a database of all patients awaiting a transplant.
The national transplant waiting list has more than 100,000 people on it. In spite of concentrated public awareness efforts of organ and tissue donation and transplantation, 18 Americans still die every day waiting for an organ that did not arrive in time. Due to the organ shortage, the practice of allowing non-citizen immigrants – individuals granted permission by the United States government to enter the country on a temporary basis – to receive transplants from American donors has undergone scrutiny.
Americans who are in desperate need of an organ transplant are traveling to other countries – such as China and Turkey – and paying thousands of dollars to receive an organ transplant. Dubbed “transplant tourism,” (purchase of a transplantable organ outside the US in a way that bypasses laws, rules or processes of any or all countries involved). This practice usually involves wealthy individuals who receive organs (most often kidneys) from young, poor and vulnerable individuals in developing countries. This practice is becoming increasingly common as the demand for organs in the U.S. increases while the supply diminishes. The most controversial cases of transplant tourism are in China where imprisoned Falun Gong members are allegedly executed solely or primarily for the purpose of transplantation of their organs.
LifeSharers urges people to sign up as “preferential donors” through LifeSharers. Basically, those who join agree to donate any useable organs upon their demise. They also agree to offer their organs first to other LifeSharers members. In exchange, they get preferred access to the organs of other LifeSharers members. That may mean that people higher on the traditional national UNOS list, who aren’t LifeSharers members, would be skipped over.
Patients needing an organ are placed on the national waiting list maintained by United Network for Organ Sharing (UNOS). More than 100,000 people in the U.S. are waiting for a life-saving organ transplant. The national waiting list for organs is a dynamic, sophisticated process for carefully evaluating and approving an individual for a major medical procedure and a post-transplant period of intensive aftercare and lifelong drug regimens.
Public misunderstanding exists surrounding the financial aspects of organ donation and transplantation. The work that organ recovery agencies perform is vital to the overall donation and transplantation process; however, costs associated with the work are subject to misinterpretation. Recent media stories exposing the “high costs” of a particular organ may have adverse effects on public perception of the altruistic gift of organ donation.
The US transplant network is operated by the United Network for Organ Sharing (UNOS) under contract with the federal government. They have been operating the system since it began in 1987. UNOS maintains a database of all patients awaiting a transplant.
- When an organ donor becomes available, each patient in the database is matched by the computer against the donor characteristics (blood type, height and weight). The computer then generates a list of patients ranked according to objective medical criteria such as blood type, tissue type, size of the organ and medical urgency of the patient. Other factors are time spent on the waiting list and distance between the donor and the transplant center. The specific criteria differ for each type of organ.
- Celebrity or social status plays no role in determining who receives an organ transplant.
- More than 100,000 men, women, and children in the United States are waiting for a life-saving transplant.
- Each year, approximately 28,000 people receive the transplant they need.
- One donor can save and enhance up to sixty lives through organ and tissue donation.
- There are many families who, having made the decision to withdraw the ventilator from their gravely injured loved ones, wish to donate organs. Donation after cardiac death (DCD) makes it possible to honor those wishes.
- DCD is considered only after the family has decided to withdraw the ventilator.
- A patient is considered a candidate only if it is predicted that the heart will cease functioning within 60 minutes of removal from support.
- Death is pronounced by the attending physician, who is independent of the transplant team.
- More than 50 organ procurement organizations (OPOs) nationwide have recovered organs via DCD.
- Approximately eight percent of all deceased organ donors are DCD donors.
- Four organs – kidneys, liver and pancreas – are typically recovered from DCD donors.
- DCD has broad-based support from medical professionals and ethicists nationwide.
- Prior to the introduction of brain death laws, DCD was the way in which all organs were recovered for transplant, and was a common practice prior to the 1980s.
- Donor designation is the practice of ensuring that a person’s expressed wish to be an organ and/or tissue donor after death will be fulfilled, through legal means such as a donor registry
- We recognize the right of every individual to make a personal decision about donation and respect the importance of honoring those wishes to extend the gift of life to those in need.
- Donor designation does not change the importance of talking to loved ones about donation. Knowing the wishes in advance gives family members comfort that their loved ones’ wishes are being fulfilled.
- Donor families are an integral part of the donation process. Families continue to be engaged in discussions about donation and provided with compassionate and sensitive support.
- The need for organs and tissue continues to grow at an alarming rate and is truly a public health crisis.
- There are currently more than 100,000 men, women and children waiting for a lifesaving organ transplant in the United States.
- Each day, more than 133 names are added to the national transplant waiting list.
- Approximately 18 people die each day simply because the organ they need is not available.
- While the number of individuals who choose donation after death is increasing, it is not keeping pace with the number of people who need a life-saving transplant.
- Patients on the waiting list are forced to wait, sometimes for years, for a compatible organ from a deceased donor to become available.
- Living donor transplants are a viable alternative for patients waiting for a kidney, liver, pancreas or lung transplant.
- An increase in living donors will alleviate pressure on the organ transplant waiting list, making it possible for more people to receive much-needed transplants.
- The most frequent type of living donation is kidney donation.
- Today, almost all transplant centers in the United States perform living kidney transplants.
- Organ and tissue donation are life-saving and life-enhancing gifts that provide those in need with hope and the opportunity to return to full, healthy lives.
- Thousands of people are waiting for a tissue transplant.
- Tissue donation affects approximately one million people in the United States each year.
- Organ and tissue donation provides strength and comfort to donor families knowing that in their loss their loved one was able to help another in need.
- Donor families often say donation is the one positive thing that came from a terrible tragedy.
- Tissues that can be donated include cornea, skin, bone, veins, heart valves, tendons and connective tissue.
- Tissue recovery organizations are regulated by the Food and Drug Administration (FDA). Many recovery organizations are also accredited by the American Association of Tissue Banks (AATB).
- The need for organs is continuing to grow at an alarming rate and is truly a public health crisis. This serious health crisis disproportionately affects the African American community.
- Of the more than 100,000 people waiting for a life-saving organ transplant, more than 26,000 are African American.
- Each day, 18 people die while they wait for the call that will save their life and another 100 names are added to the national waiting list.
- African Americans comprise 35% of those waiting for a life-saving kidney transplant.
- Diabetes and high blood pressure, two conditions that disproportionately affect the African American Community, can lead to the need for a new kidney.
- The number of African Americans who say ‘yes’ to donation falls far short of need.
- Since patients in need of a transplant are more likely to find a genetically compatible match within their own racial/ethnic group, increasing minority donations is critical.
- Lack of awareness, distrust of the medical community and misconceptions are often-cited reasons why African Americans are reluctant to designate themselves as an organ and tissue donor.
- More than 100,000 people in the United States are waiting for a life-saving organ transplant and each day another 100 people join the national organ transplant waiting list. Of those waiting, over 6,567 are Asian or Pacific Islander (API) American.
- Each day, more than 18 people – one every 80 minutes – die in the United States because of a shortage of organ donors.
- The chance of finding a matching organ is greater when donor and recipients are of the same ethnicity.
- Most API Americans in need of a transplant are waiting for donated kidneys and livers (6,463 of 6,567 – 98%).
- In 2007, only 192 API Americans became organ donors – 2.4% of all donors nationwide (Caucasians donated 67% of organs, Blacks 15.5% and Hispanics, 13.7%). The ratio of API recipients to donors is 7:1.
- One person can save up to 60 lives through organ and tissue donation.
- The need for organs is continuing to grow at an alarming rate and is truly a public health crisis.
- Of the more than 100,000 people waiting for a life-saving organ transplant, about 17,000 are Latino.
- Each day, 18 people die while they wait for the call that will save their life and another 100 names are added to the national waiting list.
- The chance of finding a matching organ is greater when donor and recipients are of the same ethnicity.
- Most Latinos in need of a transplant are waiting for donated kidneys and livers (16,464 of 16,935 – 97%).
- One person can save up to 60 lives through organ and tissue donation.
The national transplant waiting list has more than 100,000 people on it. In spite of concentrated public awareness efforts of organ and tissue donation and transplantation, 18 Americans still die every day waiting for an organ that did not arrive in time. Due to the organ shortage, the practice of allowing non-citizen immigrants – individuals granted permission by the United States government to enter the country on a temporary basis – to receive transplants from American donors has undergone scrutiny.
- Non-resident immigrants can both donate and receive transplants in the United States and in fact hundreds of non-resident aliens around the country donate their organs every year to save lives.
- Non-resident immigrants are eligible to be listed with UNOS (United Network for Organ Sharing) for an organ transplant if they meet the necessary requirements.
- The Organ Procurement and Transplant Network (OPTN) allows up to 5 percent of recipients at a transplant center to be residents of countries outside the United States.
- Fewer than one in 25 transplant recipients in the US are non-citizens, and less than one in 100 are non-resident foreign nationals. Non-citizens become deceased donors at roughly the same rate as they receive transplants; specifically in terms of living donor transplants, nonresidents are proportionally donating more than they receive.
- Organs are allocated based on a series of objective medical criteria including blood and tissue type, time on waiting list, medical urgency and the geographic location of donor and recipient. Favoritism or discrimination based on political influence, national origin, race, sex, religion and/or financial status is not permitted.
- Transplantation of non-resident immigrants is a humanitarian act and fees for service are the same as those charged to American transplant candidates and recipients.
- Transplant centers that transplant non-resident aliens are reviewed and audited by the UNOS Ad Hoc International Relations Committee.
- Non-citizens give in about the same proportion as they receive. It would be hypocritical to accept non-resident donors without accepting some non-resident patients.
Americans who are in desperate need of an organ transplant are traveling to other countries – such as China and Turkey – and paying thousands of dollars to receive an organ transplant. Dubbed “transplant tourism,” (purchase of a transplantable organ outside the US in a way that bypasses laws, rules or processes of any or all countries involved). This practice usually involves wealthy individuals who receive organs (most often kidneys) from young, poor and vulnerable individuals in developing countries. This practice is becoming increasingly common as the demand for organs in the U.S. increases while the supply diminishes. The most controversial cases of transplant tourism are in China where imprisoned Falun Gong members are allegedly executed solely or primarily for the purpose of transplantation of their organs.
- Each day, 18 Americans die waiting for an organ transplant that did not arrive in time. The best course of action to avoid this fate is not to travel oversees for a transplant, but rather to encourage more individuals to sign up with their state donor registries or otherwise commit to donate life.
- There are more than 100,000 individuals on the national transplant waiting list. Potential donors are matched to recipients through the Organ Procurement and Transplantation Network (OPTN) national organ transplant waiting list administered by the United Network for Organ Sharing (UNOS). Organs are allocated based on a series of objective medical criteria including blood and tissue type, time on the waiting list, medical urgency and the geographic location of the donor and recipient.
- The Association of Organ Procurement Organizations (AOPO) and its member organizations opposes the practice of potential organ or tissue transplant recipients traveling abroad to circumvent the ethical, moral and legal framework governing transplantation in the U.S.
- The buying and selling of organs in the United States – and most other countries – is illegal.
- Transplant tourism breaches the principles of equity and justice in organ allocation, both for the individual traveling abroad from their usual residence and for recipients in other countries deprived of the opportunity of an organ transplant. It fundamentally violates human rights and exploits humans with vulnerability.
- Americans who travel to other countries to receive a transplant take a risk. They may not receive the same standard of care pre-and post-transplant as they would in the U.S. and may also fall victim to a variety of financial and medical scams.
- Living donors who donate organs to “transplant tourists” are likely putting their own health at risk out of financial need or desperation rather than compassion.
- The U.S. donation and transplantation system is managed with great care and integrity, following strict national standards. Each organ procurement organizations (OPO) across the country is serious about their role as stewards for the precious gift of life.
LifeSharers urges people to sign up as “preferential donors” through LifeSharers. Basically, those who join agree to donate any useable organs upon their demise. They also agree to offer their organs first to other LifeSharers members. In exchange, they get preferred access to the organs of other LifeSharers members. That may mean that people higher on the traditional national UNOS list, who aren’t LifeSharers members, would be skipped over.
- There’s never been a single organ allocated through LifeSharers, while each year more than 28,000 lives are saved through the established organ allocation process.
- It’s not that people don’t want to donate. Research shows that nine out of 10 Americans support organ and tissue donation, but only 34 percent know how to make a legal commitment to do so. They can find out how by visiting Donate LIFE.
- More than 70 million Americans have signed up as donors through their state donor registries. Clearly, millions of people are willing to sign up as organ donors out of compassion without any expectation of to whom their organs should be allocated.
- LifeSharers has no formal role in the national system of organ allocation. Precious time may be wasted and lives lost if donor families have to name recipients they don’t know.
- Fairness is fundamental to an ethical organ allocation system. Organs in the US are allocated based on medical criteria such as acuteness of illness or how long a person has been waiting. LifeSharers attempts to replace medical need with a private club whose members would make a decision as to who gets the organ. For those in great medical need, it makes more sense to rely on a system that takes into account the medical necessity. LifeSharers subverts the equitable allocation of organs.
- There is no magic bullet for solving the shortage of donated organs. But we can save as many lives as possible by signing up on our state donor registries.
- The organ allocation system is fair. No one is allowed to jump to the front of the waiting list. Organs are allocated solely according to medical criteria, not personal beliefs.
- We are concerned that the promotion of a process that operates outside the organ allocation system may cause people to doubt the effectiveness of state donor registries or the fairness of the process.
- Federal laws, regulations and guidelines; state laws and regulations; and voluntary industry standards address procedures for the safe recovery and transplantation of organs and tissues.
- OPOs conduct extensive medical history and behavioral risk assessment interviews to the greatest extent practical during donor screening. Screening assesses the quality of the organs and identifies risks of transmissible diseases.
- While standard laboratory serological tests are highly sensitive and specific, there is the potential for viral and antibody levels to be very low and therefore elude detection. This can occur when a person has recently experienced an exposure episode and these levels are initially low.
- Nucleic Acid Amplification Testing (NAAT) for HIV and HCV are licensed by the Food and Drug Administration. These tests are able to detect the genetic material of the virus prior to detectable antibody production. NAAT assays are not required to be performed by organ procurement organizations for organ and tissue donor screening.
- The United Network for Organ Sharing (UNOS) policy regarding donor screening and testing sets the minimum standards for organ procurement organizations. These policies can be accessed here.
- OPOs are required to conduct the following serological testing on all organ donors: antibodies to HIV, Hepatitis B and C; a test for syphilis (RPR/VDRL); antibodies to HTLV (which may cause T-cell leukemia and T-cell lymphoma), and antibodies to CMV (primarily transmitted in utero but can be opportunistic in immuno-compromised patients) and Epstein-Barr virus (EBV). Some OPOs, particularly those with large Latin American immigrant populations, also test for Chagas’ disease.
- Based on the results of screening, OPOs may identify a need to conduct additional testing for West Nile Virus, toxoplasmosis, or other transmissible diseases and, if the results are inconclusive or appropriate testing is unavailable, the organs may not be accepted for transplantation.
- There have been more than 300,000 organ transplants since the CDC issued its guidelines for preventing the transmission of HIV through organ and tissue transplantation in 1994.
- The Food and Drug Administration’s (FDA) Good Tissue Practices (GTP) rule specifies the minimum conditions, timing, types of tests, and associated procedures required for testing specimens in determining the absence or presence of transmittable diseases.
- Transplant centers, OPOs and the CDC recognize that a patient’s risk of dying without a transplant is often much higher than the possible risk of acquiring a disease. There are more than 100,000 people on the organ transplant waiting list in the United States. Visit UNOS.
Patients needing an organ are placed on the national waiting list maintained by United Network for Organ Sharing (UNOS). More than 100,000 people in the U.S. are waiting for a life-saving organ transplant. The national waiting list for organs is a dynamic, sophisticated process for carefully evaluating and approving an individual for a major medical procedure and a post-transplant period of intensive aftercare and lifelong drug regimens.
- The list also ensures that organs are allocated to recipients fairly and accurately within highly constricted timeframes.
- It’s a federal crime to buy or sell organs and tissues.
- Patients who are listed suffer from serious medical conditions, so they must be constantly monitored – and, if necessary, deactivated for an indeterminate period of time – to ensure that they are ready to receive a transplant when an organ is allocated to them.
- Three-quarters of those listed are waiting for a kidney. A primary factor for kidney allocation is time on the list.
- The organ allocation and distribution system is based on many factors including blood type, length of time on the waiting list, geographical location and severity of illness.
Public misunderstanding exists surrounding the financial aspects of organ donation and transplantation. The work that organ recovery agencies perform is vital to the overall donation and transplantation process; however, costs associated with the work are subject to misinterpretation. Recent media stories exposing the “high costs” of a particular organ may have adverse effects on public perception of the altruistic gift of organ donation.
- Organ recovery agencies bear the responsibility of coordinating the organ donation process. All are non-profit 501(c)(3) organizations, a federal designation indicating that their income covers expenses incurred, including but not limited to salaries, medical supplies, hospital costs,, and medical testing associated with organ donations, public education campaigns and office operations.
- Donor families are never charged for costs associated with donation or transplantation. Organ recovery agencies absorb the costs of donation, generally beginning at the declaration of brain death and extending through the organ recovery process.
- All charges and expenses incurred by organ recovery agencies are regulated and audited by the federal Center for Medicare-Medicaid Services (CMS).
- All organ recovery agencies undergo an audit process on an annual basis.
- Most expenses are direct costs associated with recovery of organs. The recovery hospital’s charges are billed to the organ recovery agency. These costs are combined with the organ recovery agency’s recovery costs, and these “acquisition costs” are subsequently billed to the recipient’s transplant center.
- Transplant hospitals charge the recipient’s insurer for the acquisition cost of the transplanted organ.
- Acquisition costs vary by organ and geographic area, typically ranging from $20,000 to $35,000 per organ. Medicare generally covers the costs of kidney transplants for all kidney recipients under the End Stage Renal Disease (ESRD) Program and covers other transplants when the center is Medicare certified. This applies only to Medicare patients. Other patients rely on whatever health coverage they possess.
- All 50 states have enacted legislation accepting death by the following definition as defined by the American Medical Association and the American Bar Association:
- Death is the irreversible cessation of circulatory and respiratory functions OR irreversible cessation of all functions of the brain including the brainstem (Brain Death)
- According to the American Academy of Neurology (AAN):
- “Brain death is defined as the irreversible loss of function of the brain, including the brainstem.”
- “The three cardinal findings in brain death are coma or unresponsiveness, absence of brainstem reflexes, and apnea.”
- “Coma or unresponsiveness” means that “no cerebral motor response to pain in all extremities (nail-bed pressure and supraorbital pressure).”
- A clinical examination is legally required in the determination of brain death. Clinical brain death examinations test for a response from all 12 cranial nerves. Such clinical tests must be performed under carefully controlled circumstances: the patient must be normal temperature, must not be under the influence of sedatives or paralytics, their electrolytes have to be within normal range, and their respiratory status (known as the acid-base balance) must be within normal limits.
- Because a complete brain death examination is so extensive and must be done under such controlled conditions, once hospital physicians pronounce brain death, organ recovery agencies routinely perform subsequent clinical examinations to confirm that the brain death diagnosis meets criteria for organ recovery.
- There has never been a documented case of recovery from brain death under circumstances where all confirmatory and clinical tests have been performed accurately.
- Per OPTN/UNOS policy, the host organ procurement organization (OPO) is responsible for verifying that death has been pronounced according to applicable state law.
