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The Transplant List Grows Longer

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WebMD Health News

March 27, 2001 (Washington) -- Earlier this month, Americans passed a medical milestone in which no one takes pride.

According to the United Network of Organ Sharing (UNOS), which works with the U.S. Department of Health and Human Services, more than 75,000 patients are waiting for a transplant. Everyday, some 15 of them will die because an organ isn't available.

"The magnitude of the organ shortage is sobering. Of those 75,000 people, probably less than a third will get the transplant they need this year. And each year, that gap widens," says UNOS president Patricia Adams, MD.

Yet seemingly, this is an avoidable tragedy. People die everyday. Why can't their organs be harvested to treat those who have no other alternative?

The answers are complex, and, experts say, have as much to do with superstition as science. For instance, organ donation doesn't disfigure the body and won't interfere with your funeral, although many fear that.

In addition, organs aren't as abundant as one might think. Most people are either too sick or old when they die to be viable donors. The "ideal" candidate is a young person who is brain dead, in other words, the victim of a traumatic injury. But there are fewer of those thanks to seat belts or motorcycle helmet laws.

"The solution is clearly to try to increase the number of people who donate since we already know on the donation side ... only about half the people who are in a position to donate choose to do so when asked," Jon Nelson, director of the Office of Special Programs at the U.S. Health Resources and Services Administration, tells WebMD. Nelson's agency oversees the federal transplant program, which consists of dozens of local procurement organizations.

Part of the problem, Nelson says, is that getting people to commit to donation is a delicate matter. Ultimately, the donor, if he or she is deceased, may not have a thing to say about it. That means the person trying to procure the organ generally must work with the grieving family, a situation requiring great tact and patience.

"It's very much an artful thing. It's a sensitivity that an individual might have that predisposes them to be successful [in convincing the family]," Nelson says. Ironically, medical science has itself become a problem in that doctors are increasingly efficient at making transplants work and coming up with new uses for them, but the pool of donors really hasn't changed much in the last decade. According to UNOS, the number on the waiting list in 1990 was around 20,000, but it grew to 73,000 by the year 2000.

One relatively new way around the shortage is state registries, which contain information about a donor's wishes and would, in theory, reduce the need to depend on the family or a driver's license, which might get separated from the body. Some 16 states have these programs, including Louisiana and Illinois.

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