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The Transplant List Grows Longer

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Still, even though up to 90% think organ donation is a good thing, only about half consent.

In Europe, Nelson says, the law favors presumed consent within limits. In the U.S., the family's wishes almost always prevail.

Until more donors step forward, the U.S. is stuck with a controversial allocation system developed by the former Clinton administration and put into place last year. It favors the sickest patients in the region, instead of providing an available organ to the nearest transplant center. That angered many who had worked hard to support their local programs.

"So the fear was the all the good work that you were doing yields nothing to your local community," Nelson says.

Meanwhile, new Health and Human Services Secretary Tommy Thompson says the new emphasis has to be on organ donation. "It's remarkable, and it's absolutely a passion of his," Nelson says.

"American generosity is unparalleled," Thompson says. "Let's use that generosity to increase organ donation and make miracles happen through transplantation."

Plenty of miracles are needed. According to UNOS, there's a shortage of nearly 50,000 kidneys alone. About 17,000 livers are needed.

While it's against the law to buy or sell organs, some efforts are being made to help live organ donors defray some of their expenses. Earlier this month, a bill passed the House that would cover travel and subsistence costs. The legislation, now in the Senate, would provide $5 million annually to states and organ banks who need to bring in donors.

Is this an ethical problem? "I'm not for buying organs. I'm not for payment, but I am for handling reasonable costs and making it convenient when you have to do this," says Arthur Caplan, PhD, director of the Center for Bioethics at the University of Pennsylvania in Philadelphia. "I think everybody understands that there's no incentive to make your kidney available [just] because someone's going to give you a free ride to the hospital," Caplan tells WebMD.

Various schemes have been proposed to increase organ supply, including covering funeral expenses for donors, or setting up an insurance fund for the family, or perhaps even some kind of a scholarship.

"Everybody's tried in many ways to game the situation and come up with something that's palatable and ethical and legal, but thus far, it's always come back to the fact that buying and selling of organs is illegal," Edward Nelson, MD, a transplant surgeon at the University of Utah in Salt Lake City, tells WebMD.

What about the possibility of getting a prisoner to donate an organ in return for an earlier parole?

"The main reason that's a terrible idea ... is prisoners have the highest rates of infectious disease of anybody," Caplan says.

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