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    The Transplant List Grows Longer


    "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.

    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.

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