May 2, 2006 -- A government panel called on American hospitals and emergencymedical responders to revamp their resuscitation procedures as a way topreserve more organs for transplants.
The recommendation comes amid a widening shortage of transplantable organsthat many experts have branded a crisis. Demand for transplantable organs hasfar exceeded the rate of transplant donations over the last decade.
Just over 28,000 organs were donated last year, far from the number neededto treat the more than 98,000 people waiting on lists for transplants as ofTuesday, according to the United Network for Organ Sharing.
New CPR Methods
The shortage has left policy makers searching for ways to boost donationsamong a largely reluctant American public.
Experts from the Institute of Medicine (IOM) said Tuesday that emergencyresponders should change resuscitation procedures in an effort to preserve theorgans of accident victims and others who die outside of hospitals. Therecommendations essentially call on responders to regularly continuecardiopulmonary resuscitation (CPR) on patients who are not revivable to keepblood flowing to kidneys, livers, and other organs so that they may be bettercandidates for possible organ donation.
Doing so could give transplant surgeons access to a pool of up to 16,000people who die with organs suitable for transplant, the panel concluded.
"Those really represent an untapped resource," James F. Childress,PhD, the panel's chairman, tells WebMD.
Financial Incentives for Organ Donations
The report also calls for federal authorities to fund more research onmethods for encouraging altruistic donations and to help coordinate a growingnumber of state donor registries on a national scale.
But the committee avoided several bolder -- and more controversial --proposals that some experts consider necessary to spur organ donations. Theyinclude calls to introduce a system of "assumed consent" -- essentiallyauthorizing surgeons to take organs from deceased patients whose wishes areunknown and whose families are not available to make decisions.
Some ethicists have also called for the gradual phase-in of financialrewards for donations, essentially beginning a system of paying for organs.Such a system has been credited with eliminating the waiting list for kidneysin Iran.
"We're not going to get many more organs by making small adjustments tothe current system," said Robert M. Veatch, a professor of medical ethicsat Georgetown University who has called for experimentation withpayment-for-donation systems.
Veatch and others have backed expanding organ donor criteria to includepatients in permanent vegetative states and permanent comas if they areirreversibly unconscious. It would be a departure from current practicesrequiring such patients to be first removed from life support, often damagingorgans in the intervening time while the heart stops pumping blood.
"It would add substantial numbers of persons who are dead with viableorgans," said Veatch.
The United Network for Organ Sharing (UNOS) strongly opposes any financialor other incentives for organ donations. UNOS officials did not respond torequests for comment Tuesday, but Francis Delmonico, the network's president,told a White House bioethics panel two weeks ago that his group would"staunchly" oppose incentives.
The IOM panel also recommended against so-called "mandated choice"laws that would compel people to affirmatively choose on tax returns ordriver's license applications whether or not they wish to donate.
A 'Conservative' Approach
Childress acknowledged that the IOM panel took a "conservativeorientation" to expanding donations. Experts were concerned that moreradical reforms could lead to a backlash among members of the public alreadylargely reluctant to sign up to be organ donors.
He said the committee chose instead to urge American policy makers andhospitals to work to enhance existing organ donation systems. "Many ofthese things if they were implemented, they would just cause people to optout," said Childress, who directs the Center for Practical Ethics at theUniversity of Virginia.
Veatch argued that the thousands of people who die each year waiting fororgans justifies drastic measures that the IOM report advocates.
"The time has come for some cautious experimentation," he said."The unmet need is great and we need a new approach."