Code Red - The organ shortage is not something to play down.

National Review Online ^ | April 14, 2008 | Sally Satel & Benjamin Hippen

[neverdem]

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April 14, 2008, 6:00 a.m.

Code Red
The organ shortage is not something to play down.

By Sally Satel & Benjamin Hippen

A few weeks ago, the Washington Post broke the dramatic medical news that as many as one third of all people waiting for an organ transplant are actually ineligible to receive one. Could this mean that the shortage of kidneys, livers, hearts, and lungs is not as dire as we thought?

Unfortunately, no. If anything, the fact that many patients are ineligible is a sign of urgency, not a reason to be complacent.

According to the United Network for Organ Sharing (UNOS), the entity that maintains the waiting list under a monopoly contract with the Department of Health and Human Services, there are 98,517 people — transplant candidates — waiting for an organ. By summer, the queue will reach a daunting 100,000, with three quarters seeking kidneys.

Are these numbers just “propaganda” meant to generate a false sense of crisis?

Yes, according to Donna Luebke, a nurse, and former member of the UNOS board of directors. “The list is what they use for propaganda,” she told the Post. “It’s the marketing tool. It’s always: ‘The waiting list. The waiting list. The growing waiting list . . . It’s what they use to argue that we need more organs. It’s dishonest.”

Luebke believes the numbers are hyped. In truth, the organ shortage is every bit as dire as it has been portrayed — even worse.

Strikingly, most patients who are designated by their physicians as ineligible for immediate transplant were once fit enough to receive an organ. Tragically, they deteriorated during the years-long wait and became too sick to transplant. And over 6,400 died last year (over two-thirds of them patients awaiting a kidney), unable to hold out for what would have been a life-saving organ.

In some regions of California, for example, where the waiting time is so protracted, physicians assume most patients will not survive long enough to receive a renal transplant. So they put every referral on the list and then when the candidate gets near the top they do the evaluation — thus, they do not “waste” their time doing evaluations on people who will die while waiting.

Another reason physicians deem patients ineligible is because they developed a reversible condition, such as infection, which make them too fragile for surgery or the anti-rejection medications that protect the new organ.

Indeed, the shortage itself is the very reason that doctors keep these “ineligible” patients on the list. If the meter were totally reset — by removing temporarily ill candidates from the list altogether — they lose all their accumulated time and would probably not survive a new wait after becoming healthy enough for transplantation. Let’s be clear: being ineligible on the list does not affect whether or not the active people get transplanted.

We cannot afford to lose sight of the reason the list exists in the first place: a desperate scarcity. If organs weren’t so hard to find, there would be no list at all or only a short one. In all of American medicine transplantation is the only treatment that is rationed by supply. With an ample pool of organs, patients would receive kidneys, livers, hearts, and lungs with the same routine efficiency as people with broken legs get them set.

In fact, the waiting time to renal transplantation is getting longer. Today is it five to eight years in major cities and by 2010 it will be ten years for some patients. With about one in three waitlisted patients on dialysis not surviving beyond five years, the majority of candidates just don’t have that kind of time.

This very trend is potent evidence why those who say the need is not so pressing are dead wrong. If the list had so many ineligible patients, then time-to-transplantation would be getting shorter not longer.

Finally, the waitlist doesn’t even reflect the full scope of the problem. A 2008 study in the American Journal of Transplantation estimates that over 130,000 dialysis patients with a “good prognosis” (defined as an expected five-year survival or longer on dialysis) are never even referred for transplantation. These voiceless thousands don’t show up on anybody’s “list.”

Nonetheless, there are concerns about crying wolf. “It’s unfair. It’s simply unacceptable,” Arthur Caplan, a bioethicist at the University of Pennsylvania’s School of Medicine told ABC News. “You can’t have one-third of the list out there that doesn’t really belong . . . you can’t inflate the numbers.”

Inflation? The real deception is suggesting that the organ shortage is a manufactured crisis.

— Sally Satel is a resident scholar at the American Enterprise Institute. Benjamin Hippen is a nephrologist and member of UNOS ethics committee.

[org.whodat]

As mentioned in other areas of this site, the United Network for Organ Sharing (UNOS) has done everything it can to discourage live organ donor transplants. Some of UNOS actions may be illegal but those actions are at the very least unethical. UNOS is an organization which makes lots of money from voluntary organ donors who sign their drivers' licenses volunteering to be organ donors upon their deaths. UNOS engages in major deception here by leading potential donors to believe that upon their deaths their organs will be donated to a person in need of a transplant. In fact, UNOS sells those organs for tens of thousands of dollars each. IRS tax returns for 2005 show revenues in excess of $ 1 billion from organ sales and registration fees in 2005.

http://www.innovativestrategies.us/donationstruth.html

[Plane_Guy]

You too can help. Hillary needs a heart. Obama needs a brain.

[caseinpoint]

My guess is that those who are ineligible to receive organs don’t include HIV-positives or murderers, right?

[Onelifetogive]

If organs weren’t so hard to find, there would be no list at all or only a short one.

Of course they are NOT hard to find, they are hard to aquire. They are hard to aquire because no one is allowed to buy or sell them.

[tired1]

contact Albania.

[the anti-liberal]

If you're an illegal immigrant you can come over the border and get all the free organs you want.

Liver transplants for illegal aliens: Entitlements + open borders = disaster( Michelle Malkin )

[the invisib1e hand]

i have a hunch that body parts is a big, dirty business.

[From many - one.]

No, the simple solution is that in order to beable to get an organ, you must have previously (prior to the condition creating the need) signed up as an organ donor.

In other words: in order to get, you have to be willing to give.

[elkfersupper]

I would sell some of mine, if I actually owned them.

[longtermmemmory]

you can’t do that. some religions forbid it.

[Merta]

Actually Hillary needs a place big enough to fit her heart in because she needs to place it near her ego, phoniness and general nastiness.

Obama cannot have a brain because his rear-end already takes up too much room up there XD.

[SunkenCiv]

...especially if you’re Serbian...

[From many - one.]

“you can’t do that. some religions forbid it.”

Yes, I can do that. Adult members of such religions would forego receiving transplants.

Simple.

[longtermmemmory]

ah and by extension if a religion does not comply with diversity discrimination laws it will lose its tax exempt status...

so what about the people who can’t donate for medical reasons? do they have to donate too? What about this vast number of unqualified recipients? IF they can’t recieve then they should not have to donate.

[From many - one.]

I don’t know what your beef is.

Register to be a donor. Health status is irrelevant, just be willing to give. (except you have to have registered pior to developing the conditon that makes you need the transplant.

Yes, some religions want the body buried intact. The practitioners are free to interpret that any way they like, but they don’t get a free ride.

The concept of an unqualified recipient will change when organs are generally available. Since one would register, normally, upon reaching adulthood, and since all kinds of tissues, as well as organs, can be useful, it would be extraordinarily rare for there to be an unqualified recipient.

Your diversity statement is a red herring. We already havae the basic rule that all religious practices are ok so long as no defined crime (human sacrifice or child rape, for instance) is committed.

[longtermmemmory]

you have an impossible absolutist postition.

there are those in the thought crime industry that say if you are a non-profit (ie boy scouts, church, charity) which excluses people of certain mating habits you should lose your taxe exempt status.

You state it is not possible because of the first amendment.

Yet in the same breath you DO allow a idential sanction for people who have a matter of conscienct that contradict you. You now also add the bonus of having PUBLIC private medical information.

I think we should focus more research on growing individual organs via cloning. (especiall with that recent growing of a heart demonstration)

Fortunatly there is not going to be a change and when one state tried to do what you said it (new mexico or arizona I believe) it was shot down on constitutional grounds before it even go out of the gate.

Donation of organs is as personal a matter as deciding on whether or not to pull the plug on the hopelessly sick. (see the “duty to die”)

[From many - one.]

None of the things you are stating as my position are actually a part of my position or even a remote extension of what I said.

No private medical information goes public, no tax exemptions are involved and I did not mention the first amendment.

All I’m saying is that if you are not willing to give, you should not be eligible to get.

I’m all in favor of cloning organs, but that’s a way down the pike and has the disadvantage of needing time to do the growing.