forum discussion #8

Tackling the Global Organ Shortage

Worldwide, there is a dire shortage of organs for transplantation.

In the United States alone, more than 100,000 people are waiting for new hearts, lungs and kidneys. Many of these patients will die waiting.

Frustrated, some patients turn to a global black market in organs.

To tackle the organ shortage, countries are experimenting with various strategies.

Israel just enacted a new law to boost the number of donors.  The law favors donors over non-donors when it comes to receiving an organ. And some Americans are pushing a controversial solution – legalizing the buying and selling of organs.

Iran is already doing that. The Iranian government gives every kidney donor $1200 and one year of free health care. This system has increased the availability of organs, but at what price?

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Listen to a story about Israel’s new law and the interview and our interview with Dr. Al-Mousawi. He’s a transplant surgeon and past president of the Middle East Society for Organ Transplantation. He is also the guest in this Science Forum discussion.

He argues that the Iranian system may have reduced the organ shortage, but it is unfair to the donors, who are often poor and underprivileged.

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Now it’s your chance to ask Dr. Al-Mousawi your own questions. Join our discussion.

  • Have you signed an organ donor card? If not, what kind of incentive would make you do it?
  • Are you in favor of a legalized market for organs? Do you think a regulated system will prevent transplant tourism and a black market for organs?
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Your Comments

  1. Error: Unable to create directory /home/worldsci/public_html//wp-content/uploads/2014/04. Is its parent directory writable by the server? Rhitu Chatterjee

    Mustafa,
    Spain is one country that seems to have been fairly successful in reducing its organ shortage. What approach have they taken? And what can the rest of the world learn from Spain?

    Thank you.

    • Error: Unable to create directory /home/worldsci/public_html//wp-content/uploads/2014/04. Is its parent directory writable by the server? Mustafa Al-Mousawi

      Thank you Rhitu
      You are right. Spain has the highest rate of donors per million population in the world.

      It seems they have managed this with an efficient organization and by appointing a transplant coordinator in every hospital. These coordinators are doctors who do coordination in addition to their job as specialist in other field of medicine.

      • Zac Radford

        They have also instituted an opt-out donation policy. Unless one opts out of organ donation, the default assumption is that one wishes to be a donor.

      • Jae Hwan

        Hello Dr. Al- Mousawi. It seems that more people needs organ transplantation. Why do you think this is so?

  2. Error: Unable to create directory /home/worldsci/public_html//wp-content/uploads/2014/04. Is its parent directory writable by the server? David Baron

    It seems to me that to convince people to become organ donors, we must first deal with perception that the organ allocation system is unfair. There’s a widespread belief in the U.S. that the rich and the powerful are more likely to get an organ than the poor and the powerless, and people are reluctant to donate if they see the system as biased and unlikely to help them in a time of need.

    Organ transplant experts insist that this perception does not match with reality — the system in the U.S. is supposed to treat all potential recipients equally, irrespective of wealth or political power — and yet the belief persists.

    Do you find this perception to be widespread in other countries? And to what extent do other countries — Iran, for instance, or Kuwait — ensure that all citizens have equal access to organs?

    Thank you.

    • Error: Unable to create directory /home/worldsci/public_html//wp-content/uploads/2014/04. Is its parent directory writable by the server? Mustafa Al-Mousawi

      Thank you David
      It is difficult to have an alloction system which is perfect. Should we allocate organs on first come first served basis? or sickest first? who decides who is sickest?. Once human judgment is involved then mistakes or other factors can make the system unfair.

      In the US influential persons and celebrities were either added to the list when they were not qualified or given priority over others. To my knowledge the US system has been revised not long ago to avoid such instances and make it more fare.

      The public everywhere, including in Kuwait are suspicious. We always try to reassure them. Transparency is essential to gain their confidence which is vital to have them continue to be donors.

  3. Have been an Organ Donor on my drivers license for a long time.
    When I came across “Lifesharers”, I saw the logic there and signed up with them, too. So now my organs are to be donated to that organization first and then for them to allocate among members.
    So, yes, I am for Israels new law-, I enacted it already on myself!
    My question for Dr. Al-Mousavi is: Why do you believe that this and other, future, incremental improvements of the organ donation process will lead to a reversal of the staggering amount of names on the waiting list?

    • Error: Unable to create directory /home/worldsci/public_html//wp-content/uploads/2014/04. Is its parent directory writable by the server? Mustafa Al-Mousawi

      Thank you Klaus
      Over the last 20 years the number of patients on the waiting lists keep increasing. This is because the indications for transplantation has widened and because organs transplanted 10 or 20 years ago fail and patients need another transplant. Unfortunately the number of donors and transplants have shown little rise.

      We can increase the number of donors in several ways. One important step is to turn more potential donors to utilized donors by early detection and referral. Another way is to encourage more people to carry donor cards. If a person knows that by carrying a donor card he is not only helping others but may be also himself, then certainly more people will think of carrying donor cards. Presumed consent, “Lifesharers and “Don’t Give Don’t Get” are successful ways to increase donors.

  4. Tarek Saeed

    People say why I should sign a donor card if I’m not sure that I’m gonna get organ when I need? To overcome the fear of unfairness of organ distribution among people I suggest to have a common site whether it’s an internet website or official local journal to mention the scoring criteria for receiving organs, to give prospective recipients serial fixed numbers according to the organ needed and to declare the name of patients given organs on regular bases by date. The Idea of “Don’t-Give-Don’t-Get” is worth to consider.

  5. Error: Unable to create directory /home/worldsci/public_html//wp-content/uploads/2014/04. Is its parent directory writable by the server? Mustafa Al-Mousawi

    Thank you Tarek
    I agree that transparancy and fairness are essential in gaining public trust when you ask them to be donors.

    Fixing serial numbers for patients might not be practical as sometimes a patient may be upgraded on the list because of sudden deteriration of his condition or having difficulty with dialysis.

    Placing names of patients on a website also violates their privacy.

    • Ahmed Halawa

      I’m against coercion, but in favour of a modified Iranian system where organ donors should be privileged indirectly. Tax reduction, employment, etc rather than cash money would be ideal. The organ can then be allocated nationally depends on the standard criteria set by the relevant country to avoid any bias. If donation is done after death, then the family of the deceased person would get the privilege. Do you think that this would help to reduce the black market?

      • Error: Unable to create directory /home/worldsci/public_html//wp-content/uploads/2014/04. Is its parent directory writable by the server? Mustafa Al-Mousawi

        Thanks for your suggestions Ahmad

        Providing tax reduction or employment is considered by many as indirect cash payment because there is a monetary gain that the donor would not have if he did not donate.

        Regarding giving privileges to deceased donor family, I think supporting donor family if in great need due to loss of their money provider (say in a sudden accident)is not as bad as inducing a living person. This supports my idea of going along the path of increasing deceased donation rather than allowing living unrelated donation.

        Thank you again.

  6. My field experience in Durban, South Africa, suggests to me that we need to get religious leaders on the boat to succeed in encouraging people to become donors. In a workshop in conjuction with Muslim imams and Muslim public, it was obvious that while Muslim patients were recipients of the organs, among Muslim public, because of certain beliefs about resurrection and human soul, there was a strong hesitation to donate. In my meeting with the late scholar Abu al-Qasim al-Khu’i in Iraq some years ago, he emphatically ruled that it was permissible to donate bodily organs and there was no problem in signing one’s driving license for that purpose. When organs are for sale then certainly only well-to-do will benefit, and this is surely against distributive justice. Mosque support is needed.

    • Error: Unable to create directory /home/worldsci/public_html//wp-content/uploads/2014/04. Is its parent directory writable by the server? Mustafa Al-Mousawi

      Thank you Prof Sachedina

      I fully agree. In Singapore the Muslims were exempted from donation according to a presumed consent law because their religious leaders were objecting to brain death and donation after death. When they were told Muslims would not get organs on the waiting list if they refused to be donors they revised their position and now Muslims there donate and receive organs.

      Islam encourages saving lives and the majority of Muslim scholars approve donation of organs but the concept of brain death is still not well acceptd. We need to explain brain death to them as some of them does not understand it well.

  7. Ahmed Halawa

    Dr Mustafa/ Prof Sachedina
    We should not ignore donation after cardiac death (DCD) which could be a valuable source of organs. It is also would be accepted by muslims as cardiac death is undisputed. I totally agree with you that the concept of brain death rather than the idea of donation is the main issue. Have you explored this route with muslim scholars?
    In Sheffield, UK I will try this route with the muslim community as an alternative to donation after brain death.

    • Error: Unable to create directory /home/worldsci/public_html//wp-content/uploads/2014/04. Is its parent directory writable by the server? Mustafa Al-Mousawi

      Dear Ahmad

      Almost all major Muslim religious leaders accept donation after cardiac death.

      I have met several famous Muslim religious scholars and found them confusing between brain death and patients in vegitative status. When brain death is explained well most of them accepted it. Perhaps you can do the same in Sheffield.

  8. About 50% of the organs transplanted in the U.S. go to people who haven’t agreed to donate their own organs when they die. As long as we let non-donors jump to the front of the waiting list if they need a transplant we’ll always have an organ shortage.

    There is a simple way to put a big dent in the organ shortage — give organs first to people who have agreed to donate their own organs when they die.

    Anyone who wants to donate their organs to others who have agreed to donate theirs can join LifeSharers at http://www.lifesharers.org. Membership is free. There is no age limit. No one is excluded due to any pre-existing medical condition.

    Giving organs first to organ donors makes the organ allocation system fairer, and it creates an incentive for non-donors to become donors.

    • Error: Unable to create directory /home/worldsci/public_html//wp-content/uploads/2014/04. Is its parent directory writable by the server? Mustafa Al-Mousawi

      Thank you Dave

      I fully agree.

      I may just add that every country should give its citizins the chance to be donors e.g. when they apply for driving licences or ID cards. In many under-developed countries people may not be aware or not given the chance to become donors.

      Given priority to have a transplant can only be applied when people are given the right to choose.

      • Error: Unable to create directory /home/worldsci/public_html//wp-content/uploads/2014/04. Is its parent directory writable by the server? Elsa Youngsteadt

        Regarding the right to choose whether to give organs–this interesting post over at Scienceblogs refers to a study which suggests that people are more likely to become organ donors if they have to check a box to NOT become a donor, rather than having to check a box to BECOME one.
        http://scienceblogs.com/cognitivedaily/2008/10/dan_ariely_at_davidson.php
        Do you have any additional information on this? Does that system really explain the rates of organ donation in European countries?
        Thanks!
        Elsa

      • Error: Unable to create directory /home/worldsci/public_html//wp-content/uploads/2014/04. Is its parent directory writable by the server? Mustafa Al-Mousawi

        Dear Elsa

        Thank you for your question
        I read the article you referred to on Scienceblogs and I have the following two comments:

        1. The figures given in the articl for donation in different European countries are inaccurate. Actually Austria and Belgium have nearly similar rates. The same applies to donor rates in Germany and Netherlands.

        2. In countries with “opting out” laws, the donor often does not have to say yes or no. He is presumed to say yes to donation unless he is against donation in which case he has to register his “no”. That is why donation rates are higher in countries with opting out (presumed consent) law because the majority of people will not write to say no unless they are strongly against donation.
        Thank you again

  9. DJ

    I’m curious about live donations. Specifically bone marrow transplants. Do you know of first hand accounts from donors describing their experiences and complications they faced following donation of bone marrow? Thanks.

    • Error: Unable to create directory /home/worldsci/public_html//wp-content/uploads/2014/04. Is its parent directory writable by the server? Mustafa Al-Mousawi

      Thank you DJ

      Since I am not working in the field of bone marrow transplantation, which is a branch of Hematology not Organ Transplantation, I cannot comment on your question.

  10. Prof.Ibrahim Alnono

    Nearly 90%of our Yemeni patients have one or more of relative donors,where they have motivation to donate one of their organs,due to strong family bonds and relegious believes.For this issue the donor shortage is minimal and specified for unsuitable related donors.

    • Error: Unable to create directory /home/worldsci/public_html//wp-content/uploads/2014/04. Is its parent directory writable by the server? Mustafa Al-Mousawi

      Thank you Prof. Alnono

      I agree with you. Most Muslim countries enjoy large families with strong bonds enforced by religious beliefs.

      Still whenever there are poor donors who are willing to sell their kidneys and patients who can afford buying them there seem to be a tendency for patients to buy kidneys rather than take them from relatives. Our experience in Kuwait has clearly showed this.

  11. Error: Unable to create directory /home/worldsci/public_html//wp-content/uploads/2014/04. Is its parent directory writable by the server? Mustafa Al-Mousawi

    I would like to thank all those who participated in the forum on Tackling the Global Organ Shortage, especially those who sent their comments and questions.

    Organ transplantation has been tarnished by unethical practices resulting from shortage of vital organs.

    Nobody should accept using the poor as organ providers. The ultimate solution is to make enough organs available by using organs and tissues from the deceased rather than burying these organs.

    If every deceased becomes a donor then we will have a surplus of organs rather than shortage.

    I enjoyed this forum. Thanks to World Science for providing the opportunity to discuss this important topic.

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