A government panel called on American hospitals and emergency medical responders to revamp their resuscitation procedures as a way to preserve more organs for transplants.
The recommendation comes amid a widening shortage of transplantable organs that many experts have branded a crisis. Demand for transplantable organs has far exceeded the rate of transplant donations over the last decade.
Just over 28,000 organs were donated last year, far from the number needed to treat the more than 98,000 people waiting on lists for transplants as of Tuesday, according to the United Network for Organ Sharing.
Longer life expectancy means that more Americans survive long enough to see their organs give out. Skyrocketing rates of obesity and diabetes put far more people than before at risk for organ failure.
New CPR Methods
The shortage has left policy makers searching for ways to boost donations among a largely reluctant American public.
Experts from the Institute of Medicine (IOM) said Tuesday that emergency responders should change resuscitation procedures in an effort to preserve the organs of accident victims and others who die outside of hospitals. The recommendations essentially call on responders to regularly continue cardiopulmonary resuscitation (CPR) on patients who are not revivable to keep blood flowing to kidneys, livers, and other organs so that they may be better candidates for possible organ donation.
Doing so could give transplant surgeons access to a pool of up to 16,000 people 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 on methods for encouraging altruistic donations and to help coordinate a growing number 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. They include calls to introduce a system of “assumed consent” -- essentially authorizing surgeons to take organs from deceased patients whose wishes are unknown and whose families are not available to make decisions.
Some ethicists have also called for the gradual phase-in of financial rewards for donations, essentially beginning a system of paying for organs. Such a system has been credited with eliminating the waiting list for kidneys in Iran.
“We’re not going to get many more organs by making small adjustments to the current system,” said Robert M. Veatch, a professor of medical ethics at Georgetown University who has called for experimentation with payment-for-donation systems.
Veatch and others have backed expanding organ donor criteria to include patients in permanent vegetative states and permanent comas if they are irreversibly unconscious. It would be a departure from current practices requiring such patients to be first removed from life support, often damaging organs in the intervening time while the heart stops pumping blood.
“It would add substantial numbers of persons who are dead with viable organs,” said Veatch.
The United Network for Organ Sharing (UNOS) strongly opposes any financial or other incentives for organ donations. UNOS officials did not respond to requests 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 or driver’s license applications whether or not they wish to donate.
A 'Conservative' Approach
Childress acknowledged that the IOM panel took a “conservative orientation” to expanding donations. Experts were concerned that more radical reforms could lead to a backlash among members of the public already largely reluctant to sign up to be organ donors.
He said the committee chose instead to urge American policy makers and hospitals to work to enhance existing organ donation systems. “Many of these things if they were implemented, they would just cause people to opt out,” said Childress, who directs the Center for Practical Ethics at the University of Virginia.
Veatch argued that the thousands of people who die each year waiting for organs 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.”
By Todd Zwillich, reviewed by Louise Chang, MD
SOURCES: Institute of Medicine report: "Organ Donation: Opportunities for Action," May 2, 2006. United Network for Organ Sharing. James F Childress, PhD, chairman, Institute of Medicine panel. Francis Delmonico, MD, president, United Network for Organ Sharing. Robert M. Veatch, PhD, professor of ethics, Georgetown University.