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Confronting the Organ Transplant Gap -- A Surgeon's Perspective

More than 100,000 patients are on the waiting list for solid organ transplants, but in 2011 there were just 28,465 transplants completed. And the shortage is only worsening as the numbers of available organs continues to drop, both from living and deceased donors.
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You've probably seen the heartbreaking stories on the nightly news:

A terminally ill child faces the prospect of death because she can't get the heart transplant she so desperately needs. A retiree with liver disease languishes for years on a waiting list as others ahead of him get new organs. A college student in need of a new kidney puts his life on hold to endure dialysis five days a week.

Patients and their families are often outraged that they must wait months or even years for life-saving transplants. I too live in a state of outrage. And here's why: Every single day in one of the richest countries on Earth, an average of 18 people die because there aren't enough hearts or lungs or livers to go around.

It's a problem of simple math. More than 100,000 patients are on the waiting list for solid organ transplants, but in 2011 there were just 28,465 transplants completed.

And the shortage is only worsening as the numbers of available organs continues to drop, both from living and deceased donors. This alarming trend has emerged even as demand rises sharply. Every 10 minutes in this country, another name is added to the national organ transplant waiting list.

How would you solve this problem?

Some would say give the organ to the person who needs it most -- in other words, someone who might die within days or hours without a transplant. Others would argue that we must invoke a war-time triage system that requires doctors to prioritize patients who might have the best chances for survival and a superior quality of life after an organ transplant.

If only it were that simple.

This is not a one-size-fits-all situation. Many variables challenge our ability to match ideal donors and recipients. These include blood types, anatomy, organ size, and other illnesses or injuries that may be present in the donor and/or the recipient.

And even if these variables line up, other troubling ethical questions arise. What if the person who needs the organ faces a low chance of surviving the surgery or recovering fully? Do we perform the transplant anyway?

What if the recipient of a new kidney is 76 years old and suffering from heart disease? What if the next person in line is 16 and otherwise healthy? Who gets the organ?

What if the patient's medical record indicates that the patient routinely forgets to take her medication or misses crucial check-ups? Does that mean the patient wouldn't be a good steward of the donated organ? Perhaps the patient needs a new liver because of cirrhosis brought on by a lifetime of alcohol abuse. What if he refuses to stop drinking? Do we still give him the liver -- even if it means that other patients face potential death while waiting for another organ to become available?

Unfortunately, I know the tragedies -- and the dilemmas -- that lie behind these kinds of decisions. As a surgeon and the director of a large comprehensive organ transplant center, I struggle with them every day I come to the office.

The irony here, of course, is that solid organ transplants have become so successful at prolonging life. Patients can walk out of the hospital with a new heart and enjoy years of productive living. Our success as surgeons and medical institutions, however, has wrought its own unintended consequence: Transplants are now so culturally accepted that the public tends to think they're easy to pull off. Nothing could be further from the truth.

If I had my way, everyone who needs a lifesaving organ transplant would get one tomorrow. And here there is hope: An initiative launched just this month by Facebook to increase the numbers of organ donors has produced encouraging results. Donor registries across the country reported a dramatic increase in online donor designations in the days after the social media giant announced its campaign.

You can help, too, by signing up to become an organ donor yourself. Two easy ways to accomplish that are by taking advantage of the Facebook effort to connect potential donors to the official registry in their region, or by registering as an organ donor when you get a driver's license in states where that is an available tool for registration. Making that commitment and discussing it openly with family and friends is the most important step toward increasing our ability to provide healthy organs to those is desperate need.

In the meantime, those of us who grapple with this special kind of heartbreak every day will make the tough decisions so that the precious resource of transplantable organs is distributed thoughtfully, carefully and fairly.

One thing we know for sure: Every name on that waiting list is a person who is dear to someone. Every patient is worthy and sympathy alone will not light the path for wise choices when the number of patients in need of a life-saving organ transplant exceeds the number of organs that are available. The most immediate and durable solution to this inequity depends upon our decision as individuals to willingly bestow upon our fellow man the ultimate gift of life through organ donation.

For more by Andrew S. Klein, M.D., MBA, click here.

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