By Victoria White
GAINESVILLE, Fla. -- With physicians making great strides in improving health through organ and tissue transplants, the waiting list for donations is growing faster than the supply.
But efforts to meet the rising demand are hampered by too little research into why some people sign donor cards or agree to the use of a loved one’s organs and many others say no, a University of Florida transplant surgeon reports.
“There has not been enough systematic study of how best to go about increasing the availability of organs,” said Richard J. Howard, M.D., Ph.D., medical director of the UF Organ Procurement Organization and a professor of surgery in UF’s College of Medicine.
Nationally, families approached at the time of a relative’s death decline to donate about half of the time. For the 62,000 people on the United Network for Organ Sharing waiting list, the shortage of organs can result in longer bouts of ill health as well as the possibility that they might die with the promises of transplant medicine just beyond their reach. Last year, 4,855 people in the United States died while waiting for heart, lung, liver, kidney and other transplants.
“Every year, we’re falling farther and farther behind, because the transplant waiting list is growing by 15 percent per year, but the number of donors has increased by just 5 percent per year,” said Howard, whose article on ways to boost donation rates appeared earlier this year in the Journal of the American College of Surgeons. “The problem with creating successful new procedures is that it makes the shortage worse by increasing the number of people who are transplant candidates.”
Scientists are working in the laboratory toward a day when organs can be grown from a few cells, or when animal tissues can be adapted for human use. But that day is likely years away. Meanwhile, the lack of solid data makes it difficult to know just what to do to increase donation rates, Howard said.
Basketball great Michael Jordan has helped give organ transplantation a high profile through his participation in the ongoing “Share Your Life, Share Your Decision” campaign, sponsored by the Coalition on Donation. Another effort of the organization is National Organ and Tissue Donor Awareness Week, April 18 to 24.
“It’s probably good to raise awareness of the issue, but it can be phenomenally costly to do so,” Howard said. “The costs are so high because there is no predicting who will soon become a potential organ donor, so you have to approach the entire population.
“It’s also difficult to show how significant of a difference awareness campaigns make because on the individual level, it may be years after they saw a commercial that they are faced with the choice,” he said.
UF researchers are starting to focus on how best to approach families at the time of their loss.
To understand what influenced them, Jim Rodrigue, Ph.D., an associate professor of clinical and health psychology in UF’s College of Health Professions, recently began interviewing families who have decided on donation.
“We know that the vast majority of people are very favorable toward the idea of organ donation, but they haven’t necessarily made their own decision about what they would do,” Rodrigue said. “We need to try to understand the factors that can help to translate that favorable impression into a real commitment.”
While Rodrigue’s study has just begun, he said he is learning how important it is for families to be approached for donation by empathetic and knowledgeable people.
“Organ procurement coordinators sometimes will spend eight or 10 hours with a family, helping them through the grieving process,” Rodrigue said. “Their jobs, I’m certain, are very stressful, and the work that they do goes largely unrecognized by the general public.”
In his journal article, Howard addresses a number of possibilities for raising donation rates, including the highly controversial idea of paying for organs or providing some other form of financial incentive. While emphasizing that there would be numerous ethical and logistical hurdles to be considered, Howard said it might be worthwhile to test incentives in pilot programs to see if they would be effective.
Other possibilities include changes in the law to require adults to record--on driver’s license applications, tax returns or other official documents--whether they wish to become organ donors. Consent could be withdrawn at any time.
Howard also suggests that his fellow health professionals make a point of asking patients at routine office visits if they are interested in becoming donors should tragedy strike.
Sheriff Stephen Oelrich of Florida’s Alachua County has become a national advocate for donation. He became involved following the 1995 death of his 18-year-old son, Nicholas, who tumbled off a balcony.
Organ donation “was about the only positive thing that came out of the situation,” said Oelrich, chairman for the National Sheriffs’ Association Gift of Life Committee. “It was the narrowest of silver linings on the blackest cloud of your life.”
Out of that narrow silver lining sprang hope for a North Florida man, who lives today with the liver that once belonged to Nicholas Karl Oelrich.
Recent UF Health Science Center news stories are available at http://www.health.ufl.edu/hscc/index.html
More information about organ donation can be found at http://www.organdonor.gov
Materials provided by University of Florida. Note: Content may be edited for style and length.
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