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Ann Thorac Surg 2009;88:1053-1061. doi:10.1016/j.athoracsur.2009.06.087
© 2009 The Society of Thoracic Surgeons
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Ethics in Cardiothoracic Surgery

Saving Lives Is More Important Than Abstract Moral Concerns: Financial Incentives Should Be Used to Increase Organ Donation

Benjamin Hippen, MDa, Lainie Friedman Ross, MD, PhDa, Robert M. Sade, MDb,*

a Metrolina Nephrology Associates and Carolinas Medical Center, Charlotte, North Carolina; Departments of Pediatrics, Medicine, and Surgery, MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, Illinois
b Division of Cardiothoracic Surgery and Institute of Human Values in Health Care, Medical University of South Carolina, Charleston, South Carolina

* Address correspondence to Dr Sade, Medical University of South Carolina, 96 Jonathan Lucas St, Suite 409, MSC 612, Charleston, SC 29425 (Email: sader@musc.edu).

Presented at the Forty-fifth Annual Meeting of The Society of Thoracic Surgeons, San Francisco, CA, Jan 26–28, 2009.

The first 300 words of the full text of this article appear below.


   Introduction
 
Ever since organ donation became clinically feasible, there have not been enough organs to go around. Figure 1 shows the rate of change from a base value in 1995 through 2008, of three variables: (1) the number of deceased donors, (2) the number of patients with end-stage organ failure who are waiting for an organ, and (3) the number of waiting list patients who either die before an organ becomes available (ie, death on the waiting list or after removal from the waiting list as "too sick to transplant") [1]. The number of potential recipients on transplant waiting lists has more than doubled, and now stands at over 100,000, whereas the number of deceased donors has increased by only half. Meanwhile, the numbers of deaths related to the organ shortage, which is now greater than 9,000 a year, has grown in parallel with the waiting list. Thus, the gap between supply and demand has grown every year for the past 15 years.


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  		Fig 1. Relative change (from 1988 baseline data) in the number of patients on organ waiting lists, deaths on the waiting list, and number of donors each year, 1988–2008. Graph derived from Organ Procurement and Transplantation Network data [1].

 
Approximately two thirds of the waiting list patients suffer from end-stage renal disease. Because the kidney is a paired organ, living individuals can donate one kidney, and several thousand donate every year, mostly to relatives with whom they have an emotional bond.

The problem underlying the organ gap is not a lack of medically suitable organs from patients dying from severe brain damage; if all such patients became donors, the waiting list would shrink rapidly, yet only half of potential deceased donors actually donate, and many potential living donors are medically unsuitable or are unwilling to donate, . . . [Full Text of this Article]






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Copyright © 2009 by The Society of Thoracic Surgeons.