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Press Room > Organ Donation/Transplantation DataClick here for national, regional, and state data on organ donation and transplantation. Here are some facts about the shortage of transplantable human organs: Dr. Robert Metzger MD, President-Elect, United Network for Organ Sharing, Prepared Witness Testimony, The House Committee on Energy and Commerce, Subcommittee on Oversight and Investigations, “Assessing Initiatives to Increase Organ Donations”, June 3, 2003 Over 81,000 patients are on the wait-list for transplantation in the United States today and more than 5000 will die this year without receiving a transplant. More startling is that almost 60% of those on the list today will die without receiving a transplant. Yet organs from deceased donors are recovered from less than 50% of actual, potential donors, resulting in the loss of thousands of life-saving transplants. Most of the small, annual 1-2% increase in the number of deceased donors has come from expanding the medical and social conditions previously used to eliminate potential donors, while the wait-list continues to grow at a rate of 12% annually. Factors Influencing Families' Consent for Donation of Solid Organs for
Transplantation “Patients who have been declared dead using neurologic criteria (irreversible loss of all brain function but maintained on ventilators) are the single largest source of transplantable organs. Unfortunately, of these 12,000 to 15,000 potential donors, fewer than 6,000 become organ donors each year. The major factor limiting the number of organ donors is the low percentage of families who consent to donation. A 1995 study of families of donor-eligible patients found that 86.5% were asked to donate but only 47.3% gave consent. Other studies have confirmed these findings.” The Consent Process for Cadaveric Organ Procurement How Does It Work? How
Can It Be Improved? “Despite the clear need for solid organs, the most comprehensive study to date estimates that only 40% of suitable individuals donate their solid organs after death.” (quoting Conrad S, Brigham L, Eakin M, Sheehy E, Hunsicker L. Association of Organ Procurement Organizations (AOPO) Death Record Review Study. Paper presented at: AOPO Briefing of Federal Officials; November 15, 2000; Rockville, Md.) Estimating the Number of Potential Organ Donors in the United States “We studied the size and composition of the national pool of brain-dead organ donors during a three-year period…The predicted annual number of brain-dead potential organ donors is between 10,500 and 13,800. The overall consent rate (the number of families agreeing to donate divided by the number of families asked to donate) for 1997 through 1999 was 54 percent, and the overall conversion rate (the number of actual donors divided by the number of potential donors) was 42 percent.” Variation in Organ Donation Among Transplant Centers “We analyzed data for 190 of the nation’s 255 transplant centers on patients who were medically eligible to be organ donors and the number of donors for whom consent was given to donate. We found that the rate of consent for donation (the consent rate) varies widely among transplant centers at the national level, as well as within geographic regions and at the organ procurement organization (OPO) service area level…compared to a national average of 51 percent.” “More than 80,000 Americans are currently awaiting organ transplants, yet fewer than 25,000 people received a transplant in 2002. During that same year more than 6,400 people died while waiting for a transplant. It is estimated that 12,000 to 15,000 deaths annually could yield organs for transplantation; however, fewer than half of those deaths led to such an outcome in 2002.” “The consent rate is the number of patients for whom consent to donate organs was given, as a percentage of all patients at the hospital who were medically eligible to donate organs. A medically eligible donor is defined as a patient aged 70 or younger whose death is determined by neurological criteria (brain death) and who lacks certain clinical conditions, such as cancers, tuberculosis, HIV, or hepatitis, among other diseases.” “…these 190 transplant centers obtained consent from a mean of 51 percent of potential donors, with a median of 52 percent.” Knowing Patients’ Preferences about Organ Donation: Does it Make a
Difference? We do know that many people who desire to donate do not sign donor cards and that many never tell their families about their desire to become donors. A recent public opinion study by Guadagnoli et al. found that although 75% of respondents under the age of 70 years indicated a willingness to donate, just over half said they had told a family member about their preference. Other studies indicate that no more than half the individuals who believe in organ donation have signed donor cards or designated themselves as such on drivers’ licenses. About 10% of families who knew their deceased relative wanted to donate reversed that decision. Gift of Hope OPO / Illinois Secretary of State Quoted in The Northern Star 2/15/2005 The Gift of Hope, an organ and tissue procurement organization, estimated that 40 percent of families say "no" when approached for permission. Even when families are notified of a donor’s decision in advance, 19 percent say no, according to the Illinois Secretary of State Web site. “Donating organs has support, not signatures” Zink's research shows that when relatives know that a loved one wanted to be an organ donor, 85 percent consent to donation when they are approached by a transplant coordinator. In contrast, when the next of kin do not know the deceased's wishes, only 53 percent give consent. (Sheldon Zink is director of the program for transplant policy and ethics at the University of Pennsylvania.) Coalition on Donation “When individuals do not make their intentions about donation known prior to their death, it is most often up to surviving family members to make that decision. Currently, the national consent rate for donation is 55 percent.” The process of organ donation and its effect on consent Objective: To identify those factors that enhance or inhibit organ donation in order to provide data to help policy makers, hospital administrators and transplantation professionals make informed choices about how to modify the donor system and to structure ‘best practice’ interventions. Methods: The study was conducted using a stratified random sample of 23 hospitals in the Pittsburgh and Minneapolis:St Paul standard statistical metropolitan areas. Each week, the medical charts of all in-patient and emergency room patient deaths at each hospital were reviewed using a standardized review protocol to determine eligibility for organ, tissue, and cornea donation. A total of 10681 patient charts were reviewed over a 4-yr period. Eight hundred and twenty-eight cases out of 1723 eligible cases were selected for inclusion in the study. Data were collected on 827 of these cases. All health care providers (HCPs) who spoke with the family after the patient’s death or discussed donation with the family were interviewed. Results: Of the 10681 patient charts reviewed, 16.5% were eligible to donate either organs, tissues, or corneas, and 87.0% of donor-eligible patients’ families were approached and asked to donate. Consent rates were 23.5% for corneas, 34.5% for tissues, and 46.5% for organ donation. Presumed Consent: An International Comparison and Possibilities for Change
in the United States The work done to maximize the efficiency of the organ donation system in the United States and the attempts to raise levels of people who sign up to donate on donor cards is very commendable. Yet in 2001 6,439 people died while waiting for a transplant, up from 4,855 patients in 1998 and nearly double the 3,916 candidates who died while waiting just five years earlier in 1996. As of July 2003 over 82,000 people in the United States are awaiting the transplant of some organ, even though a waiting list of 23,000 in June of 1991 was considered a grave concern. None of these numbers show the least sign of decrease—instead there is only a steady worsening of America’s organ shortage crisis. A contributing factor in these deaths is an inability to convert available organs into successful transplants. Whereas the demand for organs has been risen 400% over the past 10 years, the supply of cadaveric organs has remained relatively stagnant. While the waiting list has risen by 60,000, the number of deceased donors has gone up by less than 1,700—from 4,509 in 1990 to 6,182 in 2002. The technology for successful transplantation exists, and the United States has knowledgeable surgeons and an infrastructure that would allow many lives to be saved if only more organs were converted from medically suitable donors to actual transplant. At some point the system that perpetuates this problem must come into question. CADAVERIC ORGAN DONATION: ENCOURAGING THE STUDY OF MOTIVATION “Approximately 6,000 patients per year, or 16 per day, with end-stage organ failure die because of the lack of available organs. Each year only 35% to 50% of potential donors consent to donation (1). During the last 20 years, vigorous educational campaigns, both voluntary and legislative, designed to increase organ donation have failed to increase donation rates significantly. The need for organs has grown nearly five times faster than the number of cadaveric donors: the annually compounded rate (1990–2000) of increase in number of patients on waiting lists has averaged 14.1% a year, whereas the rate of increase of donors has averaged 2.9% a year (2).” (1) Gortmaker SL, Beasley CL, Brigham LE, et al. Organ donor potential and
performance: size and nature of the organ donor shortfall. Crit Care Med 1996;
24(3): 432–439. “For two decades, vigorous educational campaigns, both voluntary and legislative, designed to increase organ donation have failed to increase donation rates significantly.” Cadaveric Organ Donation: Rethinking Donor Motivation “The gap between the numbers of patients in need of organs for transplantation and the number of organs available is at a critical level nationally. From 1988 to 1996, the number of patients on waiting lists for a transplant rose from 16,026 to 50,047 (212%). Yet, in the same period, cadaver donors only increased from 4084 to 5416 (33%). Because of the shortage of donors, 1502 patients died awaiting a transplant in 1988; this number increased to 3916 deaths in 1996, an increase of 161%. This expanding gap is not due to a shortage of potential donors. By far the most common reason for nondonation is denial of consent by the donor's family; only 4800 (35%) of 13,700 medically suitable donors agreed to donation in 1993. Donation of most medically suitable organs would save thousands of lives by reducing or eliminating the gap between supply and need for organs.” “Programs have been devised to overcome the many reasons for nondonation through education, explanation, use of more appropriate personnel to request donation, and others. Yet, despite these voluntary efforts, cadaveric donation has remained nearly stable over the last decade. Government policymakers have not been unaware or inattentive to the organ gap problem. The Uniform Anatomical Gift Act, adopted by all states about 25 years ago, simplifies the process of committing to donate one's own organs. The National Organ Transplantation Act of 1984 (NOTA) created a national organ and transplantation network and this function was contracted to the United Network for Organ Sharing (UNOS). One of the major purposes of UNOS is to encourage organ donation. The Omnibus Budget Reconciliation Act of 1986 mandated hospitals to refer all potential donors to organ procurement agencies. Like the voluntary efforts cited earlier, mandatory strategies have not substantially increased rates of donation, leaving us still with a large discrepancy between potentially available organs and those donated.” Organs for All “The only state that prohibits directed donations based on group membership is Florida.” Florida Anatomical Gift Act 2004 765.513 Persons and entities that may become donees; purposes for which anatomical gifts may be made.--The following persons or entities may become donees of gifts of bodies or parts of them for the purposes stated: (1) Any hospital, surgeon, or physician for medical or dental education or research, advancement of medical or dental science, therapy, or transplantation. (2) Any accredited medical or dental school, college, or university for education, research, advancement of medical or dental science, or therapy. (3) Any bank or storage facility for medical or dental education, research, advancement of medical or dental science, therapy, or transplantation. (4) Any individual specified by name for therapy or transplantation needed by him or her. However, the Legislature declares that the public policy of this state prohibits restrictions on the possible recipients of an anatomical gift on the basis of race, color, religion, sex, national origin, age, physical handicap, health status, marital status, or economic status, and such restrictions are hereby declared void and unenforceable. “Years on Dialysis Brought Joe Mole To a Crossroads” Dialysis is one of the great life-extending treatments of all time. Despite failed kidneys that can kill a person in a matter of days, life can be preserved for a decade or more. Yet among those with kidney failure who have died, roughly one in five chose to quit dialysis, according to government data. Forgoing dialysis means nature takes its course, poisoning the body to death, often within a week or so. Between 1995 and 1999, about 36,000 people died this way, government statistics show. Between 2001 and 2002, the latest data available, an additional 25,000 had died; the mean age of those who chose to quit dialysis was 74. The number is likely to keep growing because more people are receiving dialysis. Fueled largely by an increase in diabetes, the number of Americans on dialysis machines doubled between 1988 and 2003, to nearly 325,000. About 100,000 people start the treatment each year. |
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