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ORGAN=20 DONATION www.organdonor.gov/ or (866) 728-3738 for = information on=20 organ and tissue donation in Virginia. LIFESHARERS http://www.lifesharers.com/ or (615) 351-8622 = or (615)=20 356-3918

Growing numbers of people planning to donate their organs say that if = they=20 end up needing a transplant, they merit more consideration than someone = who=20 refuses to donate.

At least 67 Virginians are among the more than 2,000 members = nationwide=20 claimed by LifeSharers, a nonprofit group founded two years ago in = Nashville,=20 Tenn.

Members are promised first crack at each others' organs, = theoretically=20 allowing them to avoid the long delays or deaths suffered by nonmembers = on the=20 national waiting list.

LifeSharers creates incentive for people to join, its members say. = Anyone can=20 - and should - join.

"It is horrible to think that while someone you know is dying and who = is an=20 organ donor might die because someone was ahead of them for an organ and = they=20 would never do the same for someone else," said member Vasilia Hilios, a = junior=20 at Virginia Commonwealth University.

Don Twombley, director of laboratory services at Longwood University, = said=20 "it makes sense to me" to want to be "ahead of people who aren't willing = to=20 give."

The organization that runs the nation's only transplant system,=20 Richmond-based United Network for Organ Sharing, disagrees with = LifeSharers'=20 members-first principle.

"Certainly, organ donation is a good thing and is not to be = discouraged,"=20 said Joel Newman, a spokesman for UNOS, which even so refused last fall = to=20 endorse LifeSharers.

Currently, organs can be donated to a specific individual, but = federal=20 transplantation officials say such directed donations no more mean = members only=20 of LifeSharers than they do members only of "the Roman Catholic Church" = or=20 "whites only" or "no Jews."

Bioethicist Laura A. Siminoff of Case Western Reserve University = criticizes=20 LifeSharers members as "double-dippers" who opt out of the national = donation=20 system yet expect the government to pick up the tab for procuring, = testing,=20 matching and transporting organs when they need them.

"How's that in the American spirit, that some people are going to get = special=20 status but everybody else has to pay for it?" Siminoff said.

Self-interest is the guiding principle, founder David J. Undis=20 acknowledges.

"You can improve your odds by joining LifeSharers," he declares on = the=20 group's Web site. There is no cost to join, but there is a 180-day = waiting=20 period before you can collect.

Undis said the current system fails to meet the national organ gap = that=20 leaves nearly three times as many people needing an organ as those who = get one.=20 Across the country, nearly 6,000 people a year die waiting for organs, = 169 of=20 them in Virginia, UNOS reports.

"Altruism isn't getting the job done," Undis said. "The organ = shortage keeps=20 getting larger and larger."

"Scrambling for organs" is harder than it should be when so many = lives can be=20 saved from one donor, said Vanessa Chapin, a Fredericksburg medical=20 transcriptionist who signed up for LifeSharers along with her husband = and two=20 children.

She prefers the LifeSharers' process. If an organ from a dead member = becomes=20 available, officials are supposed to offer the organs first to a = LifeSharers=20 member.

If no member needs the organ, or if no member is a suitable match for = it,=20 then the organ can be offered to anyone registered with the UNOS-run = system.

"Nothing could be fairer," Undis said.

Supporters insist that the current system, which allocates organs = based on=20 medical criteria rather than social worth, is indeed fairer.

Recovered organs are matched to the national waiting list, on which = patients=20 are ranked according to tissue match, blood type, length of time on the = list,=20 immune status and distance between recipient and donor. For some organs, = the=20 potential recipient's degree of medical urgency is also considered.

"Race, gender, religion, socioeconomic status or personal/behavioral = history=20 are not taken into account," says UNOS, which does give special = consideration to=20 those who have given a kidney and then find themselves needing one.

"Organ donation is a gift," said Doug Wilson of LifeNet, the=20 organ-procurement organization for central Virginia. "You give the gift = whether=20 you're going to get one back or not."

Richmond emergency dispatcher Nick Schiaffo, a member of the Virginia = Transplant Council, said he had no thoughts about payback when his son = died four=20 years ago.

"At that moment, you're not thinking of getting something back," he = said.=20 "Two people out there can see because of my son. That says volumes to = me."

Grieving relatives who donate deserve more - they deserve = reciprocity, says=20 LifeSharers adviser Lloyd Cohen, a law professor at George Mason = University who=20 has not signed an organ-donor card and wants his family to refuse to = donate his=20 organs to call attention to the crisis in donation.

At a gut level, said Dr. Mark Fox, head of the ethics committee of = UNOS,=20 LifeSharers makes some sense, much like the lottery slogan, "You've got = to be in=20 it to win it."

"But we have gone to great pains to develop a system for allocating = organs=20 that's based on something other than social worth, or money, that's = built on a=20 fairly objective medical criteria."

LifeSharers, Fox said, "undermines the existing allocation system" by = creating an open system in which its members accept organs from anyone = while=20 preferentially restricting donation to its members.

The real answer is not simply harvesting more organs, as experts = estimate=20 that only about 12,000 people a year die in the conditions essential to=20 donation, Fox said. "We still need to tackle the root problem," the = health=20 problems that lead to transplantation, he said. "Transplantation is the = victim=20 of its own success."

The organ gap is now so great that some are talking about new ways to = increase donations, such as presumed consent or compensation. The U.S. = House=20 yesterday voted to spend $5 million a year to reimburse organ donors for = nonmedical expenses involved in transplant surgery. The Senate passed a = similar=20 measure in November.

In Virginia, only about half of the families asked agree to donate, = said Dr.=20 Gerardo Mendez-Picon, surgical director for transplantation at Henrico = Doctors'=20 Hospital. "And yet almost 100 percent of those who need a transplant = wants=20 one."

He is so frustrated that he speaks publicly about systems in other = nations in=20 which those who do not agree to donate do not get transplants.

"Those things have to be discussed," Mendez-Picon said. "You get = pretty fed=20 up with all the [federal donor] initiatives that end up doing = nothing."

"Why are they doing it?" he asked of LifeSharers. "Because there is a = problem."

The basics of the nation's system of organ donation stretch back to = 1969 in=20 Richmond when the South-Eastern Organ Procurement Foundation was = founded.=20 Foundation officials and transplant experts are marking its 35th = anniversary=20 with a conference here this week.

The federal government has since declared that donated organs are = gifts,=20 spending millions over the past two decades to encourage donation. = Virginia=20 officials last summer launched an online registry for organ and tissue=20 donors.

Although more than 2 million Virginia adults have pledged to donate, = many=20 simply prefer not to think about it, just as many people do not prepare = a living=20 will, said Ken Faulkner, a chaplain with Virginia Commonwealth = University's=20 Family Communication Coordinator program.

It is wrong to presume that they have refused to donate or could even = make an=20 informed choice, he said.

"The vast majority of us don't make major life-and-death health-care=20 decisions until they are forced upon us by immediate circumstances," = Faulkner=20 said.

So far, LifeSharers' social contract remains untested. No member has = received=20 an organ from another member, Undis said, although about a dozen members = are on=20 the national waiting list.

Federal health officials question whether LifeSharers could legally = fulfill=20 its promise of providing preferred access. They say an organ-procurement = organization that honors LifeSharers' pledge would violate federal = regulations.=20 The UNOS-managed network oversees transplants except for those in the = directed=20 donations that are recognized by the federal government.

In any event, Siminoff said, it is unlikely that LifeSharers could be = practical. She notes the low likelihood of a member experiencing brain = death who=20 qualifies as an organ donor at the same time a medically compatible = member needs=20 an organ.

"LifeSharers . . . isn't going to make any kind of dent" in the organ = gap,=20 she said. "You'd have to sign up just about everybody in the country for = this to=20 make a difference. And once you did, you wouldn't need it."

Contact A.J. Hostetler at = (804)=20 649-6355 or ahostetler@timesdispatch.com=