Organ donation: Medical ethics and public appeals

A new AMA ethical policy calls for study of the effects of public solicitation for live organ donors and offers guidance for physicians.

Editorial. Aug. 14, 2006.

At this moment more than 92,000 Americans await an organ transplant that could save their lives. Each number represents a story -- a person with family and friends, school or work, hobbies and pastimes, favorite colors and foods.

Only a small fraction will get the organ or organs they need in any given year. Last year 28,108 transplants were performed, according to statistics from the Organ Procurement and Transplantation Network, administered by United Network for Organ Sharing. The lucky break can be years in coming, and thousands of people die waiting.

This sad reality breeds fear and desperation. These emotions have collided with the information age and scientific advances that allow live-donor transplants. The result is the emergence of new types of public appeals for organs from strangers.

Web sites, such as MatchingDonors.com, aiming to link candidates with potential donors have popped up. People in need of organs, their friends and families have launched their own Web pages. Transplant candidates have even bought billboard space.

The concept is always the same: An organ would come through if only people heard my story, knew about my grandma or grandpa, mom or dad, son or daughter, brother or sister, my best friend.

But these campaigns are controversial and pose serious ethical questions for physicians. For these reasons the American Medical Association at its June Annual Meeting passed policy to help guide doctors through the issues.

Solicitation campaigns have drawn heat because they go outside the UNOS system, which aims to equitably distribute organs. They seek to find a donor for a specific transplant candidate. This practice is common with live donation, which is subject to individual transplant center rules, as opposed to the national system. Anonymous donation through UNOS is the norm with organs from cadavers, but the organization does allow decedents or authorized decision-makers to donate to a specific person.