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When considering organ donation approaches, look to Spain, not Iran

Regarding "Other nations, other answers: In search of a solution to the organ shortage" (Article, Oct. 13): AMNews does readers a service when it draws attention to the growing list of candidates for organ transplants in the United States. Unfortunately, AMNews then conflates the mortality rates for the various solid organs and suggests that the Iranian model of living donor kidney vending has something to offer us here.

Experience the world over, Iran included, has shown repeatedly that organ vending is not conducive to a robust practice of deceased donation, related kidney donation or unpaid unrelated donation.

Even the Iranians are having second thoughts about the exploitation of poor and illiterate citizens. Moreover, their model is irrelevant to reducing premature deaths on the U.S transplant waiting list, because most occur in candidates for heart and liver transplants who will get no help from purchased kidneys.

But AMNews is right to bring up the far more attractive Spanish model of organ donation. Spain has moved towards maximizing deceased donation through broad societal acceptance of organ donation and the excellent organization of its national organ recovery network.

In this country, an intensive effort by the national Organ Donation Collaborative has led to an impressive increase in deceased donation.

Rates of consent for donation are increasing and have reached 80% in some parts of the country. Living donor exchange programs and other innovative forms of living kidney donation, together with removal of financial and other disincentives to organ donation, have the potential to provide thousands more transplants.

There are no easy solutions to our donor shortage. Reducing demand is central to any serious strategy, which means, among other things, addressing the epidemic of obesity that leads to diabetes and end-stage organ failure. In the meantime, we will do far better by investing our energies in measures like the collaborative that engender public trust and engagement. The Iranian model has nothing to offer us.

--Gabriel Danovitch, MD, Los Angeles

--Alexander Capron, Los Angeles

--Francis Delmonico, MD, Boston

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Properly provided drug samples do not undermine generic prescriptions

Regarding "Drug samples can mean fewer generic prescriptions for the uninsured" (Article, Oct. 6): There is no reason why providing samples to patients should influence the prescribing of generics, unless doctors are too rushed, too lazy or just oblivious to the financial plight of their patients.

Few of the uninsured will fill a prescription costing upward of a hundred dollars, as is often the case for brand-name drugs. The physician has the responsibility to know how, or if, the prescription will be paid for.

The drug companies are far from blameless, but are, after all, for-profit corporations. We physicians, as professionals, should hold ourselves to higher standards and accept blame for our own deficiencies rather than blame them on the drug companies. To paraphrase Shakespeare: The fault, dear Brutus, is not in our samples, but in ourselves.

--Roger Mansnerus, MD, Westlake, Ohio

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