Cuevas 14

Mateo CuevasWriting 39CErin McNellis April 15, 2014Organ Shortage: The Part of Society That is Left to ContributeThe world of medicine is constantly changing. There are new technological advances every year that make methods used a decade ago seem obsolete or impractical today. One medical issue that needs a big improvement is organ donations. Organ donations are a big deal because, through the numbers gathered by the Organ Procurement and Transplantation Network, (OPTN) there are currently 112,220 candidates on the waiting list as of April 15, 2014; while the number of donors, starting this year January 2014 up to April 11, 2014, the number of donors has only been 1,209. (OPTN: Organ Procurement and Transplantation Network). These numbers clearly show that the number of donors here in the U.S. do not meet the demand of those in need of organs. Most of the people that are on this list will not survive if they do not receive a transplant. The number of people who need organs will continuously rise and we cannot control that number; and the number of donors will not increase fast enough to keep up with those in need of organs. The U.S. has a problem trying to accommodate all the people who are in need of organ donations, and the people who are able to help are not doing all they can in order to solve this problem.This image from Nick Cenevivas Technical Writing Blog, A Technical Writing Bog with a Bioengineering focus, supports the research done by the Organ Procurement and Transplantation Network showing a steady increase in the number of people on the organ waiting list (Ceneviva). This graph also shows that while the number of donors is also slowly increasing, it is nowhere near meeting the demand of patients on the waiting list any time soon. The gap between the number of patients on the waiting list and those who do donate is shown, by the graph, to be increasing every year. Organ donations are vital to our society. More people are added to the organ waiting list every day and the chances of them living decrease every minute that they are not able to receive their transplant. In Sterling Sims Editorial A Brief History of Organ Transplantation from the Penn Bioethics Journal, that is comes from the University of Pennsylvania, Sims, who was a Health and Societies Major with a Bioethics concentration, gives us a summary of how transplantations have come along through history. Sims discusses the crucial need of organs from a very early start which lead to people even resorting to animal transplants to try and save somebody. Not only that but he also mentions doctors fearing transplants because they failed very often and did not get too many chances, or donations to put into other patients. But then in 1962, Dr. Murray that was a part of the first successful live transplant on Richard Herrick in 1954 also successfully transplanted the first kidney from a cadaver to a living person (Sims). This summary illuminates the major historical problems, from not understanding transplants, to doctors not being able to perform them, to, an issue relevant today not having organs to transplant. The success of Dr. Murrays transplant from a cadaver definitely opened new doors for transplants. One issue that was briefly addressed in Sims editorial was the problem with living-organ donation transplantation or also referred to as LDOT. In the medical journal Organ Donation Is Not Mutilation: The History of an Erroneous Idea, Rev. Anthony Stoeppel and Rev. Pablo Requena, MD, argued that through history organ donation was seen as a mutilation because there was no medical reason to take a good organ from a healthy person. This idea was carried out for many years and few challenged it. Through research and though the succession of kidney transplants it began to be seen that not every mutilation is wrong (Requena, Steoppel 433). Sims opinion seemed to favor transplanting for example after a successful transplant of two twins Sims mentions that, [Now] physicians had high hopes for organ transplantation (Sims). This problem had been around for a while and trying to decide whether we think LDOT is moral or not over the years has cost people lives. People who were uneducated about organ donation were easily confused and did not know whether an organ donation was mutilation or not, and according to Requena and Steoppel it was seen that way for a time. Organ donation is not a mutilation, but there are several criteria points that must be met in order for a transplant to be successful. Organ donors must be healthy and their organs must meet the criteria in order for doctors to feel comfortable to transplant them into people. This leads into the big question: if transplants have shown a big improvement through history and have even become more acceptable, truly a wonderful deed for someone to donate, then why are there not more donors to meet the number of patients who need a transplant? For example a main problem with organ donation shortage is caused by peoples decision to make the donation or not. They fear complications, that something will go wrong and that they could possible die. These fears are what contribute to peoples choice not to donate. This claim is also supported by Wojciech Baginski, who wrote an article in the American journal of Law & Medicine for the Boston University School of Law, where he discussed similar reasons and points out that through his research he found numerous people who did not donate for fear of complications. They refused to consent to transplantation because of a chance that their lives would be in danger and as a result numerous donations were lost (Baginski 563). This research helps us understand why people do not want to donate. But because of these reasons many possible organ donations were lost and several people who could have been saved did not receive a transplant from these potential donors. This though process largest negative influences towards organ donations. The decision to become an organ donor does not come so easily. There is a deeper level, which has been heavily studied, to support that there is a larger frame work on the decision to be an organ donor that lies at a psychological level. The research done by Marjan Nijkamp in the Health and Psychological Review, claims that at this psychological level of thinking those who are more educated and think well of the process, in other words being well informed and knowing the possible outcomes, and the succession rate of the operations, contributes largely to their decision to become donors (Nijkamp et al 20). Studying how people make their choice to be an organ donor at this level is very important. Figuring out what causes people to think the way they do will help pin point the main problems when it comes to organ donors, and once those specific problems that lie in the psychological level are found a solution can begin to be found for this psychological problem. But while this problem is being investigated and while people are contemplating on making their choice lets remember that people are still waiting. This image taken from Penn Medicine shows the surprising amount of time patients must wait before they can expect a transplant (Penn Medicine).

There are several other issues that influence the relatively small number of organ donations, compared to the number of patients who need one. There is a large argument that is a clear issue today, and that argument consists of morals. Are patients always in a position to make the decision of donation on their own? Deciding whether a person is capable of making that decision on their own is debatable considering what the condition of the patient is. What becomes even more controversial is leaving an organ donation choice of a person who is incapable to deciding for themselves, to someone else. The border line that decides whether a person is capable to decide organ donation for themselves or that it should be left to someone else is very thin. The current American system of cadaveric organ procurement includes the default assumption that individuals prefer not to donate their organs for transplantation after their death (Gill 37). The decision of whether to donate someone elses organs should not be left to just anybody. The consent of the possible organ donor is clearly important and this quote helps explain why so many organs are lost. The people who can contribute them did not choose whether to donate or not, so the default is that doctors assume they did not want to donate. Doctors cannot simply hand over a decision like this to anyone, it should have been the patients choice to donate or not. However if the patient never got the chance to decide for themselves the automatic decision is that they did not want to donate and therefore the opportunity to save the lives of many people is lost instantly.Have we doctors ever thought about other ways to get donations without consent from someone who cannot tell us if they want to be a donor or not. The truth is yes. There are a lot of possibilities that have been discussed, for example DCD. DCD is Donation after Circulatory Death. What that means is that if someone dies or is declared dead because, their heart stops functioning or if the patient is brain dead for example, their organs can be taken and used to save someone elses life (life gift). Deciding to take someone elses organs is a very tough choice, but even more so is deciding if a patient is dead before that can even be considered. Doing this however may save many lives because there will be more donors to get organs from. However in an article published in Pediatrics a medical magazine, two individuals that contribute their opinions to this journal Miller, and Troug argue for withdrawing this procedure. They explain that although doctors can save lives, removing the life sustaining treatment is the cause for the patients deaths and therefore is unmoral because it seems as if they are killing the patients just for their organs (Pediatrics). Killing one to save another is what Miller, and Troug point out, but it is not as blunt as this sentence. These issues are always extensively studied. I think that doctors are well equipped and knowledgeable to decide whether a patient can continue to live or not. Therefore the doctor should theoretically make the right choice when deciding to pull the plug. There will be good that comes out from deciding to take those patients organs for a possible donation.We might imagine that after doctors receive some organs that each one of those will go to saving someones life or will at least help someone. However this is not always the case. Organs do not have a long shelf life if a donor is not found right away. Organs will die in a very short time especially if they are not properly handled. According to several experts, including: Englesbe, Cutler, etc., who are a part of the Department of surgery from various universities, wrote in an article Improving Organ Procurement Travel Practices, where they say that organ transportation is a very current problem. They discussed the various forms of transportation for organs (Cutler, et al). Getting an organ from one point to another is not an easy task. There are always a lot of concerns that need to be taken into account. It is not an easy job. In the past two decades, there have been 27 reported deaths among transplant professionals worldwide as a result of aircraft accidents while traveling to procure organs (Cutler, et al). This is a horrible way to lose a life. Getting a life-saving transplant transported to someone in dire need, and then it turns out there was an incident and now the organ is lost and so is the hope for the individual waiting. I believe transplant is not complete until the patient the organ in them and is revered from their surgery. This table shows the issues that have been occurred over a little more than two decades ago. It shows that this problem of transportation for organs in not an old or new problem. It continues to influence several transplants.

Image: from Improving Organ Procurement Travel Practices in the United States: Proceedings from the Michigan Donor Travel ForumAnother thing that contributes the low number of transplants is that we have extended criteria donors or ECD. Marginal or extended criteria donors (ECD) are defined as those with a greater risk of initial poor function or graft failure and therefore and increased risk for recipient morbidity or mortality (Gastaca). In simpler terms these donors just are not as healthy as how doctors consider someone to be a prime candidate, and neither are their organs. But these donors have valuable organs that many people may use, however the standards that we have for organ transplantation exceed what doctors feel that these organs can offer and as a result, The US, for example, between 2001 and 2003, some 1200 ECD kidneys, 500 livers, and 250 hearts were discarded (Transplantation Proceedings 35). Although some may argue that the reason for not using these organs are for safety precautions, these are still organs that can be used and that are capable of helping someone else improve or save their lives. It is understandable that doctors require donors to be healthy, and that they also have high standards when it comes to choosing whether or not to transplant an organ. But having a chance to live from an ECD organ is much better than dying because a person was not given a chance. The outcome will be the same if the transplant fails and the patient dies, or if the transplant is not done, and the patient does not survive. So is it not worth the chance?Organ transplants are a very complicated process. There are several steps that need to be done before doctors decide if a transplant is an option or not. Once the choice is made everything that can be done for a patient must be done. To save a patients life, doctors need organs. The shortage in organs we have will not allow all the patients to be saved. The shortage in organ donations has many causes and there have been several studies that show why this occurs. Organ donations are a delicate topic. Bad news for one person, a donor who passes, is good news for another, a patient waiting for a transplant. The thought of being a donor scares some people because it makes them think about death. However they should be aware that people do not always die before they become organ donors. There are many possibilities for a person to make a difference and shorten the gap between the number of people on the waiting list and the number of people donating. http://www.youtube.com/watch?v=1ZRy3LoNPns. This link will show how much organ transplants are needed. It is the story of a mother and her young boy who was on the waiting list for a transplant.

Works CitedAbouna, George M. Transplantation Proceedings. Organ Shortage Crisis: Problems and Possible Solutions.Volume 40, issue 1, January-February 2008. http://dx.doi.org/10.1016/j.transproceed.2007.11.067. Pages 34-38. Web. April 3, 2014. George M. Abouna from Drexel University, College of Medicine in Pennsylvania argues the relevance that organ shortages we have today and also offers possible solutions to help obtain more donors and minimize the number of those on the waiting list. Abouna published his text on this topic in a popular magazine hoping to get his information out. George M. Abouna utilizes statistics over several years, as well as research which he used to break down the problem in a simpler form that would make it easier to follow. It is relates to my topic because it shows the true numbers and history of this organ shortage problem that have been around for a while. Not only that but it also shows a problem that contributed to the small number of organ donors. Bagneski, Wojciech. American Journal of Law and Medicine. Hasting Death: Dying Dignity and the Organ Shortage Gap. December 1, 2009. Issue 35 Pages 562-584.http://web.a.ebscohost.com/ehost/pdfviewer/pdfviewer?sid=0237dc16-7884-4c78-b025-da2d3c6e20ee%40sessionmgr4003&vid=9&hid=4209. Web. April 22, 2014 Cenevivas, Nick. "The Shortage of Donor Organs." Nick Cenevivas Technical Writing Blog. http://sites.psu.edu/nickceneviva202cblog/2013/09/18/the-shortage-of-donor-organs/.Web. April 22 2014. Cutleer, J.A, Englesbe. M.J, et al. Improving Organ Procurement Travel Practices in the United States: Proceedings from the Michigan Donor Travel Forum. The American Journal of Tranplantation. March 1, 2010. Volume 10. Issue 3, Pages 458-463.http://web.b.ebscohost.com/ehost/pdfviewer/pdfviewer?sid=eaaa5b8e-6d97-409a-a5b1-69847cdd5e74%40sessionmgr115&vid=10&hid=122. Web. April 24, 2014. This source contributes insights on the subject of organ transportation practices, as well as care of the organs while they are being handled. Several experts and well qualified individuals who are from the department of surgery from various universities, a few including: The University of Michigan and The University of Massachusetts. Along with the research conducted on the transportation methods of varies hospitals this source also includes a large graph that shows, in a simplified version, the findings for transportation failures and therefore why they are important. This is relevant to my research because it adds to the reason why there are people who are not receiving their transplants, and so this issue is just adding to the shortage of organs."Ethical Controversies in Organ Donation After Circulatory Death." Pediatrics.http://pediatrics.aappublications.org/content/131/5/1021.full#ref-19. Web. April 21,2014.Gastaca, M. Extended Criteria Donors in Liver Transplantation: Adapting Donor Quality and Recipient. Transplant Proceedings. Volume 41. Issue 2, April 2009. Pages 975-979. http://ucelinks.cdlib.org:8888/sfx_local?genre=article&issn=00411345&title=Transplantation+Proceedings&volume=41&issue=3&date=20090401&atitle=Extended+Criteria+Donors+in+Liver+Transplantation%3a+Adapting+Donor+Quality+and+Recipient.&spage=975&sid=EBSCO:a9h&pid=. Web. April 25 2014.Gatascas article was published in a credible medical journal. It is a source that is known and has been around for a long time. This article discusses the problems that currently exist with ECD donors. It talks about the much higher risks these donors have for other patients as donors. It is relevant to my paper, because it falls into place as a social problem. The people that are donating organs are older people who, according to the standards of doctors, do not meet the criteria to be good donors. They want to help and are part of a small number of people who are willing to donate, but not allowing the chance to be taken with the organs from these donors keeps the number of people on the waiting list for a transplant the same. Gill, Michael B. Journal of Medicine and Philosophy. Presumed Consent, Autonomy, and Organ Donation. 2004 Vol. 29, No. 1. Page 37-59. http://jmp.oxfordjournals.org/content/29/1/37.full.pdf. Web. April 16, 2014Health System Joins HAPs Donate Life Hospital Campaign. Penn Medicine. August 6, 2013. http://www.cchosp.com/cchpage.asp?p=2029. Web. April 21, 2014Nijkamp, Marjan D, et al. Health Psychology Review. To be(come) or not to be(come) and organ donor, thats the question: a meta-analysis of determinant and intervention studies. Vol. 2, No 1. 1, March 2008, 20-40. http://web.b.ebscohost.com/ehost/pdfviewer/pdfviewer?sid=77f0ea86-babb-43d6-be64-9e94577e9af3%40sessionmgr111&vid=5&hid=123. Web. April 16, 2014Organ Donor Crises WPTZ NewsChannel 5. Nov 13, 2013. http://www.youtube.com/watch?v=1ZRy3LoNPns. Video. April 19, 2014. This source is a video from YouTube. Even though this video is from YouTube, it was uploaded by a local news station, WPTZ Newschannel 5. In the video a mother and her young boy are shown in a hospital. The boy is in need of a lung transplant. He is lucky, after a long period of wait, to receive a transplant. The transplant fails after a few years and he goes back on the waiting list. This short video is a good example of what it is like to be in need of a transplant. It shows the options that are available and also the realities that cannot be changed. Because of the shortage of donors the boy did not make it the second time he needed a transplant. It is very relevant to this paper because is also just happened last year. This organ shortage problem is very current and is not slowing down. Requena, Pablo, and Stoeppel, Anthony. Organ Donation Is Not Mutilation. The History of an Erroneous Idea. September 1, 2013.http://web.b.ebscohost.com/ehost/pdfviewer/pdfviewer?sid=e39f03bb-7b75-4dad-a2e6-8337444eae87%40sessionmgr198&vid=7&hid=125. Web. Pages 427-436 March 2, 2014.Rev. Anthony Stoeppel, and Rev. Pablo Requena, Md, explains the view of Living-organ donor transplantation and its history going from unacceptable mutilation, to a life-saving process. They present their argument in a medical journal format from which this particular article was taken from and use a formal tone. They use extensive research that was conducted by various experts as well as their own research and observations that extended over dozens of years before they come to their conclusion. They want to inform an academic audience of the problems with organ donations that once existed in the past. Although it seemed like this issue was resolved there was not an extreme increase in the number of donors of organs. This meant that there are other things apart from this problem that also contributed and continue to contribute to the shortage problem. Saving More lives: Organ Donation After Cardiac Death. Life Gift. http://www.lifegift.org/resources/files/DonationAfterCardiacDeathBrochure.pdf. Pdf. April 21, 2014Sims, Sterling. Penn Bioethics Journal. A Brief History of Organ Tranplantation. October 1,2010. Volume IV, Issue ii. http://web.b.ebscohost.com/ehost/pdfviewer/pdfviewer?sid=85b91674-77ce-4fbc-bb34-e949637987c9%40sessionmgr112&vid=2&hid=103. Web. April 23, 2014."Transplant Rejection: MedlinePlus Medical Encyclopedia." U.S National Library of Medicine.U.S. National Library of Medicine, Web. 12 Apr. 2014.http://www.nlm.nih.gov/medlineplus/ency/article/000815.htm. Uniting People and Information to Help save Lives." OPTN: Organ Procurement and Transplantation Network. http://optn.transplant.hrsa.gov/. Web. 13 Apr. 2014