Health
Organ donation needs a bigger heart
The demand for organs is increasing, and waiting lists aren’t getting any shorter – particularly for Black Americans.
June 25, 2023
Source: Peakpx.
If you want a new liver, you’ll have to get in line.
Tens of thousands of Americans are on the waitlist for lifesaving surgery, and states can’t keep up with the demand. Black patients are hit the hardest.
According to Jewel Mullen, MD, MPH, MPA, the U.S. approach to organ donation – like much of health care – runs deep with inequity. Black patients and other patients of color face more barriers to care to prevent the need for organ donation, as well as the specialized care needed for a transplant.
In the case of kidney failure, one widely-used test resulted in late diagnoses and delayed referrals for potentially thousands of Black patients. The Organ Procurement and Transplantation Network responded in January by requiring kidney transplant programs to identify and notify Black candidates who should have qualified sooner. Programs have a full year to meet the requirement, meaning many are still waiting.
Fixing the country’s organ network is the subject of controversy. The vast majority of the country has an “opt-in” system for organ donation, meaning Americans elect to become an organ donor usually when registering for a driver’s license or ID.
Other countries have a “presumed consent” system, where the deceased is assumed to be a willing organ donor unless they expressly choose not to be. Spain adopted this approach in 1979, and is heralded as a world leader in organ donation.
Several U.S. states with long waiting lists, including California, New York and New Jersey, have considered adopting or have adopted a similar system. New York and New Jersey’s “presumed consent” laws both passed in 2020, in the early months of the COVID-19 pandemic.
During COVID-19, transplant activity worldwide plummeted, spelling disaster for those on the waitlists. Fewer were diagnosed and added, and fewer could access overburdened hospitals for transplants.
A “presumed consent” policy could be the boost the U.S. needs to prevent thousands of unnecessary deaths during a future disaster. If the U.S. is to lose fewer patients to waiting lists, however, it has to address the heart of the matter – the system itself.
See Github repository for this project.