Running Head: ORGAN DONATION
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Organ Donation
Uncovering Systems around the World
Aubree Malone
First Colonial High School
ORGAN DONATION
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Abstract
This paper will outline and explain different rules, regulations, and laws followed by different
countries around the world as they pertain to organ donation or anatomical gifts. Several
different donation systems will be discussed as the countries chosen all have different donation
systems in place to try to accommodate the needs of the people. The countries discussed in this
paper are Russia, Iran, and the United States. Since the United States of America is broken up
into 50 states which all have different laws regarding anatomical gifts, three states will be
discussed: Arkansas, Hawaii, and Virginia. These three states show the diverse laws within one
country pertaining to the same concept. One state outlines the least regulations and benefits for
donors, one state is moderate, and the last state has many regulations and benefits for their
donors.
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Organ Donation: Uncovering Systems around the World
In the United States of America, 18 people die each day awaiting an organ transplant
(“Why Organ,” n.d.), one tragedy that could be solved if more people were educated about the
processes of organ donation. Some countries require education, some have developed systems to
obtain organs without permission from the donor, and some offer financial benefits to increase
their organ supply. Nonetheless every country has laws regarding anatomical gifts to try and
regulate/increase the amount of organs in their organ supply. One donor could save up to eight
lives and aid over 50, but there are not enough life saving organs in circulation to save everyone.
Due to the need for organs exceeding the amount of organs available, many laws and transplant
systems have been put in place to try to reduce the margin between the sick and the organ
supply.
History
Throughout time, organ donation has been a debated topic, only thought to save the lives
of people who were closely related (twins and/or fraternal twins), but that turned out not to be the
case at all, seeing as there could be a match for a person whom is not related to the patient.
Organ donation is considered a life saving practice. Throughout time medical physicians have
pushed the limits with organ donation from the first successful [renal] transplant in 1954 between
a pair of twins to, creating a complex allocation system to distribute out harvested organs from
deceased patients (UNOS.org) in 1986 (“Why Organ,” n.d.). In a short amount of time, medical
professionals tested their limits with transplanting organs then brought it worldwide, to save the
lives of millions. Now that the practice has been set in stone to save lives, each country (and its
states) tries to gather more organs to put into circulation to save more lives.
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The downfall to this whole operation is the world’s population is growing, increasing the
margin between the organ supply and the amount of organs needed. As the donation system
becomes more efficient and reliable, fewer donors come forth. With fewer donors, desperation
opens up for organs spurring the thought for revised donation systems, to fit the needs of the
people in that country. Some donation systems are more equipped to the citizens, but others are
put in place by the country’s government just to shade the real issue at hand.
[American] Statistics
Donors are separated into two categories: living donors, and deceased donors. Of course
more organs come from dead donors because more can be harvested from their bodies, but living
donors are a huge source for renal (kidney) anatomical gifts. People of every age donate organs
from even the youngest (one year old), “260 (241 deceased, 19 living donors),” (“Why Organ...,”
n.d.) to the eldest of the society (65 and up), “5,070 (4,271 deceased, 799 living donors),” (“Why
Organ…,” n.d.). See appendix A for full statistics.
Even though donors come from every age range, there are not enough in circulation to
fulfill the number of lifesaving organs that are needed to save every ill person. The number of
donors has increased since the start of the practice, but looking at recent years (1991 – 2013)
these efforts are parallel with a growing population of people in need. In 1991 the difference
between donors and was 16,245: 6,953 donors and 23,198 on the waiting list. In 2013 the
margin has sharply increased with the difference between donors and patients on the waiting list
being 107,015: 14,257 donors and 121,272 on the waiting list. Between 1991 and 2013, the
number of donors has only increased by 7,304 while the number of patients on the waiting list
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has increased by 98,074 (“Why Organ…,” n.d.). See appendix A for full statistics and a graph
showing the relationship between donors, transplants, and number of people on the waiting list.
American Transplant System
Allocation (UNOS.org)
Allocation is the process in which organs are distributed to people in need. Allocation
starts at the local level from wherever the organs were harvested, then spans outwards to find an
appropriate candidate. This process allows for a fair and efficient distribution of the organs
donated. Allocation is run through a system called United Network for Organ Sharing (UNOS).
UNOS maintains a centralized computer network, UNetSM, which links all organ
procurement organizations (OPOs) and transplant centers. Transplant professionals can
access this computer network 24 hours a day, seven days a week. UNet electronically
links all transplant hospitals and OPOs in a secure, real-time environment using the
Internet (“UNOS DonateLife,” n.d.).
UNOS also owns and operates the transplant waiting list which is maintained by the Organ
Procurement and Transplantation Network (OPTN). The OPTN was created when the National
Organ Transplant Act (NOTA) was passed through Congress (“UNOS DonateLife,” n.d.).
Laws, Rules, and Regulations (adopted in America)
Uniform Anatomical Gift Act (UAGA)
All of the states follow the rules and regulations set forth by the Uniform Anatomical Gift
Act (UAGA), but not all the states follow the same version. The versions range from 1968 in
Delaware, to the latest version in 2013 followed by Oregon. Each version has the same basic
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concepts, but each is revised to accommodate more modern needs in the organ donation system.
Before the UAGA was passed, states handled their own system of organ donation. The 1968
UAGA was the first legislation put into place to regulate organ and tissue donations and was
accepted throughout all 50 states. Its sole purpose in 1968 “was to increase the number of
available organs for transplant by making it easier for people to make anatomical gifts,”
(“Legislative,” n.d.) but through generations, the law was adapted to fit the needs of the country.
The UAGA was set in place to try and unify all the states to have around the same organ
donation practices. The most common version followed by the states is the 2006 version which
tried “…to provide uniformity in state laws regarding organ and tissue donation. Additionally,
there were huge strides in the technology and practice of donation and transplantation since the
last revision” (“Legislative,” n.d.). The UAGA is one of the most important pieces of legislation
regarding organ donation practices.
Dead Donor Law
The Dead Donor Law states that vital organs should only be harvested from brain dead
patients. Brain death is classified as “Irreversible brain damage and loss of brain function, as
evidenced by cessation of breathing and other vital reflexes, unresponsiveness to stimuli, absence
of muscle activity, and a flat electroencephalogram for a specific length of time” (“Brain Death,
n.d.). All states follow some form of the Dead Donor Law. Even if not explicitly said in state’s
statutes, two doctors will declare a person “dead” when all brain function has ceased. Two
doctors with a witness are required to declare a person as deceased, so that action cannot be
brought against doctors for wrongly declaring a patient as deceased. After the patient has been
declared deceased and the family has been notified, only then will vital organs be harvested from
the deceased patient.
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National Organ Transplant Act (NOTA)
“In 1984, Congress passed the National Organ Transplant Act that mandated the
establishment of the OPTN and Scientific Registry of Transplant Recipients. The purpose
of the OPTN is to improve the effectiveness of the nation's organ procurement, donation
and transplantation system by increasing the availability of and access to donor organs
for patients with end-stage organ failure. The Act stipulated that the network be a
nonprofit, private sector entity whose members are all U.S. transplant centers, organ
procurement organizations and histocompatibility laboratories. These members, along
with professional and voluntary healthcare organizations and the representatives of the
general public, are governed by a Board of Directors. The OPTN is administered
by UNOS under contract to the U.S. Department of Health and Human Services” (“Why
Organ…,” n.d.).
NOTA also outlawed the sale of organs in the United States of America. NOTA, along
with the UAGA, are the most important legislation put in place to regulation donation practices.
State Laws
Each state within the United States of America has different laws regarding anatomical
gifts and organ donation. States range from having the first version of the UAGA created in
1968 governing their organ donation practices, to the most recent version in 2013. Each state
offers different benefits for living donors or none at all. Some states require education about
anatomical gifts in school while others do not. Also the source of revenue for each state’s
practices differ from voluntary donations to state provided funds. Each state is unique in how
they regulate their organ donation practices (“Why Organ…,” n.d.). The one uniform protocol
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that every state must maintain is their donor registries. These registries are the easiest way to
find out if the deceased wished to donate his/her organs, eyes, and/or tissues.
Donor Registries - A confidential electronic database in which individuals can enter and
store their wish to be an organ and tissue donor. Most registries are for a single state, but
a few serve more than one state. Most registries have enrollment capacity through the
motor vehicle offices and many also have online registry portals. Because registry
information is accessible on a 24/7 basis to authorized procurement personnel, it is the
safest and quickest way to determine if a deceased individual wanted to be a donor.
(“Why Organ…,” n.d.).
Donor registries expedite the allocation system because they offer a faster harvest to
obtain the organs, so they can be distributed to people in need. Registries also place less serious
decision making on the mourning family. If the decedent has already applied to be an organ
donor, this leaves that decision out of their family’s hands. Many families say this is such a hard
decision without the decedent there. The families do not want to disrespect their lived one’s
body if, when they were living, the decedent did not wish to be a donor.
Arkansas. Arkansas provides the most support for living donors including benefits like
tax breaks. The benefits are also accompanied by education in school and driver’s education for
the youth, which leads to more donors. Arkansas receives voluntary contributions and state
provided funds toward their organ donation practices. Arkansas follows the 2006 version of the
UAGA which was enacted to try and unify the 50 states in regard to their donation practices, and
was also enacted to try and strengthen the livelong decision of becoming a donor (“Why
Organ…,” n.d.). The 2006 UAGA also offered new technology to strengthen the system and
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adapted regulations regarding the person who can make the decision on donation on behalf of the
decedent (“Why Organ…,” n.d.).
Virginia. Virginia is considered a moderate state when it comes to organ donation.
Virginia requires education about anatomical gifts in only driver’s education. Virginia has
limited support for living donors which does not include tax breaks like in Arkansas. Virginia
does not provide state funds for donation practices, but does accept voluntary contributions.
Along with Arkansas, Virginia follows the 2006 version of the UAGA to regulate their organ
donation (“Why Organ…,” n.d.).
Hawaii. Hawaii offers the least support and education for donors. Organ donation in
Hawaii is very minimal. Hawaii offers no support or benefits for living donors. Also, Hawaii
does not require education in either school or driver’s education about anatomical gifts. Along
with no support and no education, the state does not provide funds for these practices and leave it
up to the people to contribute. As well as Virginia and Arkansas, Hawaii follows the 2006
version of the UAGA (“Why Organ…,” n.d.).
2006 UAGA. Arkansas, Virginia, and Hawaii, though extremely different in their organ
donation practices, all follow the same version of the UAGA which sets the basis for their
anatomical gift processes. The 2006 UAGA can be revised or adapted to the state’s own needs,
but in the case of these three states the UAGA adopted in each, sets forth the same regulation. In
the layout of the UAGA for each state their own state codes are included, but for the
understanding, the state codes have been removed and replaced with [state code] so that just the
basic outline of the 2006 UAGA is shown.
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[state code]. Preclusive effect of anatomical gift, amendment, or revocation.
A. Except as otherwise provided in subsection G and subject to subsection F, in the
absence of an express, contrary indication by the donor, a person other than the donor is
barred from making, amending, or revoking an anatomical gift of a donor's body or part if
the donor made an anatomical gift of the donor's body or part under [state code] or an
amendment to an anatomical gift of the donor's body or part under [state code].
B. A donor's revocation of an anatomical gift of the donor's body or part under [state
code] is not a refusal and does not bar another person specified in [state code] or [state
code] from making an anatomical gift of the donor's body or part under [state
code] or [state code].
C. If a person other than the donor makes an unrevoked anatomical gift of the donor's
body or part under [state code] or an amendment to an anatomical gift of the donor's body
or part under [state code], another person may not make, amend, or revoke the gift of the
donor's body or part under [state code].
D. A revocation of an anatomical gift of a donor's body or part under [state code] by a
person other than the donor does not bar another person from making an anatomical gift
of the body or part under [state code] or [state code].
E. In the absence of an express, contrary indication by the donor or other person
authorized to make an anatomical gift under [state code], an anatomical gift of a part is
neither a refusal to give another part nor a limitation on the making of an anatomical gift
of another part at a later time by the donor or another person.
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F. In the absence of an express, contrary indication by the donor or other person
authorized to make an anatomical gift under [state code], an anatomical gift of a part for
one or more of the purposes set forth in [state code] is not a limitation on the making of
an anatomical gift of the part for any of the other purposes by the donor or any other
person under [state code].
G. If a donor who is an unemancipated minor dies, a parent of the donor who is
reasonably available may revoke or amend an anatomical gift of the donor's body or part.
H. If an unemancipated minor who signed a refusal dies, a parent of the minor who is
reasonably available may revoke the minor's refusal. (2006).
Case Law
Schembre v. Mid-America Transplant Ass'n
On November 28, 1998, appellant’s husband passed away due to a fatal heart attack.
Shortly after the death of the decedent, the family (decedent’s wife and two [adult] children)
were approached by a member of the hospital staff, Guelbert. Guelbert informed the family that
the decedent did not meet requirements for organ donation, but was eligible for donation of his
eyes, bone, and tissue. The initial decision was not to allow the donation, but after appellant
talked to her children, they decided the decedent’s wish to help others justified donations.
Appellant wanted only to allow donation of decedent’s corneas and wanted to restrict all other
donations. Guelbert then talked about bone donation, which he showed the amount using his
hands, inquiring that it would be a two to four inch section removed from the leg bone above the
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knee. Appellant had more questions, but were not able to be answered by Guelbert (Schembre v.
Mid-America Transplant Ass'n, 2004).
Guelbert testified that the appellant and her children were in favor of organ donation.
Guelbert also testified that he thoroughly explained the donation process. He said he explained
that if bone and eye donation was chosen, the full leg bone and eye would be removed from the
decedent’s body (Schembre v. Mid-America Transplant Ass'n, 2004).
After discussion, Guelbert aided appellant with the consent form, which indicated the
parts being donated. Both Guelbert and appellant went through the form and checked “yes” for
bone and eye donation, and “no” for tissue donation. Even though Guelbert went step by step
through the form, appellant did not actually read the consent form on account of being “too
distraught from her husband’s death.” Appellant wanted to limit the donations from decedent’s
body, but on the face of the consent form there were no limitations. Upon completion Guelbert
passed the form over to Mathew Thompson. Thompson states he saw no discrepancies within
the consent form, and did not further contact the family (which follows protocol). Thompson
called the tissue recovery team from MTS, who performed the harvest. The MTS team removed
all lower leg bone, and the entire eye for the removal of the corneas. The family was informed
of the removal of the entirety of both eye balls, and the full removal of leg bone from the lower
leg region, after decedent’s body was released for funeral preparation (Schembre v. Mid-America
Transplant Ass'n, 2004). The issue in the case is whether the MTS recovery team acted in good
faith regarding recovery of bones and corneas, or was the MTS teams negligent in the removal of
leg bone and corneas from decedent’s body?
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UAGA Section 194.270.3 RSMo (1996), adopted and modified in Missouri states:
“[a] person who acts without negligence and in good faith and in accord with the terms of
this act or with anatomical gift laws of another state or foreign country is not liable for
damages in any civil action or subject to prosecution in any criminal proceeding for his
[or her] act,” (1996).
Florida UAGA used as precedent [because Missouri laws did not exactly fit facts of the case]
states:
FN2. Fla. Stat. Section 765.517(5)(2002) states “A person who acts in good faith and
without negligence in accord with the terms of this part ... is not liable for damages in any
civil action or subject to prosecution for his or her acts in any criminal proceedings,”
(2002).
In order for the appellant to prove negligence against the defendant, appellant must prove
that the defendant breached a duty which directly resulted in the injury of the appellant.
There is no dispute that MTS has a duty to follow the requirements set forth under the
UAGA in order to complete a valid organ donation. MTS first obtained a written consent
form which is permissible under Section 194.240.2. The form was executed by a member
of a class of persons authorized to consent to organ donation pursuant to Section
194.220.2(2). MTS presented testimony that the consent form appeared to be valid on its
face with no limitations noted. Additionally, MTS offered evidence of its standard
protocol when removing the eyes, bone, and tissue and testified that it followed these
protocols. Finally, no one from Decedent's family contacted MTS to limit or revoke the
gift which would preclude it from accepting the gift as mandated in Section 194.220.3.
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There is no evidence in the record creating a genuine issue of material fact that MTS
breached its duty in the instant case. Therefore, we hold MTS acted without negligence
when removing Decedent's corneas, bone, and tissue (Schembre v. Mid-America
Transplant Ass'n, 2004).
The court ruled in favor of the Mid-America Transplant Association. Thompson
followed protocol by checking over the consent formed signed by appellant. Thompson did not
see any signs of discrepancies, so no further contact to the family was made. The MTS team
acted in good faith without negligence by following rules and regulations set forth by the UAGA.
The MTS team only removed parts specified on the consent form without limitations. The
appellant and the family did not contact the MTS team to set forth and limitations or revoke the
anatomical gifts (Schembre v. Mid-America Transplant Ass'n, 2004).
Lawse v. University of Iowa Hospitals
On August 15, 1973, a kidney was harvested from Steve Lawse’s body in order to be
transplanted into his brother Paul’s body. Lawse was informed that he could live with only
kidney, and was informed after his surgery that one kidney had been removed. One year later,
Paul’s graft failed, and then Paul was given a cadaver transplant. Paul died years later. Lawse’s
remaining kidney failed on January 23, 1984. Lawse then received a transplant from an
unrelated donor (Lawse v. University of Iowa Hospitals, 1988).
“On May 7, 1985, plaintiff filed an administrative claim with the State Appeals Board
pursuant to Iowa Code section 25A.5 (1987)” (Lawse v. University of Iowa Hospitals, 1988).
Lawse’s claim regarded the removal of his kidney and the treatment since the surgery for the
removal. Lawse claims that he was not psychologically competent enough to donate one of his
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kidneys, and he did not understand the suffering he would endure after the removal. Lawse
claims the defendants were negligent in that they disregarded his unwillingness to donate, and
they coerced Lawse to donate his kidney to his brother. The issue in the case is whether the
removal of Lawse’s kidney was wrongful, in that the patient was not properly informed about the
risk of the removal of one of his kidneys. The other issue is should Lawse’s claim be barred due
to the statute of limitations? The two laws looked at most in this case are Iowa Code section
25A.5 (1987) regarding the period in which a client can bring up a claim, and Iowa Code section
614.1(9) (1987) which explains the statute limitations on medical malpractice (Lawse v.
University of Iowa Hospitals, 1988).
Iowa Code section 25A.5 (1987) states:
Every claim and suit permitted under [the state tort claims act] shall be forever barred,
unless within two years after such claim accrued, the claim is made in writing to the state
appeal board under this chapter. The time to begin suit under this chapter shall be
extended for a period of six months from the date of mailing of notice to the claimant by
the state appeal board as to the final disposition of the claim or from the date of
withdrawal of the claim from the state appeal board under section 25A.5, if the time to
begin suit would otherwise expire before the end of such period. If a claim is made under
any other law of this state and a determination is made by a state agency or court that this
chapter provides the exclusive remedy for the claim, the time to make a claim and to
begin suit under this chapter shall be extended for a period of six months from the date of
the court order making such determination by a state agency, if the time to make the
claim and to begin the suit under this chapter would otherwise expire before the end of
such period. (1987) [law has been revised since its passing]
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Iowa Code section 614.1(9) (1987) states:
Malpractice. Those founded on injuries to the person or wrongful death against any
physician and surgeon, osteopath, osteopathic physician and surgeon, dentist, podiatric
physician, optometrist, pharmacist, chiropractor, physician assistant, or nurse, licensed
under chapter 147, or a hospital licensed under chapter 135B, arising out of patient care,
within two years after the date on which the claimant knew, or through the use of
reasonable diligence should have known, or received notice in writing of the existence of,
the injury or death for which damages are sought in the action, whichever of the dates
occurs first, but in no event shall any action be brought more than six years after the date
on which occurred the act or omission or occurrence alleged in the action to have been
the cause of the injury or death unless a foreign object unintentionally left in the body
caused the injury or death (1987).
Lawse’s claims of wrongful removal allege that the doctor assured him that:
(1) Paul would die without his kidney when in fact his brother was doing well on dialysis,
(2) there was basically no risk to him, it was like having an appendix removed; but he
should stay away from horses due to the risks if he should injure his remaining kidney,
and (3) he was the best match. He also contends: (1) he was not told his older brother
had refused to donate his kidney, (2) other family members were told he was a match
before he was, (3) he was given limited information, and (4) he was under duress (Lawse
v. University of Iowa Hospitals, 1988).
In the case Lawse v. University of Iowa Hospitals, the issue comes about that Lawse did
not claim any negligence until he needed his harvested kidney. No one could have predicted that
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he would need that kidney or a transplanted kidney in the future, but the surgery that harvested
his kidney to transplant to his brother, was not the direct cause of his reaming kidney to fail.
While sudden coercion may have happened by the physicians stating that a close relative will die
without the donation, it does not justify the claims of wrongful removal and psychological
damage. Lawse’s claim was barred due to the six year statute of limitations. Which means since
the claim was not filed within six years the case was disqualified (Lawse v. University of Iowa
Hospitals, 1988).
Sale of Organs
The open market for organs has been a debated topic in many countries for a long time.
It is seen as a way to entice more donors, with financial compensation, to donate their organs.
Without the open market crime happens and with an open market, crime happens. Both
situations pose the same outcome with crime; however, the reasoning for said crime is different
with each issue. Without the sale, anatomical gifts are seen as a way to make quick money to
compensate immediate financial needs and with the sale, organs may be too expensive to
purchase for middle or low class citizens, so they turn to the black market for more affordable
organs.
“Cash for Kidneys”
Canadians have been juggling the idea of “cash for kidneys.” Medical professionals feel
as though if they give out financial support to those who donate their kidneys then it will
increase the amount of organs in circulation. 18 people die each day waiting for a lifesaving
organ (Why Organ,” n.d.). Canadians are willing to look more into the sale of organs because as
of right now it is illegal for certain ethical reasons. Canada has seen an increasing decline in the
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amount of registered donors, so without organ donors Canada cannot harvest needed organs.
Canada’s transplant list becomes longer and longer increasing the wait time for each organ.
Some patients have seen a wait time of over a decade, but have only been given weeks to live.
People are given hope then die before they can receive their lifesaving organ. Studies show that
people would be able to part with their organs if that had a financial incentive. For example,
receiving 1,000+ dollars for donating a kidney while still living, or giving financial support like
covering funeral costs, to families with a deceased loved one that gave up their organ
(Komarnicki, 2012). The “cash for kidneys” movement is gaining momentum because saving
more lives feels right to everyone.
Crime
The black market has sped itself up in countries in Europe. People are looking to sell
their kidneys for financial compensation. A man with two children says it is just a small
sacrifice he has to make to feed his children (Bilefsky, 2012). The black market is definitely not
something that will ever abate especially with the aid of the internet. People post their organ ads
and wait for the highest bidder. Selling their organs is a way to get fast money to cope with their
financial problems. Obviously with these organ ads, people are thinking very irrationally and do
not think about future consequences and the burden this could potentially place on their family.
Their surgery could put further another load on their family than just the financial issue. In their
desperation they do not think about if the deal is genuine, or if they will get scammed or even
killed for their organs. This phenomenon is dangerous and with the legalization of the open
market could get worse. Organs could become too expensive with the open organ market, and
people will turn to the black market to buy cheaper organs and cheaper expenses on surgery that
may, in turn, not be safe (Bilefsky, 2012).
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But the crime doesn’t stop there; it spreads itself around the world creating a blanket
operation in which people, wherever, they are in the world, can sell their body parts for money.
In Australia, many families who are having trouble conceiving are learning that they can have a
baby within a year if they are willing to pay the right price, $10,000 - $50,000. Though this
practice is illegal in Australia, some will never stop striving for what they think they deserve.
Many poor women, like in Thailand, sell their eggs to people like this, but medical officials fear
that these women are lying about their medical history so they can gain money. The money that
the donors receive usually depends on the woman’s looks. One big provider to this illegal
market for eggs, are college women from the United States. These women could get paid
$10,000 or more, for her each egg she donates because the looks of these women are well sought
after (Baker, 2012). Like the other women who donate, these college students are trying to make
ends meet within their financial situations. In other countries, women give up their eggs to put
food on the table for their children or family, but with many more desperate women from these
third world countries, their eggs are not wanted, so they are paid much less than the rare
American donor(Baker, 2012) .
Immoral reasons for donation
The piece of the organ market talked about in this section of the paper is the open market
for living donors that donate their kidneys for financial benefit. The sale of organs can lead to
immoral reasons for donating. Donation should be a moral obligation, not a way to make
money. With the sale, many people will see it as just a way to make money. The reason the sale
is even considered a moral system within some countries is because it creates more organs in
circulation that will, in turn, save many lives. Part of the argument is that people do immoral
things all the time for no reason, with this, at least the turn out, is a saved life.
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Iranian Transplant System
Iranians undertook the financial benefit system of organ donation, which is essentially
selling organs for money. Within Iran living donors can donate their kidneys for financial
compensation. In the 1980s many countries frowned upon handing out money for donation
practices and passed laws outlawing the sale, as seen in the United States when NOTA was
passed. Some countries do not see anything wrong with financial compensation for lifesaving
organs. After careful evaluation Iran adopted the renal financial incentive form of organ
donation of 1988. Iran’s amount of renal donations sharply increased since this adoption, which
then lead to the eradication of the renal transplant list in 1999. With this system in place, Iran
performs more renal transplants from living-unrelated donors than from deceased donors (Ghods
& Savaj, n.d.). “By the end of 2005, a total of 19,609 renal transplants were performed (3421
from living related, 15,356 from living-unrelated and 823 from deceased donors)” (Ghods &
Savaj, n.d.). With the growing number of patients with end stage renal failure needing a kidney
transplant, many countries are looking to develop a new system to increase the number of
kidneys in circulation (while still avoiding financial incentives for donation), but none of the
proposed systems will completely eradicate the waiting list, like as seen in the Iran model
(Ghods & Savaj, n.d.).
Financial Benefit
As stated before, many countries during the 1980s passed legislation regarding the sale of
organs. Many countries outlawed the sale, but some after careful consideration decided that with
financial incentives the citizens within their country would be more willing to donate their
organs or donate the organs of their deceased loved ones. Sometimes the human race just needs
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a little push to do something nice for others. The biggest issue in the medical community with
giving out financial incentives for organs is that it could lead to unethical transplant practices.
As long as the donation practice is closely regulated, the unethical practices should not come
about (Ghods & Savaj, n.d.).
Russian Transplant System
The Russian transplant system is based off of a policy derived from the Soviet Union in
the time of the Cold War. After the Cold War, Russians lost trust in their government, which
led to a severe decrease in organ donations/transplants. Then when “command form organ
donation” was adopted from the Soviet medical System, it rendered a negative response from the
public as it was seen to violate the rights of the deceased individuals (“Transplant coordination in
Russia,” n.d).
Implied Consent
“Implied consent” or “command form organ donation” means that a person is
automatically assumed to be an organ donor upon the time of their death (“Transplant
coordination in Russia,” n.d). The relatives of said person have no say in the matter. One of the
main reasons countries do not adopt the implied consent system, is because it can be considered
disrespectful to the decedent’s body. There are so many reasons why people are not organ
donors some of which are considered religious reasons, so assuming that a person is an organ
donor, without their or their family’s consent, could violate the rights of that person. Silence
does not mean yes; only yes gives consent. So with the implied consent system, there will be
organs harvested from people who did not wish to be organ donors, which ultimately sets up
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little trust. If a country’s government constantly disrespects its people, it will soon lose all
power.
Conclusion
Though the organ supply is not sufficient enough to help every person in need, the
systems put in place in different countries are beginning ideas towards a solution. Practices in
both Iran and Russia are highly debated because they both pose ethical questions. Even though
The United States’ system is considered the most ethical because all donations are voluntary,
their system does not offer a practical solution to the organ shortage problem because without a
sufficient amount of donors, not all the sick will receive the lifesaving organs they need. No one
wants an innocent life to be taken, so these systems presented are only to help save the people.
Although ethical issues are present in some of these systems, they all lead to the same positive
solution: thousands of saved lives. Taking into account the positives and negatives of each
system, saved lives will always trump the negative outcomes.
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Appendix A
American Statistics
All information, charts, and pictures were derived from organdonor.gov
People of every age give and receive organ donations. In 2013, 28,953 people received organ
transplants. Below is the number of recipients by age group followed by the number who
received organs from deceased and living donors:
1 Year Old: 260 (241 deceased, 19 living donors)
1 - 5 Years: 545 (437 deceased, 108 living donors)
6 - 10 Years: 292 (228 deceased, 64 living donors)
11 - 17 Years: 721 (591 deceased, 130 living donors)
18 - 34 Years: 3,081 (1,983 deceased, 1,098 living donors)
35 - 49 Years: 6,310 (4,699 deceased, 1.611 living donors)
50 - 64 Years: 12,674 (10,516 deceased, 2,158 living donors)
65+ Years: 5,070 (4,271 deceased, 799 living donors)
As of December 4, 2012, the percentage of recipients who were still living 5-years after their
transplant is noted below for kidney, heart, liver, and lung.
Kidney (deceased donor): 83.4%
Kidney (living donor): 92%
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Heart: 76.8%
Liver (deceased donor): 74.3%
Liver (living donor): 81.3%
Lung: 55.2%
In 1991, there were 6,953 Donors, 15,756 Transplants, and 23,198 Waiting list
In 1992, there were 7,091 Donors, 16,134 Transplants, and 27,563 Waiting list
In 1993, there were 7,766 Donors, 17,631 Transplants, and 31,355 Waiting list
In 1994, there were 8,203 Donors, 18,298 Transplants, and 35,271 Waiting list
In 1995, there were 8,859 Donors, 19,396 Transplants, and 41,203 Waiting list
In 1996, there were 9,222 Donors, 19,765 Transplants, and 46,961 Waiting list
In 1997, there were 9,545 Donors, 20,314 Transplants, and 53,167 Waiting list
In 1998, there were 10,362 Donors, 21,523 Transplants, and 60,381 Waiting list
In 1999, there were 10,869 Donors, 22,026 Transplants, and 67,224 Waiting list
In 2000, there were 11,934 Donors, 23,266 Transplants, and 74,078 Waiting list
In 2001, there were 12,702 Donors, 24,239 Transplants, and 79,524 Waiting list
In 2002, there were 12,821 Donors, 24,910 Transplants, and 80,790 Waiting list
In 2003, there were 13,285 Donors, 25,473 Transplants, and 83,731 Waiting list
In 2004, there were 14,154 Donors, 27,040 Transplants, and 87,146 Waiting list
In 2005, there were 14,497 Donors, 28,118 Transplants, and 90,526 Waiting list
In 2006, there were 14,750 Donors, 28,940 Transplants, and 94,441 Waiting list
In 2007, there were 14,400 Donors, 28,366 Transplants, and 97,670 Waiting list
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In 2008, there were 14,207 Donors, 27,964 Transplants, and 100,775 Waiting list
In 2009, there were 14,631 Donors, 28,458 Transplants, and 105,567 Waiting list
In 2010, there were 14,504 Donors, 28,662 Transplants, and 110,375 Waiting list
In 2011, there were 14,149 Donors, 28,539 Transplants, and 112,816 Waiting list
In 2012, there were 14,011 Donors, 28,054 Transplants, and 117,040 Waiting list
In 2013, there were 14,257 Donors, 28,954 Transplants, and 121,272 Waiting list
29