UpClose with Chuck Newton, Sr. Vice President, Evergreen Re

New Organ Donation Initiatives Could Lead to Major Increases in Transplants

While the number of Americans waiting for organs continues to rise, and more are dying waiting for organs that never materialize, the cry for changes in the system has become loud and clear.

Aside from the current government initiatives – from the adoption of the Uniform Anatomical Gift Act in 2006 and the Organ Donation Breakthrough Collaborative effort in effect since 2003, there also continues to be a push for increased action and donor matching via the internet.  This effort is growing at a significant rate and finally getting the media attention many hope will encourage more Americans to sign up as organ donors.

Collectively, these separate and sometimes controversial initiatives, as well as the growing influence of baby boomers coming of age and potentially needing transplants-- could significantly increase, and some say double, the number of transplants in this country in the near future.

During the last 20 years, medical breakthroughs such as tissue typing and immunosuppressant drugs have enabled a larger number of organ transplants and longer survival rates for recipients.  Unfortunately, while the success of transplantation can be celebrated, what hasn’t changed much is the fact that there continues to be an enormous shortage of organ donors and many who could have benefited from these advances in medicine die waiting for a chance.  That may be about to change.

As of March 2007, there were 95,624 Americans on the organ waiting list.  According to UNOS, in 2006, there were 28,925 transplants and 14,749 donors.  Approximately 22,200 transplants were from deceased donors, while 6,725 transplants were from living donors. 

From a financial perspective, it’s important to note the average cost of transplants is approximately $200,000, although the growing number of multiple organ transplants can drive the cost up significantly.  If the number of transplants were to double, the financial implications for health plans and other payors could be in the range of $4.5 billion a year.  Here are some of the programs that promise to make that happen.

Government Initiatives

The Uniform Anatomical Gift Act (UAGA) has been in existence since 1968 and was revised again in 1987, but it’s the 2006 revision of the act that many hope will finally make it easier and less complicated for people who want to donate their organs when they die, to do so.  The enactment of UAGA is currently underway, with plans to introduce the act in more than 30 states over the coming year, bringing uniformity to the law and regulations governing organ procurement and allocation as well as changes in organ donation practices.

Despite the existence of the first Uniform Anatomical Gift Act in 1968, which in effect abolished the old code giving next of kin complete authority over a person’s body after death, organ procurement organizations (OPOs) continued to seek permission from next of kin, even when the potential donor had expressed their desire to be an organ donor.

The UAGA 2006 encourages the creation of registries and provides for further recognition of existing registries -- such as the driver’s license donation forms -- as a document of gift. It strengthens first person consent, preventing others from overriding an individuals’ decision to make or refuse to make the gift of organ donation.  It also expands the list of legal next of kin to include friends and agents with a health power of attorney to make the gift on behalf of their client.

The Organ Donation Breakthrough Collaborative is an initiative between the Department of Health and Human Services and key national leaders and practitioners from the Nation's transplantation and hospital communities launched in April 2003.  The mission of the Collaborative is to dramatically increase access to transplantable organs.  The hope is to save thousands of lives a year by spreading known best practices to the nation's largest hospitals to achieve organ donation rates of 75 percent or higher in these hospitals.

According to the Collaborative website, 50 percent of the nation's eligible organ donors are in 200 hospitals. Fourteen of the largest hospitals in the United States have already achieved organ donation rates of 75 percent or greater. Many other large hospitals, clustered in certain donation service areas, also have average donation rates that are well above the national average of 46 percent. Rates in the largest hospitals vary from 0 percent to 100 percent.

The high rates are no accident, according to experts. The practices used by OPOs and large hospitals to generate these high rates can be replicated. The Breakthrough Collaborative was designed to help OPOs and their chosen large hospitals to close that gap rapidly. Participating teams can expect to achieve significantly higher organ donation rates.

Additionally, the Collaborative effort has as an additional goal to maximize the number of organs transplanted from each and every donor, or an average of 3.75 organs transplanted per donor, which could impact the number of transplants significantly. This effort should begin to show results this year.

Donor Net 2007 – was a mandate from UNOS to create the first national electronic organ placement system.  The program was designed to uniformly display donor data and to make electronic organ offers quickly and more efficiently.  The new electronic system is expected to take effect this April. 

Alternatives to Government Programs

LifeShares, a non-profit volunteer network of organ donors, asks members to promise to donate their organs upon death, giving fellow members first access to their organs.  The concept developed from the simple fact that most organs transplanted in the U.S. go to people who have not agreed to donate their own organs when they die.  This LifeShares contends, is unfair and one of the reasons there is such a large organ shortage in the U.S.

As of February 2007, a total of 7,947 people have signed up as members of LifeShares, an increase of 102% over last year. 

MatchingDonors.com is another internet based non-government initiative designed to match living donors.  While the number of living donors actually decreased slightly last year, there is a huge push to increase donation using technology and the kindness of strangers to help those on the organ waiting list.

The site was created in 2004 by Dr. Jeremiah Lowney of New England Baptist Hospital and Paul Dooley.  According to the website, they have successfully brought about 39 live donor kidney transplants and have another 40 scheduled in the upcoming months.

There are currently 3,925 potential donors currently in MatchingDonors.com.  For those in need of an organ, fees for finding a match range from $49 a week to $595 for unlimited usage to cover the site upkeep and other administrative costs.  According to the site, the fee is waived for those who can’t afford it and Medicare has approved reimbursement for services like MatchingDonors.

In fact in a recent People Magazine article on the program, Dr. Frances Delmonico the immediate past president of UNOS, recommends MatchingDonors as an alternative to the government programs.

Donate Life America is a not-for-profit alliance of national organizations and local coalitions across the United States dedicated to inspiring all people to save and enhance lives through organ, eye and tissue donation.  Launched in 2004, the organization has received more than $400 million in donated media to date and is determined to mobilize, not just create awareness.

Donate Life America assists in mobilizing the transplant community to educate the American public on the need for organ, eye and tissue donation and motivating the public to make an actionable donor designation. The organization publishes brochures, program kits and other materials; provides technical assistance and referral services; coordinates the national campaign for organ, eye and tissue donation; identifies measurable best practices and leads the Donor Designation Collaborative. 

 
Since 1995 organ transplants have increased 49% and multiple organ transplants have increased 346%. Given the developments in medical technology, pharmaceuticals, initiatives in government programs and social services as discussed in this article, there is every reason to believe the increases over the next 10 years will significantly exceed the historical trend and the risks involved for payors of these services.