Organ shortfall[edit]

The demand for organs

significantly surpasses the number
of donors everywhere in the world.
There are more potential recipients
on organ donation waiting lists
than organ donors. In particular,
due to significant advances in
dialysis techniques, patients
suffering from end-stage renal
disease (ESRD) can survive longer
than ever before. Because these
patients don't die as quickly as
they used to, and as kidney failure
increases with the rising age and
prevalence of high blood pressure
and diabetes in a society, the need
especially for kidneys rises every
year.

As of March 2014, about 121,600

people in the United States are on
the waiting list, although about a
third of those patients are inactive
and could not receive a donated
organ.[87][88] Wait times and
success rates for organs differ
significantly between organs due to
demand and procedure difficulty.
As of 2007, three-quarters of
patients in need of an organ
transplant were waiting for a
kidney,[89] and as such kidneys
have much longer waiting times. At
the Oregon Health and Science
University, for example, the median
patient who ultimately received an
organ waited only three weeks for a
heart and three months for a
pancreas or liver but 15 months
for a kidney, because demand for

kidneys substantially outstrips

supply.[90][citation needed]
In Australia, there are 10.8
transplants per million people,[91]
about a third of the Spanish rate.
The Lions Eye Institute, in Western
Australia, houses the Lions Eye
Bank. The Bank was established in
1986 and coordinates the
collection, processing and
distribution of eye tissue for
transplantation. The Lions Eye
Bank also maintains a waitlist of
patients who require corneal graft
operations. About 100 corneas are
provided by the Bank for transplant
each year, but there is still a
waiting list for corneas.[92]
"To an economist, this is a basic
supply-and-demand gap with tragic

consequences."[93] Approaches to
addressing this shortfall include:
donor registries and "primary
consent" laws, to remove the
burden of the donation decision
from the legal next-of-kin. Illinois
adopted a policy of "mandated
choice" in 2006, which requires
driver's license registrants to
answer the question Do you want
to be an organ donor? Illinois has
a registration rate of 60 percent
compared to 38 percent
nationally.[94] The added cost of
adding a question to the
registration form is minimal.
monetary incentives for signing up
to be a donor. Some economists
have advocated going as far as
allowing the sale of organs. The

New York Times reported that

Gary Becker and Julio Jorge Elias
argued in a recent paper that
'monetary incentives would
increase the supply of organs for
transplant sufficiently to eliminate
the very large queues in organ
markets, and the suffering and
deaths of many of those waiting,
without increasing the total cost of
transplant surgery by more than 12
percent.'[93] Iran allows the sale
of kidneys, and has no waiting
list.[95] The primary argument
against this proposal is a moral
one; as the article notes, many find
such a suggestion repugnant.[93]
As the National Kidney Foundation
puts it, Offering direct or indirect
economic benefits in exchange for
organ donation is inconsistent with

our values as a society. Any

attempt to assign a monetary value
to the human body, or body parts,
either arbitrarily, or through market
forces, diminishes human
dignity.[96]
an opt-out system ("dissent
solution"), in which a potential
donor or his/her relatives must take
specific action to be excluded from
organ donation, rather than
specific action to be included. This
model is used in several European
countries, such as Austria, which
has a registration rate eight times
that of Germany, which uses an
opt-in system.[94]
social incentive programs, wherein
members sign a legal agreement to
direct their organs first to other

members who are on the transplant

waiting list. One example of a
private organization using this
model is LifeSharers, which is free
to join and whose members agree
to sign a document giving
preferred access to their
organs.[97] "The proposal [for an
organ mutual insurance pool] can
be easily summarized: An
individual would receive priority for
any needed transplant if that
individual agrees that his or her
organs will be available to other
members of the insurance pool in
the event of his or her death. The
main purpose [of this proposal] is
to increase the supply of
transplantable organs in order to
save or improve more lives."[98]

In hospitals, organ network

representatives routinely screen
patient records to identify potential
donors shortly in advance of their
deaths.[99] In many cases, organprocurement representatives will
request screening tests (such as
blood typing) or organ-preserving
drugs (such as blood pressure
drugs) to keep potential donors'
organs viable until their suitability
for transplants can be determined
and family consent (if needed) can
be obtained.[99] This practice
increases transplant efficiency, as
potential donors who are
unsuitable due to infection or other
causes are removed from
consideration before their deaths,
and decreases the avoidable loss
of organs.[99] It may also benefit

families indirectly, as the families

of unsuitable donors are not
approached to discuss organ
donation.[99]
The Center for Ethical Solutions, an
American bioethics think tank, is
currently working on a project
called "Solving the Organ
Shortage," in which it is studying
the Iranian kidney procurement
system in order to better inform the
debate over solving the organ
shortfall in the United States.[100]