Be an Organ Donor
For many people, it can be disconcerting to think about what might happen at the end of their lives. The prospect of death is daunting, and many people prefer not to think about the details. However, an important end-of-life decision to address is whether or not to become an organ donor. Any person over the age of 18 can register to be become an organ donor, and there are a wide range of circumstances under which organs may be donated (US Department of Health and Human Services [HHS], 2018). It is possible for older people to donate their organs, depending on the way they die, or the organs may be donated when a person suffers from an unexpected accident that leaves them brain dead (Girlanda, 2016). When a patient is declared brain dead, it means that there is an “irreversible cessation of brain stem activity” (Girlanda, 2016), but in some cases, they may still have functioning organs and tissues that are suitable for donation (Yousefi, Roshani, & Nazari, 2014). If the person is registered as an organ donor, the useable organs may be removed by medical staff and transplanted into one or more needy patients (HHS, 2018). Aside from brain death, there are also several other types of death that are conducive to organ donation, such as cardiac death, but brain death accounts for between eighty and ninety percent of all organ donations each year (Girlanda, 2016). It is important to distinguish these types of organ donation—that is, donation by a registered donor who has reached the end of their life—and living donation, which is sometimes coerced and goes beyond the scope of this paper. When it comes to the question of whether or not to register to become an organ donor, the issue is limited in scope to end of life circumstances. There are a wide range of benefits to organ donation at the end of life, more people should make the decision to register to become organ donors.
In the United States, there has long been a high demand for organ donation. In 2017 alone, a total of 34,770 organ transplants were made as a result of organ donation (HHS, 2018). However, there are still far fewer organ donors than are needed within the healthcare system. In April 2018, there were over 114,000 people on the national transplant waiting list. Moreover, this number has increased significantly in recent years: in 1991, there were only about 24,000 people on the list (HHS, 2018). While it is true that the number of registered donors has also gone up in the last three decades, the rate of the increase in the number of donors has been outstripped by the increase in the demand. As of 1991, there were about 7000 instances of successful organ donation in the United States, but by 2017, that number only risen to about 16,400 successful instances of organization, which is still far fewer than the number of donations that were needed by patients on the waiting list (HHS, 2018). The discrepancy in the rate of increase between organ donation demand and actual organ donation stems directly from the fact that too few people in the United States are registered organ donors.
Perhaps the most compelling reason why more people should register to become organ donors is that organ donation can have a truly positive impact on the lives of others. A single organ donor has the potential to save the lives of eight different people (HHS, 2018). Moreover, organ donation also positively affects the people who love and support the receiver, including their family, friends, colleagues, and even their casual perspectives (Moritsugu, 2013). Therefore, from an ethical perspective, organ donation is a highly altruistic gesture (Dalal, 2015). When a person chooses to become an organ donor, it is a decision that inherently benefits others, without regard to the self (Dalal, 2015). While the end of a person’s life may be a tragedy—especially if it is cut short by an unexpected accident that leaves them brain dead—organ donation makes it possible for them to improve the world through one last act of kindness toward others. No matter what the cause of a person’s death, registering to become an organ donor ensures that their final act will be to do something that benefits others.
For more practical thinkers, another reason to make the choice to become an organ donor is that organ donors are needed, and potential donors are in a position to fulfill that need. This argument rests on the ethical principle of utilitarianism (Dalal, 2015). Given the long length of the organ donor waiting list, there is no doubt about the need for people to register to become organ donors. Every day, about 20 people on the waiting list die waiting for an organ transplant (HHS, 2018), so organ donation has a clear utility for society as a whole. Unfortunately, only about 3 in 1000 people die in a manner that is conducive to organ donation (HHS, 2018). Comparing these statistics, it is clear that the only way to ensure that the number of available organs can catch up with the number of needed organs is to increase the number of registered donors who have agreed to donate their organs. Utilitarianism necessitates that the people with the available resources—organs that are in functional condition at the time of death—should make those resources available to the others in society who desperately need them.
Another reason to become an organ donor is that it can relieve the burden on a person’s own family in the event of an unexpected accident in which they are rendered brain dead, but their organs are suitable for donation to needy patients. If a person is not a registered organ donor at the time of the accident, but the doctors determine that the organs are suitable for donation, the decision about organ donation falls to the family. This can be extremely challenging for family members during the initial period of grief. Not only does the family have to deal with the shock of the loss of a loved one, but they are suddenly faced with the question of what the person would have wanted (Yousefi et al., 2014). In addition, families who are making decisions while they are overcome with grief may be less likely to choose organ donation because they hope the patient will recover, even when the doctors have clearly specified that the patient is brain dead (Yousefi et al., 2014). Families may also have trouble understanding the process of organ donation, and there may be conflicting opinions within the family about what the person wanted (Yousefi et al., 2014). Clearly, when a person decides not to register to become an organ donor, they place their family members in a challenging decision-making position at what is likely to be one of the hardest moments of their lives—when they are stricken by grief and trying to recover from an unexpected loss. Out of consideration for their families, more people should take responsibility for their own decisions and register in advance for organ donation.
Finally, more people should register to become organ donors in order to advance the science of organ transplant. Although improvements in surgical techniques and immunosuppression strategies have reduced the failure rates of organ transplants in recent years, the success of an organ transplant is still far from guaranteed (Girlanda, 2016). In 2017, over 34,700 organ transplants were attempted, but only about 16,400 succeeded (HHS, 2018). However, every time an organ transplant succeeds, it contributes to clinicians’ understandings of the factors that play into a successful transplant. Therefore, by registering to become an organ donor, a person can contribute to advances in medical science that have long-term implications for improvements in organ donation efficacy in the future.
Critics of the argument point out that organ transplant is cost-inefficient, so it can place an unnecessary financial burden on the healthcare system (Axelrod, 2013). Organ transplant is highly resource-intensive, and for patients receiving organs like kidneys, the costs of long-term dialysis may be lower than the cost of transplantation (Axelrod, 2013). In cases where the transplant fails anyway, the transplant attempt is ultimately nothing but an economic loss. Therefore, opponents may argue that instead of encouraging organ donor registration, it is more important to focus on improving medical technology and finding alternatives to cost-inefficient organ transplant.
While it is true that the process of organ donation and transplant is not cost-efficient, there may be ways to reduce cost inefficiencies in the future, even for high-risk transplants patients (Axelrod, 2013). Also, clinicians can learn from every transplant attempt, ultimately leading to better outcomes for future patients. Therefore, regardless of the resource-intensive nature of the process and the potential strain on the healthcare system, it is worthwhile to encourage more people to register to become organ donors and thereby increase the number of transplant attempts each year.
In conclusion, more people should make the decision to register to become organ donors in the event that their organs are suitable for donation when they die. The ethical support for this argument is underpinned by both altruism and utilitarianism. People should also choose to donate their organs because it means that their family will not have to make the challenging decision for them, and it can contribute to further advancement in the medical field. Although there is a credible economic argument against increasing the number of transplant attempts, the costs of transplantation are outweighed by the potential benefits. Therefore, all US adults who are currently unregistered should take the opportunity to register to become organ donors today.
References
Axelrod, D.A. (2013). Economic and financial outcomes in transplantation: Whose dime is it anyway? Current Opinion in Organ Transplantation, 18(2), 222-8.
Dalal, A.R. (2015). Philosophy of organ donation: Review of ethical facets. World Journal of Transplantation, 54(2), 44-51.
Girlanda, R. (2016). Decreased organ donation for transplantation: Challenges and opportunities. World Journal of Transplantation, 6(3), 451-9.
Moritsugu, K.P. (2013). The power of organ donation to save lives through transplantation. Public Health Reports, 18(2), 245-6.
Organ donation statistics. (2018). US Department of Health and Human Services.
Yousefi, H., Roshani, A., & Nazari, F. (2014). Experiences of the families concerning organ donation of a family member with brain death. Iranian Journal of Nursing and Midwifery Research, 19(3), 323-30.