Gift of a Lifetime
Cont. from p5
Contrary to popular belief, waiting on the list for a transplant is not like taking a number at the deli counter and waiting for your turn to order. In some respects, even the word "list" is misleading; the list is really a giant pool of patients. There is no ranking or patient order until there is a donor, because each donor's blood type, size and genetic characteristics are different. Therefore, when a donor is entered into the national computer system, the patients that match that donor, and therefore the "list," is different each time.
The other major guiding principal in organ allocation is: local patients first. The country is divided into 11 geographic regions, each served by a federally-designated organ procurement organization (OPO), which is responsible for coordinating all organ donations. With the exception of perfectly matched kidneys and the most urgent liver patients, ft.irst priority goes to patients at transplant hospitals located in the Conregion served by the OPO. Next in priority are patients in areas served by nearby OPOs; and finally, only if no patients in these communities can use the organ, it is offered to patients elsewhere in the U.S.
Contrary to the image of organs always crisscrossing the country, 80 percent of all organs are donated and used in the same geographic area.
Such locally oriented allocation makes medical sense because less time between donor and recipient usually means more chance of a successful transplant as well as fewer logistical complications that could threaten the viability of the organ.
Experience has shown, furthermore, that people are more likely to donate organs if they know that other people in their own community will benefit.
.Of course, debates about organ allocation will continue as long as there is such a large gap between patients who need transplants and the number of organs donated. Who, for example, should get priority, people who are the sickest or those who have the greatest chance of surviving and achieving a long life?
And what is the significance, if any, of someone's personal behavior? Should a much-needed heart go to a person who was a heavy smoker or a liver to someone who has suffered from alcoholism? These are difficult questions for which there are no easy answers.