Organs for transplantation are so scarce, and the imperatives for organ procurement are so compelling, that some folks seem to do the darnedest things (even if we leave recent and not-so-recent stories about China out of this discussion).

Consider the recent story of a transplant surgeon who allegedly put the interests of potential recipients above those of a potential donor and got socked with criminal charges in California as a result — a striking story and the impetus for my writing about organ transplantation today.

There are clearly points of tension between donor and donee, e.g., choosing a "good death" unattended by tubes and machines vs. going all-out to preserve organs for transplant. Patient self-determination butts heads with the so-called Breakthrough Collaborative, which has, for the past several years, sought to increase the "conversion rate" (i.e., rate of organ donation by eligible donors).

New federal regulations governing transplant centers don’t really address procurement efforts, and state laws are being revised to allow for more organ donations, by potentially impinging on donors’ wishes for a good death in order to preserve donated organs.

The demand for organs has always outpaced supply in this country (OPTN figues show a US organ transplant waiting list of about 98,000 at the moment), and these recent developments are just some of the ways folks are trying to deal with this. For further background, there is an interesting Joint Commission white paper on organ donation, a few years old but worth a read.

Another sort of approach, which I would personally like to see explored more fully in this country, would be adoption of a "soft" presumed consent law — a reversal of the current legal presumption regarding consent to organ donation, but with appropriate protections allowing individuals and family members to opt out. For background on this approach, see the British Medical Asscociation’s recommendation regarding presumed consent.

It seems to me that we’ve been waiting for science fiction solutions — like artificial hearts (though Jarvik is now hawking Lipitor) and xenografts — to become mainstream, instead of dealing with this issue head-on.

David Harlow