iD Ideas Discoveries March 2017

WHAT REALLY

DECIDES WHO

WILL RECEIVE

AN ORGAN

DONATION?

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CONCEPT:

BRAIN DEATH

There are some

120,000 people

waiting for an

organ donation

in the U.S. But

only about 14,000 organs are

donated per year. The waiting

times for these individuals is

consequently extremely long.

On average, a person waits

around six years for a kidney

and up to two years for a heart

or a liver. But what does that

really mean? Does the chance

of receiving an organ increase

the longer a person is on the

waiting list? Not necessarily:

Because during conversations

with their seriously ill patients,

physicians are sometimes only

conditionally honest... Along

with the “hard” criteria (blood

type match, possible rejection

reaction, etc.) that determine

whether a donor organ is right

for a given patient, there are

also numerous “soft” criteria.

And these play a crucial role in

the allocation of organs. For

example, many of those waiting

for a donation are not aware that

“The ranking of waiting patients

gets recalculated every time an

organ becomes available,” says

Axel Rahmel, the chief medical

offi cer at the German Foundation

for Organ Transplantation.

However, even if these dice

are rolled in the patient’s favor,

that doesn’t mean the person

will automatically be selected

for the transplant—far from it.

In fact, this doesn’t even mean

that the person will receive a

new organ at some point at all.

But how can that be?

As soon as only two patients

are left on a list—for example,

for the allocation of a kidney—

and they are extremely similar

in terms of their measurable

criteria, then it’s a tie. For the

more than 93,000 people who

are waiting for a kidney in the

U.S., it’s a problem that occurs

more often than most people

would guess. In this situation,

in order to choose a patient to

receive the organ, the doctors

must take the soft criteria into

account in addition to the hard

criteria. These are things that

aren’t measurable per se but

are often based on subjective

assessment. For the doctors

responsible for the decision,

that presents a dilemma. They

must select an organ recipient

based on factors like urgency

and lifestyle—a maddeningly

diffi cult task. In practice, this

might mean that a 47-year-old

alcoholic has less chance of

receiving a donor liver than a

17-year-old girl suffering from

a hereditary condition who is

otherwise healthy. For critics,

that is a hard pill to swallow:

Without objective criteria, they

believe a red line is crossed.

Patrick McMahon, a former

transplant coordinator in New

York, has even accused some

doctors of “playing God.”

Contrary to the

popular belief,

dead people

cannot donate

organs. “You can

only transplant

organs that are

alive,” explains

cardiologist

Paolo Bavastro.

In order for

doctors to be

able to take

organs from a

live body without

committing a

criminal offense,

the defi nition of

“brain death” was

introduced in

1968. It means
      brain functions
      are irreversibly
      switched off and
      can’t be switched
      on—though other
      bodily functions
      are still active.

“Why certain disclosure

obligations do not apply

to transplant medicine is

a mystery to me.”

PAOLO BAVASTRO, CARDIOLOGIST

i

ideasanddiscoveries.com 65 Mar 2017