When the wife and younger daughter of Rear Admiral Kenneth Moritsugu of the US Navy were fatally injured in separate automobile accidents, he authorized the donation of organs and tissues from both of them.
Moritsugu, acting surgeon general of the US, calls organ donation "the ultimate act of human kindness." But the number of donor organs falls far short of the need. As of June, 97,000 people awaited lifesaving transplants in the US, and each day the waiting list grows five times faster than the donation rate.
People typically wait three to five years for donated organs, and each day 17 of them die.
But, as Moritsugu noted recently in The Journal of the American Dietetic Association, "The shortage of donor organs is a medical problem for which there is a cure."
When the decision is made to donate, he said, those families, "often in a time of grief and tragedy, rise above personal concern to help others in need of lifesaving transplantation."
The parents of Laurie McLendon, 42, chose to donate when their daughter suffered cardiac arrest at New York-Presbyterian Hospital. Two women received her kidneys, a burn unit received skin, her corneas went to an eye bank, and her liver was transplanted into a 61-year-old pediatric oncologist, Michael Harris of Englewood, New Jersey, who had contracted hepatitis C years earlier while caring for a patient.
Other organs and tissues that can be donated are the heart, pancreas, lungs, intestines, bone marrow, heart valves and connective tissue. A kidney, part of a liver, lobe of a lung and bone marrow can be obtained from living donors. But three out of four transplanted organs come from people who die and had indicated their willingness to be donors by signing an advance directive or by telling the person designated to speak for them when they can no longer speak for themselves.
Although willingness to donate has risen in recent years, major hurdles remain. Some people, for example, believe incorrectly that patients who might otherwise be saved are sometimes "killed" for their organs. Strict regulations are in place to prevent this.
In the early days of transplantation, donated organs and tissues came from victims of cardiac death, people who were no longer breathing and had no pulse, and whose hearts could not be revived. Often by the time organs could be removed after a cardiac death, they had been without a blood supply for too long and were unusable or unlikely to survive in the recipients.
In 1968, death was redefined as occurring when the brain ceased to function, although the heart may continue to beat with the support of drugs, and breathing is sustained by a ventilator. With a brain-based definition of death, organs are often in much better condition for transplants.
But just 1 percent to 2 percent of patients who die in hospitals are declared brain dead. And because continuous circulation is needed to keep organs healthy, deaths that occur outside a hospital are almost never a source of usable organs. Thus, donation after an unexpected fatal cardiac arrest is rare.
There are several ways to increase the supply of organs. They include persuading more people to agree to be donors when they die, putting hospital policies and procedures in place to foster organ donation, obtaining more organs donated from the victims of brain death and cardiac death and increasing the number of live donors, especially people unrelated to the recipients.
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