In 1954, Joseph Murray performed the first successful transplant of a kidney at the Peter Bent Brigham Hospital. This work by Murray and his colleagues created the field of solid organ transplantation and ushered in an era of breathtaking scientific innovation.
Today, patients whose organ failure previously might have conferred a death sentence have a sliver of hope. With the help of powerful immunosuppressants, donor organs help patients with otherwise terminal illnesses live better, longer lives.
Still, some five decades after Murray’s Nobel Prize–winning achievement, the potential of his work remains largely unfulfilled. On the top floors of the Brigham’s shimmering new Shapiro Cardiovascular Center, countless patients lie in bed for weeks at a time awaiting heart transplants. It’s no different anywhere else.
For the lucky few, the prolonged wait ends in a hurried commotion. A slow progression to the top of the transplant list is punctuated by the excited news that a heart is available—followed by an emergent operation that might happen at any hour of the day.
For the unfortunate others, the wait ends when a patient’s organs, one by one, begin to shut down, rendering any potential transplant futile.
Death while waiting for a solid organ transplant is not a failure of medicine, but instead a failure of culture and public policy. In 2007, 6,674 people passed away awaiting a lung, heart, kidney or liver transplant. In Massachusetts and the rest of the country, organ donation operates as an “opt-in” system. Individuals are not considered organ donors unless they explicitly declare their desire to be one. The individual’s autonomy to make decisions about if and how his body is used at death is paramount.
Though respecting individual autonomy is critical, an opt-in approach ignores special considerations specific to organ donation. Most of us choose to ignore our own mortality. We make little effort to declare our wishes regarding our organs upon death. Family members left puzzling about how best to respect a deceased loved one’s wishes do so at the peril of the organ’s viability. An organ is only good for transplant within a small window after death.
Other nations, recognizing the dearth of donor organs and the preventable nature of death while awaiting transplant, have undertaken an active reconsideration of their policies. Late last year, Prime Minister Gordon Brown announced the strong possibility of the United Kingdom shifting to an “opt-out” approach to organ donation, in which an individual is an organ donor unless otherwise specified.
Research by Alberto Abadie, a professor at the Kennedy School of Government, suggests that in countries such as Spain, where consent for organ donation is presumed, rates of organ donation are 20 to 25 percent higher.
Massachusetts—the birthplace of organ transplantation—could lead the nation by at least raising the question of presumed consent through a public referendum or bill of law.
If this change were made, I suspect that the era of death-by-waiting might mercifully come closer to an end.
Sachin Jain, HMS ’08, is an HMS clinical fellow in medicine, Brigham and Women’s Hospital, and a research fellow at the Institute for Strategy and Competitiveness, Harvard Business School
The opinions expressed in this column are not necessarily those of Harvard Medical School, its affiliated institutions or Harvard University.
