Why More Than 120,000 Americans Can’t Get The Organ Transplant They Need

Elaine Moss, left, wife of lung donor Stuart Moss, hugs Brenda Shepherd, whose husband Mike was the recipient of the transplant, after they received word that the operation was successful on Wednesday, Jan. 8, 1997 CREDIT: AP PHOTO/CHRIS PIZZELLO
Elaine Moss, left, wife of lung donor Stuart Moss, hugs Brenda Shepherd, whose husband Mike was the recipient of the transplant, after they received word that the operation was successful on Wednesday, Jan. 8, 1997 CREDIT: AP PHOTO/CHRIS PIZZELLO

A single organ donation — including that of the heart, kidney, liver, and bone marrow — can save eight lives and potentially improve the health of 50 people.

High health care costs, however, often prevent many people from carrying out the altruistic act. That’s part of the reason why the number of patients in the United States in need of a healthy organ currently stands at more than 120,000, according to the National Kidney Foundation.

In the upcoming weeks, the American Society of Transplant Surgeons, in conjunction with the American Renal Society and the American Society for Transplantation, will release white papers calling for studies on compensation for organ donation, which the National Organ Transplant Act of 1984 outlaws.

Since the Department of Health and Human Services (HHS) carried out the law, the organ donation waitlist has increased by more than 1200 percent. Medical officials haven’t been able to meet the increasing need for organs. As a result, more Americans have died in the process of waiting for an organ than in World Wars I and II, Korea, Vietnam, Afghanistan, and Iraq combined.


“When it comes to transplant organs, the United States unfortunately is not as progressive, liberal or free-market as Iran or Riyadh,” Thomas A. Firey, senior fellow for the Maryland Public Policy Institutes, wrote in the Herald-Mail Media last month. “As a result, another 6,500 Americans will die this year because they didn’t receive a transplant, and the waiting list will top 125,000 suffering souls. It’s well past time to reform one of America’s deadliest laws.”

Lawmakers on both sides of the aisle worry that compensating organ donations would encourage poor people to sell their organs for a quick dollar. But Dr. Sigrid Fry-Revere, founder of Stop Organ Trafficking Now, told Medical Daily that failing to provide medical coverage for the practice has made it so that only a wealthy few can donate organs, which has exasperated the supply gap.

“If we just covered people’s funds to donate, it would increase the flow of donors significantly and this is not creating a market for organ donations,” said Fry-Revere. “A market is not the way to go…but we have created a model where only the rich can donate.”

Fry-Revere has some cause for concern. Donating organs can cost anywhere between $5,000 and $20,000 and six weeks out of work, which doesn’t bode well for 90 percent of American households that wouldn’t be able to shoulder those expenses without going into debt. Before the passage of the Affordable Care Act, volunteers often couldn’t afford follow-up care because their insurers designated organ donation as a preexisting condition, despite studies showing that people could lead healthy lives after the procedure. That’s part of the reason why only 30 percent of Americans sign up for organ donation.

Supporters of organ donor compensation cite Iran’s success in eliminating its kidney donation wait list with its legal organ market — funded by the government and local charities — that has been in existence since 1982. While different than what many Americans have expressed support for, Iran’s efforts have compelled officials in Australia and Singapore to at least consider following suit.


In the United States, however, efforts to increase the organ supply in the last 40 years — including the creation of computer registries — have focused on the deceased and the consent of their families. Facebook has also recently allowed users to disclose their organ donation status on the social network as a means of compelling others to join the registry. But even the use of cadavers — which account for more than two out of three organ transplants — can’t help close the increasing organ gap.

In recent years, a growing chorus of health care providers have argued that lawmakers should revisit the National Organ Transplant Act and create some kind of system that will protect organ donors from egregious medical costs. The American public seems to agree. According to a poll conducted by NPR and Thomson-Reuters Health in May, nearly 60 percent of respondents supported compensation in the form of credits for health care needs, while nearly half wanted tax credits. More than 80 percent also expressed support for the practice when it involved the transfer of kidneys, livers, and bone marrow.

“It’s clear they’re saying there is a difference,” Dr. Ray Fabius, chief medical officer for Thomson Reuters’ health unit, told NPR. “Any living donor should be recognized, and it should be handled by insurance companies.”

For a large portion of the American population, however, organ donation may not be a possibility, even if HHS puts methods of compensation in place. A recent study presented at the American Society of Nephrology found that preventable health conditions — including obesity, alcoholism, diabetes, skin cancer, high blood pressure, HIV, coronary artery disease — disqualifies a majority of Americans from donating.