Organ Donation

Organ donation has become the treatment of choice for end-stage renal disease (ESRD) in addition to other types of organ failure, notably heart, liver, and lung. By all accounts, the shortage of transplantable organs is a public health crisis with one person on the United Network of Organ sharing (UNOS) transplant waiting list dying approximately every 17 min. In 2005, there were more than 90,000 individuals awaiting transplantation.

There are two possible sources of organs for transplant: deceased organ donation that has provided the major source of transplantable organs and living donation usually, but not always, from the families of waiting recipients. Deceased donors are the only feasible source of heart donation and are by far the single most important source of livers, lungs, intestinal organs, and pancreata. Most living donation involves kidneys (92%) or liver segments (8%).

The number of deceased and living donors for all organs was 14,491 in 2004, with 7,593 deceased and 6,898 living donors. The number of all organ donors has increased at an average rate of 7% per year. Although the increase in living donors has been a major contributor in helping ameliorate the organ donor shortage in the United States, the numbers of persons on the waiting list is growing faster, with a net increase in the waiting list of 11% per year.

The other major change in the donor pool has been an inclusion of older donors and a change in the cause of death of donors. The average age of deceased donors rose by 2.1 years between 1996 and 2001 and is now in the mid-30s. Living donors are, on average, a year older than deceased donors. Living donors are more likely to be female (approximately 58%), while deceased donors are more frequently male (60%). A total of 79% to 82% of living donors are white, and deceased donors are also predominantly white (85%). Total minority donations increased by 56% from 1992 to 2001, while the number of white organ donors increased by 32% overthesameperiod.

These trends in the organ donor profile reflect the continued shift away from the young adult who dies from a traumatic head injury to the older adult who dies from a cerebrovascular event. The progressive increase in the median age of deceased donors over the past 10 years has exceeded that of the general population since 1996.

In 2001, there were 695 donations resulting from anoxic brain deaths, up 12% from 2000 and up by 32% since 1995—the fastest rise among the causes of death for deceased donors. The rise in anoxic deaths resulted primarily from the increased frequency of drowning, drug intoxication, and cardiovascular events. Cerebrovascular deaths continue to lead as the primary cause for deceased donations (43% of all deceased donors in 2001).

Consent to organ donation by families of braindead patients has been a major barrier to maximizing the numbers of solid organs available for transplant in the United States. Despite public opinion polls reporting that more than 85% of the American public is willing to donate, fewer than half choose to donate a family member's organs when asked.

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