Organ Donation Rates: How the US Stacks Up
(NEW YORK) -- Facebook may have provided a boost to organ donation in the United States since its donor registration button launched last year, but organs are still scarce, and about 18 people die every day as they wait on a transplant list, according to the U.S. Department of Health and Human Services.
But not all countries require that people who choose to donate organs register as organ donors at the Department of Motor Vehicles or online, as we do here.
Some countries have opt-out systems in which citizens are presumed organ donors unless they formally opt not to donate their organs when they die. Other countries even offer incentives such as payment for living kidney donations or preferred treatment for donors if they ever need to become a transplant recipient.
Read on to learn how organ donation practices differ around the world.
Although there are more than 118,000 people on the organ transplant waiting list in the United States, only 8,143 underwent transplants from deceased donors in 2012, according to the Organ Procurement and Transplantation Network, which allocates organs as a result of the National Organ Transplant Act of 1984.
With its opt-in program, the United States has the fourth-highest organ donor rate, with 26 donors per million people in the population, according to data from the National Transplant Organization in Spain, which compiles organ donation rates annually.
The United States, however, leads the world in actual transplant rates, which Dr. Tom Mone, a past president of the Association of Organ Procurement Organizations, says means doctors can use more of the organs they harvest.
"It's fair to say we're doing as well or better than anyone else," said Mone, who is now the CEO of One Legacy, a nonprofit organization focused on organ donation. "But we have such a large number of people and a very good chronic care system, so they can wait longer as the waiting list grows."
Registration is different in each state, and a few have proposed opt-out systems in which people are automatically assumed to be consenting donors unless they opt-out. However, this has never gotten far in state legislatures, said OPTN spokesman Joel Newman.
"Once these bills are introduced, concerns arise about individual rights, rights to make an individual decision," Newman said.
Colorado tried to get an opt-in law passed a few years ago, but the lawmaker who introduced the bill pulled it in 2011 because the reaction was so negative, according to the Denver Post.
Mone said about 75 percent of the people who are brain dead and could donate organs actually wind up donating them. That's not bad, considering that of all people who are eligible to donate blood, only 7 percent do so, he said.
"The bad news is even if they donated 100 percent of the time, we would not wipe out our list," he said.
Spain is widely considered the gold standard in organ donation because it has had the highest organ donation rate of any other country in the world, with 35.3 organ donors per million people.
Unlike the United States, which has an opt-in policy, Spain has an opt-out policy. But Mone said Spain still asks families whether they want to donate their loved ones' organs before they're harvested. As such, there's no true presumed consent program.
"While there are a number of European countries that have a law [for presumed consent], none of them have actually relied upon them," he said.
This week, top doctors and health officials reportedly visited Spain to learn more about how to improve their organ donation and transplant systems, according to the Spanish news site Local.
But not all opt-out programs are created equal, said Dr. James Lim, chief of transplant surgery at Hackensack University Medical Center.
"Look at places like Greece," he said, adding that Greece has an opt-out system but poorer organ donation rates. (It has 6.9 donors per million people in the population, according to the National Transplant Organization in Spain.)
He said a lot has to do with educating the public on how organ donation works, especially if it's new to the culture. Even in New Jersey, he said he's heard urban legends about organ transplants in which patients believe doctors want organ donors to die so they can harvest their organs. Those rumors simply aren't true, he said.
In Israel, there's a special incentive to donate organs: If you ever need an organ transplant, you'll be given priority as a recipient over someone who isn't a donor.
Mone said Israel has seen an uptick of organ donor registrants since the program was introduced a year ago, but it's too soon to tell whether the uptick resulted from the incentive.
"The results are preliminary but very promising," Mone said. "In the U.S., it's spurring good conversation."
Although the National Organ Transplant Act of 1984 made it illegal to buy or sell organs in the United States, selling a kidney is legal in Iran and has been for more than a decade, said Mone.
The program has helped Iran keep up with its demand for kidneys, but the vast majority of people selling them are among the nation's poor. As a result, some of them have faced health problems from selling their kidneys, Mone said, citing a recent study.
"It's not as benign as one would hope it would be," said Mone.
Here are a few other countries' donation rates, in donors per million in the population, according to the National Transplant Organization, from Spain's report:
United States: 26
United Kingdom: 17
This list doesn't include rates for all countries.
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