UNOS condemns deceased donor solicitation
Hospitals urged to avoid privately obtained organs
In a move the transplant medicine community anticipated for several months, the United Network for Organ Sharing (UNOS), the entity designated by the U.S. Department of Health and Human Services to coordinate organ transplants and donations in the United States, has adopted a position statement opposing private efforts to solicit deceased organ donors for transplant candidates when no personal bond exists between the patient and donor or donor family.
The position statement was drafted by UNOS and the Organ Procurement and Transplantation Network (OPTN), the entity operated by UNOS to bring together medical professionals, transplant recipients, and donor families to develop organ transplantation policy. The statement was announced at the UNOS/OPTN semiannual meeting in November, following several months of study.
The position statement addresses only donations solicited from dying donors or the families of deceased donors. The practice of soliciting living donors — those who are willing to donate a kidney, for example, to someone in need of a transplant — still is under study by UNOS, and a position statement is expected within a few months.
The controversial practice of soliciting deceased donors gained national attention in the summer of 2004, when Houston resident Todd Krampitz was diagnosed with a severe liver cancer that left him too sick to be considered a candidate for a donor liver through UNOS.
Krampitz’s family launched a billboard and online campaign to find a family who would direct their deceased loved one’s liver to Krampitz, in what is called a "directed donation," and within a month, a donor was found and the transplant took place.
He and his family have since become proponents of organ donation, but critics say the damage done by the publicized transplant, which they say leap-frogged Krampitz past better candidates for transplant, could have long-term effects on the system through which organs have always been allocated.
"Organ donation is a gift, not a transaction," according to OPTN/UNOS president Robert Metzger, MD, echoing earlier statements by UNOS and ethicists who have been dismayed at the surge in private networks through which patients in need of organs solicit them from living donors or the families of deceased donors, effectively side-stepping the sometimes years-long wait that transplant patients experience through the traditional UNOS route.
Critics of the private organ solicitations say obtaining organs outside the UNOS system can mean organs go to less-sick individuals and mean additional delays for patients whose needs may be more life-threatening.
"Most deceased organ donation takes place anonymously through the national organ distribution system," Metzger stated in a press release accompanying the announcement. "At times donors or donor families want to donate to a specific person they know, and we support that. But we strongly oppose public or private appeals that effectively put the needs of one candidate above all others and pose concerns of fairness."
UNOS is urging its 410 member organizations (every transplant hospital program, organ procurement organization, and histocompatibility laboratory in the United States) to help "ensure equity within the transplant system."
"If an OPTN member institution is involved in a situation concerning a public plea for donation of deceased donor organs to a specific individual, the Board recommends that the member reinforce to the candidate and/or donor family that the OPTN system is designed to allocate organs equitably according to the greatest need and/or benefit of all candidates," the position statement urges. "Should the candidate or donor family persist in their wishes, the member institution should act foremost to ensure equity within the transplant system, with additional consideration of relevant medical facts, ethical guidelines, and applicable laws and allocation policies."
Metzger says public appeals and private brokering of donor organs erodes the public’s trust in the fairness of the established allocation system. The majority of deceased donor transplants occur anonymously and without specifying an intended recipient of the donated organ, with rare cases of families of deceased patients specifying to whom they wish organs to go. The UNOS statement does not condemn directed donations among family members or other patients and donors who have an established relationship.
"The existence of a personal bond that would cause a donor or donor family to favor a named transplant candidate is rare," according to the UNOS statement. "Attempts to develop such a personal bond through unsolicited contact with or public appeals to families of deceased donors are problematic."
UNOS/OPTN maintain that the national transplant allocation system maintains fairness for all candidates. Organizations and individuals who support the private solicitation of donor organs, however, say the long waits on UNOS recipient lists justify family members doing all they can to obtain lifesaving transplants for their sick relatives.
"Recognizing that organ donation and transplantation are founded on altruism and equity, the OPTN/UNOS Board of Directors opposes any attempt by an individual transplant candidate (or his/her representatives) to solicit organ donation from a deceased donor ahead of other waiting candidates in a manner that subverts the established principles and objectives of equitable organ allocation," the UNOS statement continues. "This is a particular concern when commercial space is utilized to solicit directed donation from a member of the public for a specific candidate. Such efforts may divert organs from patients with critical need to those who are less ill. In addition, such appeals, although well-intentioned, compromise the principle of fairness."
The UNOS position statement left no doubt that the organization officially condemns soliciting organ donations through advertising. The position statement is not an official policy, meaning transplant centers and surgeons can choose to ignore it.
Sherril Lanthier, director of Houston’s Multiorgan Transplant Center at The Methodist Hospital, where Krampitz’s transplant took place, said in a press statement following the announcement of UNOS’ position statement that the hospital will review the new recommendation.
"We look at everything that comes from UNOS and we follow their guidelines," Lanthier said. "We will look at it ourselves and make a policy within the hospital."
More than 87,000 people in the United States are awaiting organ transplants, and more than 6,000 people on the list die each year while waiting, UNOS data reflect. An estimated 17,000 patients are waiting for liver transplants.
Directed donations of organs, from living or deceased donors, is legal in many states; however, it is illegal in all states for any party involved in an organ donation to profit from the gift.
- United Network for Organ Sharing, 700 N. Fourth St., Richmond, VA 23219. Phone: (804) 782-4800. Fax: (804) 782-4817. Position statement on solicitation of deceased donor organs is available on-line at: www.unos.org.