Organ Donation

Organ donation is a medical process in which tissue or an organ from a living or dead individual is transplanted to another individual. Advancements in modern medicine have made it possible to transplant a variety of organs and tissues, including the heart, lungs, liver, kidneys, intestines, pancreas, eyes, skin, bone, and tendons. Some organs, or parts of organs, can be transplanted from living hosts, while many other transplanted organs are obtained from recently deceased bodies.

The United States uses an "opt-in" system for organ donation in which individuals must explicitly volunteer to allow their organs to be donated after death, while other nations use an "opt-out" system in which all individuals are considered organ donors unless they explicitly state that they do not wish their organs to be donated. Individuals who wish to become living donors or to donate organs and/or tissues after death can register this preference with state agencies and with a variety of private medical organizations that link donors with medical institutions and potential recipients.

Unlike the United States, Spain has an "opt-out" policy, in which every individual is considered an organ donor unless they specifically choose to opt out of the system. Creating an opt-out system thus creates a larger pool of potential donors and eliminates situations where an individual might have chosen to donate an organ or tissue but died before having the chance to opt in to the system. However, opt-out systems are controversial, because some feel that organ donation is a personal decision and that individuals should not need to decline in order to control the use of their body tissues.

Brief History

Organ and tissue transplantation is the process of harvesting organs or tissues from the body of one individual and medically transplanting the tissues into the body of another individual. Transplanted organs can be used to help patients whose organs have been damaged due to injury or disease. American plastic surgeon Dr. Joseph Murray conducted the first organ transplantation in 1954—a kidney transplanted between identical twins—and later won the Nobel Prize in medicine for his discovery. Since the 1960s, advances in surgical techniques and technology have made it possible to transplant a variety of different types of tissue, including the heart, lungs, liver, kidneys, bones, veins and arteries, skin, and eyes.

The human body has a tendency to reject tissue transplanted from another body, owing to the immune system, which identifies the foreign tissue as a potentially harmful agent. To combat this, scientists have developed what are called "anti-rejection" medicines that lower the immune system response and allow the patient’s body to more readily adjust to the presence of foreign tissue. To reduce the risk of rejection, physicians use factors such as blood type and the presence or absence of certain types of immune system proteins to match organs and tissues with potential hosts.

Organs can be taken from living bodies or from the bodies of the recently deceased. Living donors can donate parts of organs like the liver, pancreas, skin, intestines, or a lobe of a healthy lung. The most common living donation is the kidney, because a healthy individual with two functional kidneys can donate one kidney without serious risk to their health. Living donation is often more successful than donations from deceased individuals, because the tissue is active and healthy at the time of transplantation.

Organs and tissues can also be taken from dead bodies, though this process is time-sensitive, because organs will begin to decay and lose viability for transplantation as soon as death occurs. As the time between death and transplantation is sensitive, transplantation science depends on the ability to quickly harvest and transport organs from deceased individuals.

Organ Donation in the United States

The United States utilizes an "opt-in" system in which individuals must consent to allow their organs to be donated after death. In some cases, an individual’s immediate family can consent to donate the deceased individual’s organs.

The laws involving organ donation and the procedure for registering as a potential organ donor differ between states. The US Department of Health and Human Services provides links through their website to help individuals determine the relevant authorities in each state to help them register as an organ donor. A number of states have integrated organ donation with driver’s and nondriver’s licensing procedures. For instance, in the state of Pennsylvania, individuals obtaining official state identification can give consent to donate organs or tissues and the label "organ donor" will be printed on the front of the state-issued identification card.

The US Health Resources and Services Administration estimated in 2024 that more than 103,200 patients were waiting for an organ transplant. Of that number, most were awaiting a kidney transplant. In 2024, approximately seventeen people died waiting for an organ transplant in the US each day, while a new person was added to the waiting list every eight minutes. The previous year, more than 46,000 transplants were performed in the US.

Need for Donation

In most countries, the number of patients waiting for organ donation far exceeds the number of potential and available donors. As such, the potential for using social media and social capital to find organ donors has complicated the traditional organ donation process. For instance, in 2015, thirty-nine-year-old Belgian car salesman Roel Marien posted a message on Facebook asking for a living kidney donor. Marien found eight willing donors, but Belgian physicians refused to perform the operation on the basis that it was unfair to award organs to individuals who were more "attractive" or skilled with social media, especially given that over one thousand individuals were already waiting on the Belgian transplant lists. In 2015, thirty-nine-year-old Belgian car salesman Roel Marien posted a message on Facebook asking for a living kidney donor. Marien found eight willing donors, but Belgian physicians refused to perform the operation on the basis that it was unfair to award organs to individuals who were more "attractive" or skilled with social media, especially given that over one thousand individuals were already waiting on the Belgian transplant lists.

In the United States, there are no restrictions prohibiting individuals from using social media or other alternative methods to search for potential living donors. In 2012, Facebook adopted a feature that allowed users to add their organ donor status to their public profile and provided a link to donor registry sites. The introduction of the feature resulted in a significant increase in the number of people registered as organ donors, inspiring organ donor organizations to begin using social media to attract potential donors and to match donors and recipients. Critics of using this method argue that allowing public petitions for donors could lead to a situation in which individuals are tempted or engage in "organ trading" or "purchasing organs" from potential donors.

During the coronavirus pandemic, questions arose about the safety of donating organs from deceased people who had suffered from COVID-19. Some experts worried the organs would not be healthy enough to be transplanted or that COVID-19 could be transferred with the transplanted organs. New protocols were put in place to test potential donors for coronavirus infections before removing organs, but rules were unclear regarding the handling of organs from bodies that tested positive for the disease. Furthermore, those suffering from long-term effects of COVID-19 (often called "long Covid") usually do not test positive for the virus, but some medical experts feared their organs may still carry the infection.

In 2024, surgeons at Massachusetts General Hospital successfully transplanted a genetically modified pig kidney into a human recipient. While the long-term prognosis remained unclear immediately after the procedure, the fact that the surgery was initially successful led many observers to hail the achievement as a milestone in the field of organ transplantation.

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