A report by the American Heart Association reveals that the rich are more likely to get a transplant than those with less money. Researcher Raymond Givens looked at data on all transplants from 2000 to 2013 and found that people who registered themselves on more than one donor list were less likely to die whilst waiting on the list, more likely to receive a transplant and were more likely to be wealthy.
At time of writing there are 122,594 people on waiting lists in the US, and over the last ten years for which data is available that number has increased by 50% whilst donations have remained flat. Less than 40,000 transplant operations will take place this year. The system, then, is under more strain than ever and your chances of being given a donor organ are getting longer all the time.
In the US the organ donation system is managed by the non-profit United Network for Organ Sharing (UNOS). Whilst UNOS coordinates the program nationally there are many regional registration centres where people are added to the waiting lists. To be eligible for addition to one of the lists it is necessary for the candidate to have accommodation in the area for recuperation after surgery and, of course, money to travel across country as required. Most centres also require their own set of tests to check for clinical suitability; these can cost between $20,000-$50,000 depending on the organ. It is a system ripe for gaming, if you have the money for a seat at the table.
Givens showed that 2% of people waiting for a heart are multiply listed, 6% waiting for a liver and 12% of those needing a kidney. Death rates were found to be higher for those that were only present on one list. For heart transplants the death rate was 12% versus 8%; for liver it was 17% versus 12%; and for kidney it was 19% versus 11%.
Givens himself thinks the system is unfair and should be redesigned so as not to allow multiple listings. Ultimately, though, what we really need is more people to step up and allow their organs to be reused once they’re finished with them.
I’m very pleased to say that there is no [legal] way in the UK to throw money at the system to bump yourself up the list which, personally speaking, is as it should be. Organs are allocated based on clinical need, distance between donor and recipient and length of time on the list. Plus, from next month in Wales the system will be changing from an opt in one to an opt out one. Currently, if you want to donate your organs you have to do what I have done and contact NHS Blood and Transplant to tell them you want to help out. In Wales, the new system assumes that if you have not specifically contacted them to say so then you do not have a problem with organ donation and they will do with them as they see fit upon your death.
I’m genuinely excited to see how this will affect those on the waiting lists over the coming years, it will surely be a force for good. Other countries that have opt out systems already in place, like Spain and Austria, have transplant rates nearly double that of comparable countries with opt in systems. I hope the rest of the UK and, indeed, the world will not be long in following suit.