Millions of Californians are willing to donate organs, but relatively few do. Here’s why BY JON HEALEY
"You don’t have to die to be an organ donor — you can donate one of your two healthy kidneys and a big chunk of your liver, among other body parts. But even though the total number of living and deceased donors is about 50% higher now than in 2016, a wide gap still remains between the demand for organs and the supply.
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"The first successful organ transplant on record took place more than 150 years ago, when a Swiss-born physician grafted small pieces of a patient’s skin into a wound in the patient’s arm to speed healing. (Yes, your skin is an organ. In fact, it’s the body’s largest organ.) But transplanting an organ from one person to another is significantly harder because the recipient’s immune system tries to reject the foreign tissue as if it were an invader, not a potential savior.
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"In 1984, the National Organ Transplant Act brought the regional efforts together into a national Organ Procurement and Transplantation Network. Among other duties, the network was tasked with creating a list of individuals who need organs, developing a computerized system for matching them with donors, and helping organ procurement organizations distribute organs “equitably among transplant patients” nationwide.
"The network is currently operated by a single contractor: the United Network for Organ Sharing, usually referred to by its initials, UNOS.
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"Perhaps the biggest limit on organ donation is how quickly organs deteriorate in the body after the heart stops beating. When organs are deprived of oxygenated blood for more than 20 to 30 minutes, they become too damaged to be transplanted, Mone said, adding, “Nobody’s solved that medical riddle yet.” (The clock ticks more slowly for bone and tissue, which can be recovered up to 24 hours after the donor’s time of death, Mone said.)
"As a consequence, kidneys, livers and other vital organs are taken only from patients who die in a hospital while on a ventilator. Only 1% of the roughly 2.8 million people who die in the U.S. each year fit into that category, Mone said, and of that group, less than half of the organs available are fit to transplant.
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"According to Mone and Sellers, properly packaged kidneys ordinarily last for 24 to 36 hours outside the body, while a healthy liver can typically last six to eight hours, and a heart or lungs only three to four hours. Given the short shelf life, Mone said, OPOs typically won’t remove organs other than kidneys if no recipients have been lined up.
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"White and Latino patients and their survivors authorize donations at a significantly higher rate than Black or Asian patients and survivors, a situation that Mone said reflects distrust of the system and cultural opposition to organ donation. Although the organ donation authorization rate in OneLegacy’s region was 87% for white and 73% for Latino patients from 2017 to 2020, it was only 58% for potential Black and Asian donors, the organization says. The rates for the U.S. as a whole follow a similar pattern.
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"According to OneLegacy’s statistics for 2021, nonwhite people in its region receive a share of the transplants that’s proportionate to their numbers, but not to their need. Making matters worse, Mone said, Black Americans suffer from kidney failure at three times the rate of white Americans, yet they aren’t getting on the waiting list for transplants at that rate."
HT: Frank McCormick
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