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Organ donors still scarce

6 July 2010 -- Demand for organs outstrips supply in almost every country of the world. In many places the wait for an organ can be measured in years. One way to improve the situation is by donors making sure their families understand their wishes, which allows doctors to proceed with the donation process.

Transcript of the podcast

Veronica Riemer: You're listening to the WHO podcast and my name is Veronica Riemer. In this episode we look at organ transplantation and worldwide efforts to increase organ donations.

Organ transplantation is the only treatment for terminal organ disease - whether due to illness or injury. Kidney transplants are the most frequent form of transplantation globally. But other organs can also be transplanted, like: the cornea, heart, liver, lung, pancreas, and small intestine.

Organs can be obtained from people who have died or from those who are clinically brain dead but whose body functions are maintained artificially.

Living organ donation is becoming more frequent. While this has been discouraged both for safety reasons, and to protect live donors from exploitation; kidney donation by well-selected living donors can carry negligible risks, so long as rigorous selection procedures, careful surgery and follow up of the donor and recipient are assured. In all cases, doctors match donors to recipients to reduce the risk of transplant rejection.

Demand for organs outstrips supply in almost every country of the world. This can result in offers of incentives for donation, profit on donated human organs or exploitation of the disadvantaged. Dr Günter Kirste, the Medical Director of the German Government agency for the procurement of organs told us about the challenges this brings.

Dr Günter Kirste: Speaking about my country, we are far away from the demands, so waiting time for example for a kidney in Germany is about 6 years. So that says how far we are away from the demand. Other countries have a waiting time of 2-3 months only, and there are other countries where there even is no supply of deceased organs for people needing a transplant. They only have living donations.

Veronica Riemer: Dr Francis Delmonico is a Professor of Surgery at Havard Medical School, Massachusetts General Hospital. He explains how national health services can facilitate organ donations.

Dr Francis Delmonico: The essential is to have in every country a competent authority that oversees the practise of donation and transplantation, that monitors that activity, that then mandates to the hospitals that every imminent death should be referred to the organ donation agency for the consideration and opportunity of deceased donation.

Veronica Riemer: While most countries in the developed world have a legal system of oversight for organ transplantation, the fact remains that demand far outstrips supply. As a result, a black market has arisen in many poorer countries enabling those who can afford to buy organs to exploit those who are desperate enough to sell them. Sometimes, people travel to other countries specifically to buy organs they can't find at home.

Until recently Pakistan was in this situation. But now a new organ transplantation service is being introduced to set up an organ donor card programme, to prohibit commercial transplantation and outlaw organ trade. This month President Asif Ali Zardari of Pakistan signalled his personal support for the service by signing an organ donor card to bequeath his organs upon his death.

However, carrying a card does not mean that doctors will automatically harvest your organs. Hospital staff will first talk to the family and should they refuse to agree, there will be no organ donation. Dr Luc Noel, Coordinator for Clinical Procedures at the World Health Organization explains:

Dr Luc Noel: The idea is to think about it before being confronted with the difficulties of death in your environment among you loved ones. Donation of organs after death, when you don't need them any more, is a civic gesture. As a civic gesture it should be taught at school. It is all a matter of realizing the community needs to care for its citizens, its residents.

Veronica Riemer: Seventeen years ago Carol Miller received the kidney donation that saved her life. She told us about her long wait for a kidney.

Carol Miller: I had to wait a year and a half. I probably would have had to wait longer but the minute I found out I was eventually going to have a transplant I got my name on the list. I went through all the screening with all the different doctors that you have to go through, to make sure you are fit to receive an organ. So it to about a year and a half. I was actually very thankful that I got it as soon as I did because I had to start dialysis before the organ came. I was hoping get the organ before having to do dialysis but my doctor said my blood was getting to a point where I would have to do dialysis to stay healthy enough to get the transplant. So I did dialysis for about 2 months and that’s why I was surprised when the organ came at that point because mentally I was trying to prepare myself for even a longer period of time. Because so many people have to wait so many years.

Veronica Riemer: Carol also explained to us why it is important that organ donors talk to their families.

Carol Miller: It would be really important for donors, after they consider being a donor they must talk to their families and make sure their families understand their wishes. So that they can come to an agreement ahead of time so that the family is not struggling after the death when things are very confusing. That will up the number of organs for all the thousands of people waiting around the world for organs.

Veronica Riemer: Today, thanks to her donor, Carol travels extensively as an aid-worker and has assisted at the Oklahoma city bombing, the aftermath of 9/11, the Indian Ocean Tsunami, and has spent three years raising money for measles vaccination for children in Africa. She is committed to helping other people live longer in recognition of the gift she received.

That's all for this episode of the WHO podcast. Thanks for listening. If you would like more information on this issue look for links on the transcript page of this podcast. For the World Health Organization, this is Veronica Riemer in Geneva.

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