Monday, February 15, 2010

We are the world - Musings on how we can lessen the global trade in body parts

As Valentine's Day approached, I got to thinking about what it means to give of ourself to family, friends, and total strangers.

A Canadian Blood Services press release about a new initiative, "Improving organ and tissue donation and transplantation (OTDT) in Canada," made me wonder what motivates some to give so generously, whether by donating blood or by donating tissues and organs.

The blog's title comes from the Lionel Ritchie - Michael Jackson song of the same name. It's hard to realize that it was 25 years ago that 'United Support of Artists for Africa' (aka 'USA for Africa') recorded what has become the biggest selling single of all time:

The song has been in the news again recently as it was re-recorded just this month to help the people of Haiti:
Organ & Tissue Donation
This blog concentrates on organ donation and tissue donation (rather than blood) and focuses on organ donation in Australia, Canada, UK, and USA. Some random statistics:

In 2008, 259 Australians donated organs benefiting 846 transplant recipients [NSW Factsheet]

Around 1700 people are on Australian organ transplant waiting lists at any one time. In 2009, 247 organ donors gave 799 Australians a new chance in life. [AODAW]


In 2008 CBS was given a government mandate to develop a recommendation for a new national OTDT system in consultation with stakeholders, the public, and the medical community.

"Canada is one of the only countries in the western world without a national, coordinated system for organ and tissue donation and transplantation. [OTDT, 2010]
Statistics from Organ Donation & Transplant Association of Canada
  • 4330 people were on the waiting list for an organ transplant.
  • 215 people died while waiting for an organ transplant.
  • 303 people withdrew from the waiting list. (People are withdrawn from the waiting list when they become too sick to receive a transplant, opt out of the surgery, or their health improves.)
  • 2083 transplants took place.
  • 1541 of those transplants were made possible because of deceased donors.
Also see Organ donation & transplantation in Canada (Govt. of Canada):The organ donor rate in Canada continues to be mediocre despite efforts in recent years to increase it....

  • Last year 3,237 organ transplants were carried out in the UK but the number needing a transplant is steadily increasing, with almost 8,000 people currently waiting for a transplant.
  • Around 1,000 die while waiting because of the shortage of donated organs. [NHSBT, 2008]
From OrganDonor.Gov:
  • ~77 people receive organ transplants daily
  • 19 people die daily waiting for transplants (~7000/yr)
International Donation Rates
In 2007, the USA ranked 4th in organ donation, Canada 12th, and Australia 17th. (International Registry of Organ Donation & Transplantation, according to Transplant Australia)

Transplant Australia also notes
  • Spain, Belgium, France, Norway, and Italy have “presumed consent” laws, where everyone is considered a donor unless they specify otherwise.
  • USA and Finland have an ‘opt in’ consent law where citizens provide express and informed agreement to donate organs in the event of their death.
  • Many factors beside legislation affect donor rates, including hospital processes, public awareness, religion and culture, road death toll rates and others.
  • Donation is still discussed with the family and the objections of next of kin are not overruled in Australia and all comparable countries, whether a presumed or informed consent model is in place.
Related news items - Spain leads the way in organ donation

There are many reasons why more of us do not donate our organs and tissues:
Although not this simple, in most economies a shortage of organs will operate like shortages of other commodities and obey the laws of supply and demand, i,e, if demand increases while availability decreases or remains low, prices will rise.

Invariably, shortages mean that the rich will be able to obtain expensive goods and services unavailable to the poor. Globally we see this with HIV/AIDS and hemophilia:
Comparisons from World Federation of Hemophilia 2008 Global Survey on the use of FVIII concentrates (see p.27) show a striking trend:
FVIII use per capita* (% recombinant) * total IUs used divided used by total population
  • Australia: 6.21 (87%)
  • Canada: 4.64 (100%)
  • USA: 5.21 (81%)
  • Georgia: 0.39 (0%)
  • India: 0.005 (0%)
  • Nigeria: 0.0003 (19%)
To get a sense of life in the developing world, see the typical patient profiles in this paper:
With body organs, we get the specter of the poor selling their body parts to rich 'medical tourists' of the industrialized West.
In effect, the low rate of organ donation by those of us in the privileged West has consequences.
  • Not only do our friends and loved ones die waiting for transplants.
  • We also unwittingly contribute to our fellow citizens prolonging their own lives by preying on the least fortunate on the planet, those so desperate that they will give up a kidney to feed their families.
Valentine's Day has just passed and many of us showed our love of others by giving a card, a gift, etc. Can we each do more? As the song goes.... (listen along by right clicking and opening in a new tab or window)
We are the world
We are the children
We are the ones who make a brighter day
So let's start giving...
How to Become an Organ Donor
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