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opt in or opt out?
a question of survival
by lucy lediaev

I work for a company that makes tissue typing and antibody detection tests used in organ transplantation. Donors and recipients must be tissue typed to assure the best possible match and to reduce the odds of rejection. Antibody detection tests are used to assure that the patient has not formed antibodies against the donor, both before and after the organ transplant. Because of my job and friends who have received organ transplants, I closely follow news about organ transplants.

One of the most pervasive problems for patients who require a transplant is the shortage of suitable organs and, more importantly, donated organs that match the recipient’s tissue type. For certain ethnic minorities, the search for a match is even more daunting when their ethnic group is under represented in the general population.

Because of the shortage of organs worldwide, many patients die before a suitable organ is found. Or, they are so sick by the time an organ is found that chances of survival are greatly reduced. My late friend Peter received a donor liver about twelve years ago. He led a reasonably normal life for about seven years until his liver began to fail. He had hepatitis C, probably the result of a blood transfusion many years before. The virus had taken its toll on his transplanted liver. He was again put on the transplant list, but because of liver failure, his kidney was also damaged and needed to be replaced.

For a number of medical reasons, it’s important for the donor organs to come from a single donor if at possible. So, now added to the wait for a matching donor was the need to find a donor whose liver and kidneys were in reasonable shape. In addition, a closer match is required for a successful kidney transplant than for a liver transplant. The liver acts as a filter and is more forgiving of a mismatch.

After just over a year on the waiting list, Peter received both a liver and a kidney. I wish I could tell you that this story had a good outcome, but his already failing health and advanced age led to failure of both the liver and the kidney. Peter never left the hospital and spent most of his remaining time on earth in the ICU at UCLA Medical Center.

Just this morning, I read a story about British Prime Minister Gordon Brown’s support of a plan to let citizens of Britain opt out of being organ donors. Basically, any deceased person would be considered a donor unless he or she had opted out of becoming a donor, or if the family objected to donation. Right now, Britain has a donor rate of only 13 donors per million of the population using an opt-in model, similar to the program in the United States. This is despite the fact that in a recent survey 90% of Brits say they are in favor of organ donation. By contrast, Spain which has an opt-out model, has the highest donor rate in the world at 34 donors per million. France has a similar opt-out program, but has only 22 donors per million. Interestingly, the USA, with its opt-in model, is somewhere in the middle with 25 donors per million.

The debate is just beginning in the UK. British patient organizations appear to be in favor of improving the opt-in program to make it more effective. Government representatives see the opt-out program as a quick fix to saving lives. Each year there are approximately 8000 on the waiting lists; 3000 receive organs and 1000 die. Clearly, there are arguments on both sides. The task force looking at this issue will hold a public consultation to gather more information before it makes a recommendation. I imagine the debate will continue for some time, because there is no simple answer to the question of opting in or opting out.


A freelance writer and full-time grandma, Lucy Lediaev retired recently from a position as web master, tech writer, and copy writer in a biotech firm. She is enjoying retirment more than she ever dreamed and is now writing about topics that are, for the most part, interesting and fun. She also has time to pursue some of her long-time interests, such as crafts, reading, sewing, baking, cooking, and the like.

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robert melos
1.24.08 @ 3:33a

Is there any data on people barred from opting in? I'm curious because even though I lead a safe lifestyle I can't donate blood because I fall in what is considered a high risk group.

lucy lediaev
1.24.08 @ 1:21p

In California, anyone can opt in as a donor. However, at the time of the potential donor's demise, complete testing would be done to assure that the person is free of HIV, hepatitis A, B, and C. In addition, the person's blood or tissue would be screened for other persistent viruses, which might or might not screen them out as donors. In addition, a patient with Hep C might be given a liver from someone who tests positive for Hep C if the donor organ is still in good shape. In addition, the general condition of the donor and the donor's organs would be taken into account. The screening process is surprisingly thorough considering the speed with which the organ needs to be harvested and then grafted.

I believe other states with opt in programs are very similar. Certainly, the screening process is pretty uniform across the United States, because there are national organizations involved in setting standards for organ transplantation.


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