Reciprocity Can Reduce the Organ Shortage

(Note: April is National Organ and Tissue Donor Awareness Month.)

The institutional ethics of our current system of obtaining and using transplantable organs are in dire need of improvement.

When a transplantable organ becomes available, someone has to decide who gets it. In making these life-and-death decisions, the government-recognized monopolist in this field, the United Network for Organ Sharing, doesn’t give a potential recipient any credit for registering as an organ donor. UNOS is totally unconcerned that it gives about 50 percent of all organs to people who haven’t themselves agreed to donate their organs.

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If there were enough organs to go around, this wouldn’t matter. But because about half of all transplantable organs are completely wasted due to the failure of half of our population to sign up as organ donors, the transplant waiting list is long and getting longer. About 95,000 Americans are now waiting for transplants, and more than half of them will die before they get one.

In our view, this is a compound tragedy. Not only are people suffering and dying needlessly as potentially life-saving organs are taken to the grave, unutilized, but the government-run monopoly has failed to bolster donation rates by implementing a system of reciprocity that links one’s ability to receive with one’s willingness to give.

As a result, people can refuse to donate organs when they die but still get an organ transplant if they need one, even ahead of someone who had agreed years earlier to be an organ donor. A person can even circumvent a loved one’s wish to donate their organs, resulting in the deaths of several potential recipients, and still get a transplant ahead of a person who has agreed to donate. This is clearly unfair, but UNOS has shown no interest in fixing its organ allocation rules.

Fortunately, a private, nonprofit organization has been created that allows individual donors to impose the needed reciprocal linkage on our petrified government monopoly. What a rare treat it is to be able to force one’s views onto government, rather than the other way around! Since your organs belong to you, you can exercise your legal right to decide who gets them when you die, and join a growing group of donors who have decided they want their organs to be offered first to fellow organ donors.

The group is called LifeSharers. Membership is free and open to all at or by calling 1-888-ORGAN88. Nobody is excluded because of any pre-existing medical condition, and parents can enroll their minor children. A six-month waiting period is required before getting preferred access to the organs of other members, to encourage people to sign up before they know they need transplants.

Giving organs first to organ donors makes the organ allocation system fairer. But more importantly, reciprocity in organ allocation gives non-donors a powerful incentive to become donors — by agreeing to donate your organs you could literally save your own life. And as the number of reciprocating donors increases, the ability of "free riders" to get an organ goes down, thus magnifying the incentive to donate.

Imagine what would happen if reciprocity were the law of the land. If UNOS said they would no longer make organs available to non-donors, and moreover that there would be a three-year incubation period for one’s eligibility to kick in (rather than LifeSharers’ much more modest six months); just about everybody would immediately register to donate and thousands of lives could be saved every year.

If the consent rate from suitable post-mortem donors was raised to 85 percent, just about everyone currently on the waiting list could get a transplant within three years and newly listed patients would get transplants much faster.

UNOS seems more interested in political correctness than in saving lives, so reciprocity is unlikely to become the law of the land anytime soon. But nothing is stopping you from taking one small — but concrete — step toward improving the organ allocation system.

Nothing could be fairer, and nothing will reduce the organ shortage faster.


Harold Kyriazi is a research associate in the department of neurobiology at the University of Pittsburgh School of Medicine. He is also chairman of the Ad Hoc Committee for Solving the Intractable Organ Shortage. David J. Undis is executive director of LifeSharers.