Organ Donation Opportunities for Action (2006) / Chapter Skim
Currently Skimming:
2 Trends and Patterns
2 Trends and Patterns
Pages 45-76
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ORGAN DONATION STATISTICS AND TRENDS The number of organ donors has increased each year since 1988, from 5,902 total donors in 1988 to 14,489 donors in 2005 (OPTN, 20061)
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. Organ Donors In 2005, there were 7,593 deceased donors and 6,896 living donors (OPTN, 2006)
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has leveled off, and in 2004 and 2005 there were slightly fewer living donors than deceased donors. Since 1988, more than 390,000 organs have been transplanted, with approximately 80 percent of the transplanted organs coming from deceased donors (Table 2-3; OPTN, 2006)
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. 16,000 14,000 12,000 donors 10,000 of 8,000 6,000 4,000 Number 2,000 0 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 Year All Donors Deceased Donors Living Donors FIGURE 2-2 Organ donors by donor type, 19882005.
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bData are for number of organ transplantations.
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bIncludes deceased and living donors. c0.7 percent of transplant recipients are of unknown ethnicity.
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. Living Donors In 2005, there were 6,895 organ transplants from living donors: 6,562 kidney transplants, 323 liver transplants, 7 intestine transplants, 1 pancreas transplant, 1 kidney/pancreas transplant, and 1 lung transplant (OPTN, 2006)
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Totala 52.4 47.6 Sex Male 58.3 40.9 Female 41.7 59.1 Age (years) < 1 1.3 0 15 2.5 0 610 1.3 0 1117 6.7 0 1834 25.8 32.1 3549 26.0 47.0 5064 25.9 20.0 65+ 10.3 0.9 Unknown 0 0 aA total of 7,593 deceased donors and 6,896 living donors.
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. Potential kidney transplant candidates constitute approximately 70 percent of the individuals on the entire Organ Procurement and Transplantation Network (OPTN)
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Longer waiting times are particularly a problem for minority patients awaiting kidney transplantation (Table 2-7)
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A close match by HLA typing and time spent on the transplantation waiting list are the primary criteria used to allocate kidneys from deceased donors, with transplant candidates with no HLA mismatches given top priority (Roberts et al., 2004)
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. The initial impetus for many living donors between 1998 and 2003 may have been the desire to donate to patients with hepatocellular carcinoma with preserved hepatic function; these patients did not receive additional priority on the waiting list for deceased-liver transplantation and would have been excluded from receiving a transplant if they developed advanced or metastatic hepatocellular carcinoma (Hanto et al., 2005)
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found adjusted patient survival rates of 93 percent at 3 months, 88 percent at 1 year, 80 percent at 3 years, and 74 percent at 5 years. Similar survival rates were seen for recipients of livers from living donors.
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. Because heart transplants -- unlike several other organ transplants -- cannot benefit from living donation or split-organ donation, the supply of hearts for donation is more restricted.
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. Lung Approximately 1,000 lung transplants are performed each year, with only a few lung transplants being partial lobe transplants from living donors (Table 2-11)
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Lung Transplantation, July 1, 2004, to June 30, 2005 Donors Number of deceased-donor transplants 1,272 Number of living-donor transplants 7 Posttransplanta Adult/teen graft survival (%) at 1 year posttransplantation 82.18 Waiting List Number of individuals on the waiting list at start 3,864 Number of individuals on the waiting list at end 3,538 Number of new patient registrations 1,811 Mortality rate while on the waiting list 0.13 aJanuary 1, 2002June 30, 2004.
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. In 2005, there were 540 pancreas transplants and 903 joint pancreas and kidney transplants, the majority from deceased donors; only one pancreas transplant and one kidney-pancreas transplant from living donors were performed (OPTN, 2006)
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Demographics In 2005, approximately 60 percent of deceased organ donors were men and 40 percent were women; the reverse is true for living donors (OPTN, 2006)
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conducted telephone interviews about attitudes regarding organ donation and transplantation in 6,820 U.S. households and found that men were 50 percent more likely than women to be in a more committed stage to discuss organ donation with family members.
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Individual Decision Making Past studies have found that minority populations signed donor cards at lower rates, expressed less willingness to donate, and had lower consent rates overall; but recent statistics indicate a trend toward increased rates of consent to deceased organ donation. A random-digit-dialing telephone survey of 453 individuals in three cities in the early 1990s found that African Americans were more likely than white Americans to believe that healthcare professionals will not do as much to save their lives if they are designated organ donors and to characterize the organ distribution system as unfair (Siminoff and Saunders Sturm, 2000)
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examined the cultural attitudes of Asian Americans regarding organ donation in a mail survey with 421 responses and compared them with those of their Caucasian counterparts. The Asian Americans in that study emphasized the importance of maintaining body integrity after death and displayed a lower level of trust of doctors in matters concerning organ donation.
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Under these principles both the Shia and Sunni branches of Islam view organ donation as permissible provided the gift is freely given. Organ donation is generally supported in Arab countries; however, some Muslim schol ars, particularly on the Indian subcontinent, have not been supportive of deceased organ donation.
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Confucianism and Taoism Official declarations regarding organ donation have not been made in Confucian ism and Taoism. Traditional Confucian views accept the inevitability of death, while Taoism supports more aggressive measures to prolong life.
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As the different results of these various studies suggest, much remains to be learned about the role that religion and spirituality, in official and folk manifestations, play in organ donation decision making. Family Discussions Regarding Organ Donation Studies indicate that individuals who are willing to discuss donation with family members are more likely to have signed organ donor cards (Morgan and Miller, 2002; Morgan, 2004)
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trusted the healthcare system regarding organ donation, 32 percent of African Americans, 15 percent of Hispanics, and 7 percent of whites agreed with the statement "Doctors would not try as hard to save me if they knew I was an organ donor." Other surveys have also found that potential donors are concerned about not receiving the necessary medical attention if they have agreed to be an organ donor (Nolan and Spanos, 1989; Minniefield et al., 2001; Minniefield and Muti, 2002)
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Altruism is the unselfish concern for the welfare of others, and in deceased organ donation this particularly applies to the goal of improving the life of (usually unknown) patients who are the potential recipients of the donated organs.
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1998. The stability of family decisions to consent or refuse organ donation: Would you do it again?
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1999a. The public's willingness to discuss their preference for organ donation with family members.
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2002. Beyond the organ donor card: The effect of knowledge, atti tudes, and values on willingness to communicate about organ donation to family mem bers.
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2003. Comparison of black and white families' experiences and perceptions regarding organ donation requests.
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Institute of Medicine Committee on Increasing Rates of Organ Donation. Wolfe R
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