Enter as "Subject": New organ donor policies needed to reverse America's crisis

Then copy and paste from below:

Although each organ donor can save eight lives with organs (two kidneys, two lungs, the liver can be split into two, heart and pancreas or intestine) and over 2 million people die every year in the USA, there were only 8,024 donors last year who donated after passing away. In addition, one patient dies every 82 minutes while waiting for an organ. 8,024 is a tragically low number, especially when over 98,200+ Americans are on organ waiting lists, including more than 74,000 with diabetes and other renal diseases. Clearly, the present organ-recovery effort that is entirely based on the policy of "altruism" is failing to reverse or end this organ-donor crisis because the waiting list keeps rising and the length of time in which someone dies while waiting (82 minutes) keeps decreasing.

To address America's organ-donor crisis, many transplant surgeons, medical directors, medical ethicists and OD advocates are now urging policy makers to actively begin pilot projects in various states of new models of consent for organ donation and organ recovery, including "Presumed Consent" (PC), "Donation Benefits" (DB) to donor families and nationally regulated governmental/insurer reimbursement to living kidney donors.  

The PC motto is, “Your Choice First.” Every American’s wish will be honored as follows: extensive publicity will notify all citizens that they will be presumed to be an organ donor and that if they object, they may "opt-out." Those who say “no” will be kept in an opt-out registry to insure their wishes are honored. PC is a policy that is in effect in over 20 countries. The AMA and British Medical Association have voiced support for PC and in two reports by the AMA's Council on Ethical and Judicial Affairs it is recommended that "physicians should encourage and support properly designed pilot studies, in relatively small populations, that investigate the effects of [Presumed Consent]." In addition, the Department of Health and Human Services' Advisory Committee on Organ Transplantation recommended a pilot study of PC to involve 4-5 states. Existing Presumed Consent bills are presently being evaluated by the Delaware and Nevada legislatures.  

Policy makers should also focus attention to considerations or benefits to donor families that will increase the rates of donation, and the Secretary of the Department of Health and Human Services should redefine by regulation the meaning of “valuable consideration” per the National Organ Transplant Act. Accommodations to achieve the above shall be referred to as “Donation Benefits” (DB) and "national regulation of government and insurer payment to living kidney donors." 

For burial expenses, a Donation Benefit of $10,000 or more shall be paid to a donor family that agrees to allow their loved one's organ(s) to be used for transplant. Who pays the $10,000? Insurers. Sixty percent of transplants are kidneys. Each patient taken off of the kidney waiting list saves up to $400,000 for the payers, be they Medicare (60 percent) or private insurance companies. A deceased donor who provides two kidneys, for example, would save insurance companies or Medicare between $400,000 and $800,000.

National regulation of government and insurer payment to living kidney donors would proceed as follows: the government and private insurers would provide a combination of the following benefits to an adult donating a kidney: $50,000/lifetime medical insurance (Medicare)/tax benefits.

On 3/31/08 in an article (written on behalf of himself and not the expressed views of any of the organizations he serves) in the Los Angeles Business Journal, Thomas Mone publicly endorsed small scale trial projects to incentivize kidney donation with the government providing health insurance to a living donor. Thomas Mone is CEO of OneLegacy, the largest non-profit organ procurement organization in the USA. He is also President of the Association of Organ Procurement Organizations, and is a Director at UNOS.

Note that when the National Organ Transplant Act (NOTA) was passed in 1984 to prevent payment for organs, our government (i.e. UNOS) had no waiting list and it was not until 1989 that one was started---it reached only 19,095 patients by 12/31 of that year.

New organ donor policies would not only provide more organs, but they would also reduce the need for split liver transplantation, artificial organs, and xenotransplantation.

"But with the emphasis on individual rights in our country, they would never pass in Congress," some argue. We'll never know unless we try and we owe it to all 99,500+ to give it our best effort and start debating these policies. As transplant surgeon, Adela Casas, MD, said, "I think it will be a hard road but a battle worth fighting for."

Please join with us and come out publicly for pilot projects of these three new OD policies, that can actually co-exist, in your speeches and publications and by voicing your strong support to your peers.

Thank you for your time and consideration.

At the Loma Linda University Medical Center Transplant Institute:
-- Okechukwa Ojogho, M.D., Member, ASTS, Director, Transplantation Institute; Associate Professor of Surgery
-- Pedro Baron, M.D., Member, ASTS, Director of Pediatric and Adult Liver Transplantation; Associate Professor of Surgery
-- Zeid Kayali, MD, MBA, Hepatologist; Medical Director of Liver Transplantation
-- Richard Swabb, M.D., Board Certified in Internal Medicine, Board Certified in Nephrology
-- Jill Weissman, Pharm. D., Transplant Pharmacist, Loma Linda University Medical Center
-- Julia A. Nofrada, RN CCTN (Certified Clinical Transplant Nurse)
-- Leigh Aveling, DMin., MFT, Chaplain and Associate Professor, School of Religion

At Stanford University School of Medicine:
-- Waldo Concepcion, MD, Member ASTS, FACS; Chief of Clinical Transplantation, Chief of Pediatric Kidney Transplantation, Associate Professor of Surgery, Stanford University School of Medicine.

At Scripps Green Hospital, La Jolla, CA
-- Donald Hillebrand, M.D., Hepatologist; Medical Director, Liver Transplantation  
 
At the University of South Dakota, Sanford School of Medicine, Sioux Falls, SD:
-- Adela T. Casas-Melley, M.D., ASTS, Pediatric/Transplant Surgeon, Sanford Children's Specialty Clinic; Associate Professor-Academic Faculty; Member, Editorial Board, Transplant Chronicles
 
At the Nazih Zuhdi Transplant Institute at INTEGRIS Baptist Medical Center, Oklahoma City, Oklahoma:
-- Nicolas Jabbour, M.D., Member, ASTS, Medical Director

At the Cleveland Clinic:
--John J. Fung, MD, PhD, FACS, Chairman of the Department of General Surgery and Director of the Transplant Center.
 
At the Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center:
-- Raymond M. Planinsic, MD, Director of Hepatic, Intestinal and Multivisceral Transplantation Anesthesiology

At the VA Pittsburgh Healthcare System
-- Thomas Cacciarelli, M.D., Chief, VA Pittsburgh Healthcare System Liver Transplant Surgery Program
 
At the University of California – Davis Medical Center:
-- Lorenzo Rossaro, M.D., Medical Director, Liver Transplant Program, Chief of Gastroenterology and Hepatology

At the University of Southern California Hospital, Los Angeles, CA:
-- Yasir A. Qazi, M.D., Medical Director, Kidney-Pancreas Transplant
-- Kianoush Banaei-Kashani, M.D., Keck School of Medicine of USC, Division of Nephrology
-- Jay Vidhun, M.D., Dept. of Nephrology, Kidney Transplant

At the California Pacific Medical Center:
-- Robert G. Gish, MD, Medical Director Liver Transplant Program; Chief: Division of Hepatology and Complex GI; Member of the American Association for the Study of the Liver, the American Gastroenterological Association, the American Society of Transplant Physicians, and the International Liver Transplant Society

At the NYU Medical Center (New York University School of Medicine & Hospitals Center):
-- Lewis Teperman, MD, Associate Professor, Chief and Director of Transplantation Surgery; Member: UNOS Liver & Intestine Committee, Member, Board of Directors: American Liver Foundation, New York Regional Transplant Program and Latino Organization for Liver Awareness

-- Phil Berry, M.D., Advisory Committee for Organ Transplantation (ACOT) appointed by Secretary Tommie Thompson, Health & Human Services, 2001-2004; Past President, Texas Medical Association; President, Texas Medical Assoc. Foundation 

-- Leonard J. Morse, MD; Commissioner of Public Health, Worcester, Massachusetts; Professor of Clinical Medicine and Family Medicine and Community Health, University of Massachusetts Medical School; Chair Emeritus, AMA CEJA; Past-President, Mass. Medical Society (Presumed Consent support pursuant to AMA Opinion 2.155)

--James N. Eustermann M.D. FACS; Board Certified General Surgeon; Diplomat, American Board of Surgery; Fellow, American College of Surgeons; Medical Director

-- Sally Satel, MD, Staff Psychiatrist, Oasis Drug Treatment Clinic, Washington, D.C.; Resident scholar, American Enterprise Institute; Coauthor of One Nation Under Therapy and author of PC, M.D.

-- Diane Furchtgott-Roth, former chief economist, U.S. Department of Labor; senior fellow, Hudson Institute

-- Charles J. Goodacre, DDS, MSD; Dean of the School of Dentistry, Loma Linda University; Past President, American Board of Prosthodontics; Board Member, American College of Prosthodontists; Redlands, CA

-- Richard Darling, DDS; Past National Public Citizen of the Year (NASW); Author: Coma Life, an autobiographical memoir of three liver transplants

-- Terence McCarthy, President and Founder; Dave Courtney, Vice President and Director of Public Relations; The Presumed Consent Foundation

-- Bill Remak, Chairman, California Hepatitis C Task Force; Secretary, National Association of Hepatitis Task Forces; Member, Board of Directors of the Pharmacy Council on Hepatitis and Liver Disease.
 
-- Ralph H. Treiman, Past-President, American Liver Foundation, Greater Los Angeles Chapter

Thomas Mone's article and subsequent discussion with him by Dr. Darling regarding incentivizing living kidney donation with governmental health care insurance may be accessed here.

The policy of governmental and insurer reimbursement to living kidney donors was originally derived by the public announcement/support of this new OD policy by Arthur J. Matas, MD, who is professor of surgery, Director of the Renal Transplant Program at the University of Minnesota and former President of the American Society of Transplant Surgeons. Dr. Matas CV. Dr. Matas informatively answers questions on ABC News.

A portion of this letter was prepared utilizing language from the American Liver Foundation's resolutions: http://www.liverfoundation.org/about/advocacy/organdonationpolicy/

The Presumed Consent Foundation http://www.presumedconsent.org/membrshp.htm

Donation benefits as proposed by many eminent professionals and citizens, including Mr. Richard DeVos, heart recipient and co-founder of Amway:  http://fairfoundation.org/organdonation/donation_benefits.pdf   

USA organ-donor waiting list http://www.optn.org/. One dies every 82 minutes here.

AMA CEJA Opinion 4-1-05 is at http://www.ama-assn.org/ama1/pub/upload/mm/369/ceja_opinion_2_155.pdf
Opinion 7-A-05 http://www.ama-assn.org/ama1/pub/upload/mm/369/ceja_7a05.pdf.
AMA Opinion 2.155 is referenced in the former.

The Lancet is the European counterpart of the American Medical Association's "Journal of the American Medical Association." A 6/8/07 Editorial in the LANCET states, in part,
"“…although ethically and morally suspect, the case for legalising and regulating the commercial sale of human organs may appear to have the upper hand." Full Editorial is here: http://fairfoundation.org/organdonation/LANCET.htm

The British Medical Association's support for PC and endorsement of PC by Britain's Chief Medical Officer is at http://fairfoundation.org/organdonation/BMA_on_Presumed_Consent.pdf

In regards to the debate over Donation Benefits to a cadaveric donor family, it may be noted that companies such as Genzyme Biosurgery, LifeCell, LifeNet Health and others are expected to have gross revenue of over $200 million dollars by 2012. Their business is providing human cells, tissues and organs for transplant. Full story. Some of UNOS’s organ procurement organizations are also now entering this lucrative business. Is it ethical to allow businesses and OPO’s to profit/receive financial gain from patients' cells, tissues and organs, while patients and their families are not allowed the same benefit?
 

When the National Organ Transplant Act was passed in 1984 to prevent payment for organs, UNOS had no waiting list and it was not until 1989 that one was started---it reached only 19,095 patients by 12/31 of that year. With close to 100,000 dying souls now waiting, can we morally justify preventing patients and their families from donation benefits while others reap substantial profits from their body organs, tissues and cells?