Newswise — Organ donation is usually a selfless act, but is donor altruism enough to reduce transplant waiting lists? Is willingness to donate influenced by racial and ethnic tensions, and how is donor altruism affected when those tensions escalate into violence? A Forum in the January 15th issue of Transplantation highlights some timely but difficult issues related to altruism in organ donation:· People who commit to being an organ donor should have priority for receiving an organ in case they need a transplant, according to a proposal by two New York transplant surgeons.· However, some commentators question whether such a plan would meet its goal of increasing organ donation, as it might favour older, sicker patients.· Organ donation among Jews and Arabs in Israel is generally unaffected by ethnic/religious considerations, but this may be changing with the resurgent violence in that country, a new study shows.· The focus on crossing racial/ethnic barriers in transplantation shows that we have not yet reached the point of "true altruism," according to a commentary by Sir Raymond Hoffenberg.

Forum Article 1. — Relying on potential donors' altruism is inadequate to deal with the chronic shortage of organs for transplantation, write Drs. Jonathan D. Sackner-Bernstein and Seth Godin of St. Luke's-Roosevelt Hospital Center, New York. They propose a new scheme in which people who sign up to become organ donors would have top priority to receive organ transplants. The authors believe that making willingness to donate the key determinant—rather than time on a transplant waiting list—would increase the organ supply in a "fair and equitable" way.

To ensure fairness, patients who are already on the waiting list would have the first chance to sign up. The authors believe that many useful organs could be obtained from transplant candidates who die while awaiting organs.

The plan has the potential to cut waiting-list times from months to days, spurring a sharp increase in the number of people willing to commit to be donors, Drs. Sackner-Bernstein and Godin believe. The proposed system, they write, "will grow in its impact as people realize that such a commitment to become a donor—even if it were never to happen—can save their life or the life of their child."

Forum Article 2. — However, a commentary by Drs. Stephen J. Wigmore and John L.R. Forsythe questions whether the plan would actually work to increase organ donation. The system might favour older, sicker patients, who are much more likely to need an organ than younger people who have yet to consider such a possibility. The commentators also question the number of usable organs to be obtained from patients who die on the waiting list. Drs. Wigmore and Forsythe emphasize that, whatever incentives are used to promote organ donation, they must meet some key principles: "justice, equity of access, and avoidance of racial or other bias."

Forum Article 3. — Ethnic/religious prejudice is not a deterrent to organ donation in Israel, suggests a study led by Tamar Ashkenazi of the Israeli National Transplant Center. The researchers found that organ donation rates among Arabs and Jews were proportional to their representation in the population. Jews, who make up about 82 percent of the Israeli population, accounted for about 75 percent of organ donors. Muslims, representing 15 percent of the population, accounted for 13 percent of organ donors. Other groups, including Arab Christians, accounted for five percent of the population and ten percent of organ donors.

Across ethnic/religious groups, most families cited altruism as their main reason for consenting to organ donation. The authors write, "Apparently, altruism cuts across the boundaries of religion and ethnic groups, even in a country where conflict prevails."

However, the researchers fear that Muslim Arabs have been less likely to donate since the start of the current Palestinian Intifada in September 2000. Since then, the consent rate among Muslim Arab families has been 28 percent, compared to 53 percent for Jewish families. Some Muslim Arab families have refused to donate because they fear rejection by the community for "cooperating with Jews."

Forum Article 4. — Commenting on the Israeli study, Dr. Raymond Hoffenberg expresses sadness that "transplants across ethnic or religious barriers are still regarded as remarkable." He concludes, "It would be nice to think that one day transplants will take place from one human being to another without it being felt necessary to publicise the events or claim them as bridge-building exercises. That would be closer to my concept of true altruism."

"Organ Donation: Altruism"TransplantationJanuary, 2004

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Transplantation (15-Jan-2004)