From The New England Journal of Medicine, June 11, 1998
The supply of donor organs is the Achilles' heel of transplantation. Although the disparities among need, demand, and supply are often discussed, they are rarely understood. For example, each year well over 120,000 people in the United States could benefit from organ transplantation, but fewer than 75,000 are ever placed on a waiting list. Meanwhile, more than 4000 patients die each year while waiting for a donor organ to become available, and only 21,000 actually receive the transplant they require. Despite these figures, more often than not, we are erroneously led to believe that the potential supply of donor organs is adequate to meet our needs. Chapman and colleagues have compiled an interesting collection of papers dealing with three themes relevant to any discussion of the shortage of donor organs: organ and tissue donation in society, the process of organ and tissue donation, and methods of increasing organ and tissue donation. The editors are to be commended for bringing an international perspective to a serious problem. Most of the chapters complement each other, and the themes emerge in a logical manner. The clinical chapters are nicely integrated with those on public policy and cultural and legal issues. Unlike many books on donor issues related to transplantation, this one includes chapters on bone marrow donation and tissue banking. Some chapters are better than others. A few, such as the chapter on public attitudes toward organ and tissue donation by Smith and Braslow, merely rehash old issues and offer few new insights. Others, including that by Calne on ethical issues, are remarkably ethnocentric. In the wake of renewed interest in the use of organs from donors whose hearts have stopped beating, the chapter on brain death by Pearson is particularly timely. Complementing this is an interesting chapter on legislation by Dickens, Fluss, and King. Daar does an excellent job of addressing the thorny issue of paid organ donation, directing attention to cross-cultural nuances. The donation of organs by living donors is discussed at length by Allen, Lynch, and Strong. They conclude that through a process of self-determination, informed persons decide to become donors, despite the risk involved. I am less than impressed with many of the chapters that attempt to put a positive spin on efforts to educate the public about the need for organ donation. It is hard to argue with the validity of such efforts, but in the end, there are precious few data to justify the hyperbole. I sometimes wonder how much money is wasted on competing, often self-serving, efforts to increase the supply of donor organs. The final chapter, written by White, examines xenotransplantation as the solution to the shortage of donor organs. Although brief, this chapter is a fine introduction to an area of research that will prove increasingly controversial. In fact, the efforts of White and his colleagues have already been stalled as a result of ethical debate regarding the practice. Overall, I was impressed with this book. At times, it nearly qualifies as a reference book, although I think the authors could have done more to quantify some of the issues they addressed (e.g., need, demand, and supply). I also think it would have been appropriate to end the book with a sobering chapter that pointedly describes a variety of misconceptions associated with transplantation. For example, strange as it may seem, we live in a society that is as confused about when life begins as it is about when life ends. Moreover, I find it almost ludicrous that more people kill themselves each year in the United States than benefit from the proverbial gift of life. Despite the merits of transplantation, I continue to think of it as a procedure that is vastly oversold relative to its lifesaving contribution. As potential donors, it is important that we all understand the value of a worthy donation, which we, or our loved ones, can conceivably make under appropriate circumstances. Reviewed by Roger W. Evans, Ph.D.
Copyright © 1998 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.
Book Description
Organ and Tissue Donation for Transplantation is a unique book bringing together detailed analyses of the problems surrounding organ and tissue donation. The increasing mnumber of organs that can be transplanted and the rising number of patients on waiting lists have reached the point where availability or organ donors has surpassed the immunological problems as the major challenge for transplantation. In direct response to these problems, this book addresses all aspects of organ and tissue donation and the methods used to increase donation. Organ and Tissue Donation for Transplantation examines the many different approaches, both at legislative and individual levels, to improve donor rates. The inclusion of a technical section considers the practical aspects of donation and testing to prevent the transmission of disease for living organ donation, cadaver organ donation and tissue and bone marrow donation. Legal and social aspects are considered extensively, as are the various strategies used around the world to increase organ donation, from the United States and Australia, to Spain and the rest of Europe. This book will prove to be an invaluable guide for all transplant units and intesive care units where knowledge of organ and tissue is required.
Book Info
NSW Red Cross Blood Bank, Sydney, Australia. Compendium of detailed analyses of the problems of organ and tissue donation. For practitioners. 44 contributors, 12 U.S. Rating
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