CHAPTER 82: The Science of Resuscitation Addressing the Organ Shortage Crisis

INTRODUCTION

EPIDEMIOLOGY

• According to the U.S. Department of Health and Human Services (HHS), there have been 874,987 transplants between 1988 and 2021.

• More than 113,000 patients are currently waiting for a transplant in the United States.

• On average, 20 people die every day due to the lack of organs available for transplantation, representing a total annual average of 7,300 deaths.

• The rate of organ demand has increased five times in the last 25 years, while donors have only increased twofold. This large disparity between organ need versus organ availability, currently represents one of the most important challenges to overcome in the field of Transplantation.

• In the United States, only 0.3% of deaths result in organ donation. Although one donor can provide up to eight life-saving organs, due to multiple system barriers and medical challenges, only two to three organs are transplanted.¹

• The organ donation rate varies substantially between different states in the United States: 94% of the population in Montana are registered donors, while only 23% are registered donors in New York.

THE “OPT-IN” AND “OPT-OUT” STATUS

• Around 95% of all U.S. adults support organ donation; however, only 58% of U.S. adults are enrolled as donors. This notorious mismatch between supporters and registered donors raises the question of how much longer the United States can endure the “opt-in” system, which has been suggested as the most important cause of this disparity.

• The “opt-in” system assumes every person as a non-donor, except, if through an administrative process, such as the driver’s license application, the person voluntarily changes the status from non-donor to registered donor. For the “opt-out” system every person is a donor by default for which a voluntary administrative process is required for a change in status to non-donor. Countries with this presumed, or by default consent (“opt-out” system), have successfully addressed the organ shortage; more than 90% of the population donate their organs. It is a statistical fact that countries with the opt-out system have the highest donor rates.

INCREASING ORGAN DONATION

• Societal education can play a role in increasing organ donation rates by identifying societal and cultural barriers to donation, correcting false information, and increasing awareness. Due to the shortage of organs for transplantation, there has been increasing discussion on donation after cardiac death (DCD).

• Expanding organ donation requires a multifaceted approach, including the revision of laws related to organ donation; the what, when, and how medicine can be used to improve the number of viable organs.

• Laws surrounding organ donation include discussions of the opt-in versus opt-out systems, donation after brain death (DBD), DCD, ...