Organ Donation

In 2022, more than 157,000 organ transplants were performed worldwide, with the highest numbers of postmortem donations occurring in Spain, the U.S. and Portugal. That year the U.S. reached an annual record of more than 42,800 transplants, as well as the formidable milestone of completing the one millionth transplant in the country’s history. Yet even as the number of donors continues to grow globally, the need for life-saving organs far exceeds the available supply. In the U.S. alone, more than 100,000 people are on the national transplant waiting list at any given time, while an estimated 17 people die every day because the organ they need never becomes available. In order to motivate more people to become organ donors, ongoing education and outreach initiatives seek to build public trust in the integrity, fairness and equity of the organ donation process.

The first successful organ transplant (a kidney) was performed in the U.S. in 1954. In the decades that followed, medical advances made organ transplants an increasingly viable life-saving option for patients whose own organs could no longer function. Meanwhile, laws and systems have been established (and continuously updated) to oversee, coordinate and track the complex processes of organ donation, recovery and matching with qualified candidates.

In the U.S., organ donation is regulated under the Uniform Anatomical Gift Act (UAGA). A  government-contracted non-profit organization, the United Network for Organ Sharing (UNOS), oversees the vast network of transplant hospitals, organ procurement organizations and thousands of volunteers that comprise the nation’s transplant system. An adult who wishes to become a donor is advised to sign up with their state organ donor registry, check an organ donor box on their driver’s license or state ID and communicate their wishes to loved ones. The U.S. process for becoming a donor is described as an “opt-in” system, because a person is assumed not to be a donor unless they take active measures to indicate their consent. By contrast, Spain uses an “opt-out” system, which presumes a person’s consent to donate unless they take measures to indicate otherwise.

There is considerable debate about the relative merits of opt-in vs. opt-out systems for increasing the supply of donated organs. Beyond this and other structural issues, many proponents of organ donation continue to focus on attracting more donors by cultivating a narrative of honor around the act of “giving life.” Particularly for deceased donors and their families, organ donation can be an opportunity to transform the loss of one life into new possibility for another, thereby creating a legacy of generosity and hope.

Contributor: Erin Brown