Demand for Organ Transplants
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Over the past decade, the demand as well as the costs for organ transplants around the world has increased dramatically. In the United States and Canada in 2001, approximately 24,000 organ transplants took place, while approximately 80,000 patients remain on the waiting list for organ transplants due to a shortage of compatible donors. The costs associated with organ transplants have also increased substantially with some procedures such as a liver transplant increasing in price by 42% since 1998. The reasons behind the disparity between patients that need organs and the number of transplants that actually occur are complex and hinge on the availability of organs for transplants, the availability of physicians and facilities to perform the transplants, and the costs associated with the procedure.
Organ Transplants Shortage
As a result of the shortage in available organs for transplant, a national organ allocation and procurement system has developed in the United States under the direction of the Department of Health and Human Services (HHS). HHS has divided the United States into multiple service areas, with a higher priority given to patients within a geographic service area when an organ becomes available from a donor within the same service area. The United Network for Organ Sharing (UNOS), which is a non-profit firm, administers the allotment and procurement system for the federal government. The stated mission of UNOS is to provide an equitable allocation of available organs for the most severely ill patients. UNOS generates a computerized priority list of patients based on factors such as:
- Donor size
- Blood type
- Medical urgency
- Geographic area
- Length of waiting time for an organ transplant
In the event that there is no potential recipient that is an adequate match for the organ within a service area based on the evaluated factors, the organ can then be used for a recipient in another service area. The data on which UNOS bases its decisions comes largely from the evaluation teams at the transplant centers, who determine the patient’s status with respect to the more subjective factors such as medical urgency and prognosis. In practice, the organ allocation decision is a two-step process. In the first step the physicians at the transplant center combine both physiological and social factors in the determination of the viability of an organ transplant for a specific patient. In the second step, UNOS places the patient on the waiting list with a priority in accordance with the information provided by the transplant system.