Patients who desperately need surgery don't go directly into the operating room. They go on a waiting list kept by a government contractor. The list gets longer and longer. More than half of the patients die waiting for surgery.
That situation is a fact of life for people in the United States who need an organ transplant. They wait, suffer, and often die because not enough people donate kidneys, livers, hearts, and other organs for transplantation.
The national waiting list for organ transplants quietly reached a milestone last October, rising above 90,000 patients for the first time. The United Network for Organ Sharing (UNOS) keeps that list, and oversees organ transplants nationwide, under a contract with the U.S. Department of Health and Human Services.
By early 2006, the waiting list was edging toward 91,000. In addition to those who die waiting, hundreds of others become too sick to undergo surgery.
The record-sized waiting list is a positive sign - in one way. Organ transplantation has become so successful that transplants are an option for more patients. Patients who once had no hope are now going on the waiting list, where there is hope for a life-saving transplant.
However, the list's size reflects a dismal failure of years of effort by UNOS and others to increase organ donation rates in the United States.
One accounting, for instance, found that there were only about 2,000 more organ donors in 2004 than there were in 1994. But there were 50,000 more people on the waiting list in 2004 than there were in 1994.
The system for recruiting organ donors is based on altruism - selfless giving of oneself for the benefit of others without any thought of personal gain. People are supposed to instinctively want to donate their organs, and those of terminally ill relatives, to help others.
Altruism is one of the finest values. This trait actually helps scientists define humanity and separates human beings from other animals.
Potential organ donors don't respond to that approach for a variety of reasons. One may be a consideration that can throw altruism out the window - fairness.
Every other party in an organ transplant benefits in some material way from their role - except the donors.
Organ recipients, of course, get a new chance at life. Transplant surgeons and other medical personnel are as altruistic as anyone, but they don't work for free. Hospitals collect sticker-shock bills. Pharmaceutical companies profit from the sale of anti-rejection drugs.
Increasing the sense of fairness does not necessarily mean cash for people who agree to donate their organs after death, or relatives of terminally ill patients.
There have been proposals for tax breaks, for instance, and for giving organ donors priority status on the UNOS waiting list if they or their relatives ever need a transplant. Other efforts include those being tried in Ohio. Sparked by efforts at the Medical University of Ohio, transplant centers in the state have adopted a "paired exchange" approach for live-donor kidney transplants. If your family member or friend needs a transplant but you don't match, MUO matches you with a family in a similar situation and you swap kidneys.
We can try fresh ways of recruiting donors, or let this terrible situation continue, with sick people kept waiting until they die.