How the Organ Transplant System Is Stacked Against the Most Needy, and Why You Should Be a Donor

Being an organ donor is simple and can save lives; conceivably, eight lives. But the system is very much in need of reform.

Ever see the bumpersticker, “Don’t take your organs to Heaven, Heaven knows we need them here!”? Regardless of whether you believe in God, these stickers make a good point: Why are we taking our organs to the crematorium, or burying them six feet underground, when we could use them to avoid someone ending up in the same situation? And by same situation, I mean dead.

More than 100,000 Americans are waiting for lifesaving operations. Unfortunately, organ donation rates do not match organ demand. Each year 6,000 or more people die waiting for organ transplants. What’s more, because the organ transplant system operates with a built-in bias against the poor, minorities are nearly half as likely to receive organs, even though they are more likely than whites to need them. In 2008, 7,182 people died waiting for organs; 4,638 people died waiting for kidney transplants, and 1,542 of them were black. In other words, 64 percent of deaths on waiting lists are for kidneys, and 33 percent of deaths on the kidney waiting list are black patients.

Blacks in America donate organs (13 percent of donors) at about the same rate they make up the population (14 percent), but they represent a disproportionate 35 percent of the kidney waiting list. More problematic is the fact that many in need of an organ do not even make the lists, or not in time, stymied by a complex patchwork system that discriminates against poor and minorities in any number of ways, many of which can be fixed.

Be an Organ Donor

Unfortunately, the steps for signing up to be a donor are not as well known as they should be. Some people do not even know whether they are organ donors, and different states have different processes for enrollment. Some states allow donors to sign up online, while other states have donors sign up at the DMV (sometimes as easy as checking a box), upon renewing a driver’s license or ID card. Most states have both (ideal) or one of these policies in effect, but others also offer the option of obtaining, and carrying, at all times, a donor card -- which, realistically, not everyone does.

One organ donor can save an incredible eight lives. With organ donation, death is an opportunity for others to live. But myths abound, perhaps discouraging people from signing up. One is the absurd idea that a physician may let an organ donor die to save people on the transplant list. Needless to say, it's only after death that organ donor networks are notified of an available organ. Also, it's not like doctors rifle through wallets to check for organ donor status before making a life or death decision. Plus, only certain deaths -- usually brain deaths -- make organs viable for transplant.

As of now, roughly 40 percent of the U.S. population are registered organ donors. Lack of awareness and longstanding myths are the driving forces behind most people opting out of donating -- all major religions, for example, accept or encourage organ donation.

Racial Bias in the Organ Transplant Process

Minority populations are disadvantaged in organ transplantation in several ways. Three key factors prevent African Americans from receiving kidneys at rates equal to whites. First, African Americans exhibit higher rates of diseases that cause kidney failure, like hypertension and diabetes. Five percent of people on wait lists died in 2008 and, more specifically, 4.6 percent of people on kidney wait lists perished. Second, the African-American population has a high prevalence of type B blood, which is more rare in the general population (and a problem because blood type matching is necessary for a successful transplant). Third, race-linked poverty and socioeconomic issues make it much harder to navigate the organ transplant system.