The number of people in need of a life-saving organ transplant is constantly growing with nearly 106,000 people currently waiting for an organ transplant in the United States. Every state has programs dedicated to growing the number of people who are registered organ donors. Many states ask people if they want to register as an organ donor when they renew their drivers license, marking registered donors with a red heart on the front of their license. This allows the owner of the license to unmistakably declare their intention of becoming a donor upon their death. However, there is also a demand for living organ donors. Living organ donors can donate one of their kidneys or a portion of their liver. Detailed information about living donation can be found here: Living Organ Donation
Recently, the American College of Physicians issued a statement to update the definition of death as follows:
In a new position paper, the ACP joined the ongoing debate that could reshape the cardiorespiratory and neurologic standards determining death. The ACP supported replacing the word “irreversible” in the UDDA with “permanent” to define circulatory determination of death.
The ACP statement also advocated separating issues about determination of death from organ transplantation and affirmed the importance of the dead donor rule, which says that organ procurement cannot cause death.
Questions have emerged about the use of the word “irreversible,” the ACP committee said.
The UDDA states that an “individual who has sustained either (1) irreversible cessation of circulatory and respiratory functions, or (2) irreversible cessation of all functions of the entire brain, including the brain stem, is dead. A determination of death must be made in accordance with accepted medical standards.”
The ACP called for replacing the word “irreversible” with “permanent” in the first clause, so it would read that an individual “who has sustained either (1) permanent cessation of circulatory and respiratory functions, or (2) irreversible cessation of all functions of the entire brain, including the brain stem, is dead.”
The distinction was proposed in 2010 to clarify death in organ donors after circulatory determination of death (DCDD). Prevailing DCDD protocols permit donors to be declared dead once their heartbeat and circulation completely ceased for 5 minutes. Critics pointed out that, even when donors have do-not-resuscitate orders, it might be possible to successfully resuscitate them after their heartbeat and circulation had stopped for 5 minutes.
The ACP also called for more education about how death is determined. Training for medical students, residents, and fellows may help improve communication skills over the long term, the committee suggested. Broad public education about determining death also is needed.
“If the circulatory criterion of the UDDA were revised by substituting the adjective ‘permanent’ for ‘irreversible,’ it would make explicit that current death determination practices in DCDD donors are lawful,” Bernat said.
There is a bill before Congress to strengthen protection for living donors. H.R. 2923, known as the Living Donor Protection Act, was introduced into Congress on April 27, 2023 and referred to the subcommittee on health. It is currently stalled in that committee.
A summary of the Bill appears below:
“This bill prohibits certain insurance carriers from discriminating against, and provides other protections for, living organ donors.
Specifically, carriers may not deny, cancel, or otherwise impose conditions on policies for life insurance, disability insurance, or long-term care insurance based on an individual’s status as a living organ donor.
The bill also expressly specifies that recovery from organ-donation surgery constitutes a serious health condition that entitles eligible employees to job-protected medical leave.
In addition, the Department of Health and Human Services must update educational materials on living organ donation to include information about the benefits of living organ donation and about access to insurance for living organ donors.”
Under current legislation, living organ donors are not protected under FMLA provisions for time needed to recover from donation surgery as it is considered an elective surgery. Likewise, they are not protected from discrimination by insurance companies who may consider being a living organ donor to be a pre-existing condition. H.R. 2923 is being presented before Congress to change both of these issues.
The American Kidney Fund supports the passage of H.R. 2923, stating, “By passing the Living Donor Protection Act of 2023, Congress would reduce the barriers people face in becoming living donors and giving an organ to someone in need,” said LaVarne A. Burton, President and CEO of the American Kidney Fund.
The demand for living kidney donors is great, with approximately 87% of the nearly 106,000 people on the national transplant waiting list seeking a kidney. On average, 13 Americans die every day waiting for a kidney transplant. Receiving a kidney from a living donor is the healthiest and safest option for the tens of thousands of people on the transplant waitlist.
American Kidney Fund Commends Introduction of Federal Living Donor Protection Act of 2023
You can help to support this bill by contacting your congressional representative in Washington and urging them to vote yes on H.R. 2923. Additionally, you can register to be an organ donor the next time you renew your driver’s license, or you can do it today at this link: Register today
In these two ways, you can help improve the future of organ donation in the United States.
Dawn Levitt, Author 