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Four Ways We Can Shorten the Organ Donor Waitlist

More than 20 people die every day waiting for a transplant.
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In 2016, for the fourth straight year, more organs were transplanted in the US than ever before. That's the good news. But other statistics have remained grim for the last two decades: Nearly 120,000 Americans need an organ and 22 people will die every day waiting for one that never comes.

We have an organ donor paradox in the US: While more than 95 percent of Americans support organ donation, barely more than half are registered to donate. In some states, the stats are even more off-balance: Only 27 percent of adults in New York are registered, even though they have the third highest need for organs.


What we need to do is obvious—increase the number of registered donors—but the how has always been far less clear. Here are four potential fixes.

Do a Better Job of Pestering People
One way to get more people to sign up is the most obvious: Just ask. "Most people sign up through their DMV office," says Helen Irving, CEO of LiveOnNY. "But you may be renewing your driver's license only once every eight years. We're not asking often enough and we're not making it easy for people to sign up." In May 2012, Facebook added a feature that made it simple for people to register—it just took a couple of clicks (something you can still do). The results probably won't surprise you: In its first day, 13,012 people added their names to the donor list, a 21-fold increase. "Ease of access is key," Irving says.

Make Donors Opt-Out, Not In
Turns out there's an even easier way to get everyone signed up: Don't ask them at all. Rather than an opt-in system, which is what we currently have, some argue that we should have an opt-out system, one that presumes you are cool with being an organ donor unless you say otherwise.

An opt-out system could close the deadly gap between supply and demand in the US. In 2006, Alberto Abadie of MIT and Sebastien Gay of the Congressional Budget Office compared donation rates in opt-in versus opt-out systems. They found that the rates were 25 to 30 percent higher in opt-out countries. That's promising news for us: Last year, there were 27,628 donations from dead donors. When you do the math, that means switching to an opt-out system could increase donations by 8,288—enough to potentially cover the nearly 8,000 who die every year on the waiting list.


Give People Something in Return
A single donor can change the lives of 85 people. According to Donate Life America, your organs could save eight, give sight to two more, and your tissue could help as many as 75. But if appealing to the purely altruistic angels of our nature doesn't do the trick, then there's another way to increase the number of donors: Give them something back.

This is known as the priority rule, and Chile, Israel, and Singapore have one. The basic idea is this: If you sign up to be an organ donor, then you receive priority for receiving an organ. Singapore combined an opt-out system with a priority rule: if you opt-out, you also give up your priority if you need a transplant. In January 2010, Israel implemented a broader priority point system that also rewards people for making a donation while they are alive and to families of people whose organs were successfully donated. The switch to the priority rule in Israel has led to record numbers of registrations, according to work done by Alvin Roth, an economics professor at Stanford and winner of the Nobel Prize in economic sciences, and his colleagues.

"It gives you a potential reward for having been willing to be an organ donor yourself," says Roth. "Another way to look at it is, it makes it more likely that when you do donate, you are donating to someone who would do the same for you had the situation been reversed."


Though they are still studying the effects of the program, one potential concern with priority rules is that you may not give a scarce organ to the person who needs it the most. But there's a way we can avoid that problem, too. "These priorities in Israel aren't absolute priorities," says Roth. "They give you an extra push when there's a tie. It's still the case that the sickest patients get organs first."

Address Racial Disparities
But in order to make any organ donation system work better, we also need to address mistrust of the health care system itself—one of the common reasons why people refuse to donate and why African Americans in particular are less likely to be registered to donate. "We hear folks say that there's a fear of signing on a registry and believing that healthcare providers won't take good care of them," says Irving.

The fear that health care providers won't do their jobs or will harm patients is one that we need to take very seriously, since it has been true many, many, many times for people of color in the US. "As a physician at Duke, there are patients who lived through a time period where they literally couldn't get into Duke hospital," says Julius Wilder, an instructor in Duke's department of medicine. "They didn't have access to resources and they didn't have access simply because of the fact that they are black. The fact remains that it is still a very vivid and painful memory."

Mistrust is one symptom of a deeply rooted and widespread disease: Racial barriers to quality health care, one that accounts for other well documented racial disparities in organ donation—African Americans, for example, are more likely to need a kidney transplant but less likely to get one.

The solution to improving trust and, thus, organ donation rates, then, is to improve fairness in health care more generally. "Access to good primary care and primary care physicians could be a very valuable resource in terms of increasing organ donation across the board," says Wilder.