Emergency physicians can have a critically important role in organ and tissue donation. Without the active involvement and leadership of emergency physicians, donor organs and tissue can, and unfortunately often are, needlessly wasted. It is emergency physicians who, through their compassionate and knowledgeable interactions with the relatives of the recently deceased, can play a key role in facilitating the recovery of usable organs and tissue. Unfortunately, despite significant legislative and educational efforts, many usable organs and tissues are still not harvested and go to waste.

The demand for organs and tissue is currently high and growing. As of August 7, 1996, the United Network for Organ Sharing reported 47,000 registrations on its organ transplant waiting list. Among those were:

• 33,151 registrations for a kidney transplant
  
• 6,809 registrations for a liver transplant
  
• 3,659 registrations for a heart transplant
  
• 2,137 registrations for a lung transplant.
  

In contrast to these numbers, the number of transplants actually performed during the calendar year of 1995 was:

• 10,891 kidney transplants
  
• 3,922 liver transplants
  
• 2,361 heart transplants
  
• 871 lung transplants.
  

As troubling as this discrepancy is between organ demand and supply, it would be even more distressing if we were to include the considerable number of patients who are never added to the transplant waiting lists because their physicians know that their medical condition and priority would only doom them to having no real chance to ever receive an organ. The inevitable consequences of this discrepancy between organ demand and supply, are the deaths of the patients who are on organ transplant waiting lists and never receive a transplant which are as follows:

• 1,814 patients awaiting kidney transplants
  
• 954 patients awaiting liver transplants
  
• 746 patients awaiting heart transplants
  
• 385 patients awaiting lung transplants.
  

The total number of reported deaths of patients on the National Organ Procurement and Transplant Network registration list in 1996 was 3,916. We can only expect to see this number rise as the organ supply grows slowly, at best, and the demand increases much more rapidly. Because of medical advances and the success of transplants (improved surgical technique and immunosuppressant drugs), individuals who in the past would never have been placed on an organ waiting lists, now are. As a result of our successes in organ transplantation, the disparity between demand and supply will continue to widen.

All physicians who are involved with organ donation—and this will include most, if not all, emergency physicians—must be aware of the laws pertaining to organ and tissue donation. Despite the fact that a Uniform Anatomical Gift Act (“UAGA”) was developed and then widely adopted by the states, variations in state law persist. The original UAGA was drafted in 1967 and was promptly adopted by all of the states, although there were some variations, generally minor, in the individual state statutes. A second UAGA was drafted in 1987 and has now been adopted, again with some variation, in eighteen states. As a result of the development of the second Uniform Act, there are currently two different “uniform” laws in effect in the country. While there is certainly much more uniformity in organ donation law among the states since the 1968 Act was widely adopted in the late 1960's, there is still variation, sometimes significant, between the states. Because of the variation among the states, each emergency department must have in place specific policies for requesting organ and tissue donation, which are in compliance with all applicable state and federal law. In fact, portions of these organ and tissue procurement procedures and policies have been legislatively mandated. In addition to hospital policies, each regional organ procurement agency will have in place its own policies regarding the harvesting of organs and tissue, and cooperation between hospitals and their local organ and tissue procurement agency is to be encouraged..

The vast majority of Americans support the concept of organ and tissue donation and this consensus has been consistently demonstrated in national and various statewide polls. A national Gallup Poll in 1993 found that 85% of those people polled supported organ donation. This support was not gender-specific, with 87% of men and 83% of women supporting organ donation. An Iowa study in 1995 surveyed 834 Iowans on their opinions regarding organ procurement. In this survey, 97% of respondents supported the donation of organs for transplant. While the level of support for organ donation was quite high, only 43% of those people in Iowa who generally supported organ donation had made the appropriate notation on their driver’s license. Given the fact that organ procurement agencies, as a general rule, will not harvest organs without a relative’s consent, it is more important that individuals discuss the desire to donate their organs with their families. Unfortunately, the frequency of these discussions may not be any greater than the 43% who had noted their desire to donate on their licenses. Despite this overwhelming support for organ donation, the gap between the demand for organs and the available supply continues to widen.

Significant obstacles to organ and tissue donation remain, and include concerns that: the body will be mutilated, the harvested organs will be sold, medical care will be compromised in order to facilitate the death that must occur prior to organ harvest, organs will be removed prior to death, a reluctance to think about death and discuss organ donation, as well as various religious suppositions.