In fact, the average OPO spends more time encouraging doctors and nurses to make referrals than it spends procuring organs. Encouragement may take the form of training sessions, one-on-one visits, or even a visit to the intensive-care unit itself.
The final step in the process is the most delicate and thus in many ways the most difficult: obtaining the family's permission. Families of potential donors have suffered a terrible loss. Some OPOs prefer to have their own experienced staff approach the family. Others depend on hospital staff. All must depend on the doctors involved to inform the family members that their relative has died. Since U.S. law forbids payment for organ donation, all such decisions are voluntary and must be motivated by the desire to help someone else. .
III. KINDS OF TRANSPLANTS.
Of course, kidneys are not the only organs being transplanted. In 1990 over 4,700 livers and over 4,100 hearts were transplanted worldwide, along with more than 1,000 pancreases and 250 lungs or heart-lung combinations. In each case, a majority of these procedures occurred in the United States.
During the late 1980s, the total number of heart and liver transplants grew rapidly, though the number of donors did not. This imbalance reflects an increase in multiple-organ donation. Donors who previously donated only kidneys were increasingly providing hearts, livers, and pancreases. By 1992, 72 percent of all U.S. organ donors provided more than one organ. While trustworthy data are hard to obtain, it is likely that ten years earlier the figure was less than 25 percent.
The number of actual donations must be compared with the number of potential donors to be properly understood. In 1975 the U.S. Centers for Disease Control estimated that about 25,000 potential donors were available each year in the United States. A study in 1991, however, examined hospital death records far more carefully and estimated the size of the national donor pool at only 10,000 to 12,500.
