Sep 10 2004
When asked, most Americans will say that donating to worthy causes is a good thing. And many will put their time and money where their mouths are and volunteer or pony up or both. Except when it comes to donating blood and tissue.
Kieran J. Healy, an assistant professor of sociology at the University of Arizona in Tucson, says “while people in this country still think it's a worthy issue, when the time comes to do it, many will back away.” But why rates of donor procurement vary so much across the country is not that well understood.
Healy addresses this in the current issue of the American Sociological Review ("Altruism as an Organizational Problem: The Case of Organ Procurement"). He researched why rates of altruism vary, depending on the organizations that foster such behavior.
Organ donation is a highly structured business that relies on more than just finding qualified donors. Prior to federal legislation in 1984, organs were the property of the surgeons who harvested them. The law now says that organs are gifts, and are a public good that cannot be sold. The result has been the creation of a national network of laboratories and hospitals where transplants are performed. There also are more than 60 organ procurement organizations (OPOs) that find potential donors, secure consent from their next of kin and distribute the harvested organs to patients on waiting lists.
From the individual organ donor's point of view, organ donation is a one-shot exchange, usually made by that person's survivors. But from the procurement organization's point of view, it's a routine problem they need to solve - and some do it better than others.
“In order for an OPO to be successful,” Healy said, “they have to be logistically effective. That requires resources, scope and persistence.” In a study of 61 OPOs around the country, these three factors combined to improve the procurement rate by 20 percentage points. OPOs that are larger and better-funded and better-staffed generally find it easier to generate opportunities to give. Likewise, having a reach into more places where potential donors can be found helps as well. Persistence, Healy found, measures the degree to which an OPO pursues a potential donor once the opportunity is discovered.
Potential organ donors often are those unfortunate enough to have been mortally injured by a traffic accident, gunshot wound, stroke or other trauma and unable to give their consent. OPOs must exert extraordinary care when approaching an often grieving next-of-kin to ask for permission to use their loved one's organs.
In addition, Healy found, some populations are more likely than others to yield potential donors. Factors such as population density, ethnicity, socio-economics, age, religion and education figure into an OPO's ability to procure organs. In particular, more densely populated areas had higher procurement rates. On the other hand, having poorer, more racially diverse, or more highly educated people in an area was associated with a lower rate of procurement.
"It seems like the upper Midwest and Northeast do better," Healy said. "This also is partly due to environmental reasons. Some areas of the country are more sparsely populated, or have lower accident rates or differences in statutes."
These organizations, he said, also have pursued long-term strategies over the last three decades to create the notion that donating organs is altruistic for the donor and beneficial to the community. "Gift of Life" is one example of a catch phrase that virtually everyone associates with either organ or blood donation.
In Tucson, Ariz., where Healy works and teaches, this lesson was recently brought home to the community when a young teenager, Carlos Valencia, needed a bone marrow transplant to treat his leukemia. Organized support rallied at least 2,000 individuals to come in to be screened as potential donors. While none was found and the young man died, Healy said the strong organizational effort was clear.
"Letting people know and providing them with these opportunities ensured a good turnout. You can imagine if you organized it badly, the results would not have been nearly as successful," he said.