Experts Stumped On How To Improve Procurement

Byline By Elizabeth Neus

Gannett News

The first time Cheryl Eshenour thought about organ donation was in a Hershey, Pa., emergency room while her 12-year-old son was on life support, near brain death after a freak bicycling accident.

"Two and a half months before Jonathan's accident, I had to get my driver's license renewed. I said no (to organ donation), because I didn't understand it," said Eshenour, 45, of Hershey.

Had it not been for the kind and sensitive approach taken with the grieving Eshenours -- Cheryl, her husband, Randy, and Jonathan's brothers Nathan, then 17, and Matthew, then 14 -- and the time they were given overnight to understand that Jonathan wasn't going to survive, they probably would not have donated his organs, she said.

And the four men and women who received his gift in 1997 might not be alive today.

That delicate line is walked daily by those who work in the nation's transplant system. Out of the 2.2 million Americans who die each year, only 14,000 die in such a way that makes them suitable donors. Barely half become donors.

Experts for years have tried to puzzle out what stops families from agreeing to donate a loved one's organs, especially because the idea of organ transplantation itself is generally met with approval.

The issue becomes crucial as the number of people waiting for organs grows. Nearly 70,000 people are waiting for organs of some sort, with about 45,000 waiting for kidneys and more than 15,000 waiting for livers, the two largest groups of potential recipients.

Liver patients have at least two relatively new options -- accepting part of a liver split so that it goes to two patients instead of one, or accepting part of a liver from a living donor, whose own liver regenerates. But it's still not enough.

Many in the field are concerned that the public's willingness to donate might be hurt by the nasty public battle over how livers in particular should be distributed.

The fight has reached all the way to Congress, which is working on laws determining who would run the transplant system.

"There are things you can do to discourage donation," said Dr. Todd Howard, director of liver and kidney transplantation at Barnes-Jewish Hospital in St. Louis and chair of the liver committee of the United Network for Organ Sharing.

"All it takes is a little story about how the transplant system is not fair. We've been dealing with damage control for five years now."

The number of donors has increased little over the past few years. In 1999, families donated organs from 5,812 deceased relatives, up only 10 from 1998.

Copyright © 2000 The Detroit News.