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Filler: 'No give, no take' for organs

Photo Credit: Michael Geissinger

Last week, nestled in my email inbox, was a plea from the New York Blood Center for platelets. I'm on their list because I donate fairly often, and they're doing a hard sell because a lot of donations happen via school and college programs. Summer brings dwindling supplies.

But why do we ever run low on blood, or organs and marrow needed for donation?

I've often heard people exclaim, "I would give, but I just don't like needles."

A note to anyone who says this: People willing to give blood aren't needle fetishists out for a cheap thrill. I mean, I love cheap thrills, but not ones involving blood loss.

Saying, "I'd donate blood, but I hate needles" is like saying "I would give to charity but I hate having less money."

At first blush, there appears to be a simple solution to the shortages of available organs, blood and marrow: If you aren't registered to be an organ donor, you can't be an organ recipient -- or you at least must be below all the registered donors on the list. Ditto bone marrow. And if the blood supply gets real low, and you aren't a donor, no transfusions for you.

But it turns out that bright idea is about half bright.

According to Harry Schaffler, executive director of donor marketing for the New York Blood Center, blood donation in this country was done on a system of credits and debits up until about 50 years ago. Thus the term, "blood bank."

"The problem," said Schaffler, "was that people donated, earned the credit, and never donated again. So we went to a model we call 'community responsibility,' that encourages people to donate regardless, and that works better. While supplies do get low, we never truly run out."

Yet the idea is smart when applied to organs and marrow.

Alex Tabarrok, who heads the Center for Study of Public Choice at George Mason University, has a name for the concept that enrolled organ donors would start at the top of the list when they need transplants: "No Give, No Take." He says it's already helping in Israel, where the idea has just become law. Israel has had an unusually tough time getting people to become organ donors, but once the rules changed last month, the response was extraordinary. Israelis are offering up their organs in the case of their death so fast they are overwhelming the system.

There are exceptions that make sense. In Israel, people can't enroll to be organ donors until age 17, and children are put on wait lists based solely on their conditions. Some who need transplants don't have any organs healthy enough to harvest if they die, so putting them on a donor list doesn't make any sense. But in general, everyone ought to be willing to give marrow or have their organs harvested if they die -- or be willing to die for lack of an organ or marrow because they hadn't agreed to donate.

In the United States, about 8,000 people die for lack of an organ donor annually. About 3,000 more die waiting for bone marrow. Simply put, if you're not a registered donor, you may someday be complicit in one of those deaths.

"There's a huge shortage of organs available," said Tabarrok. "With the increase of diabetes and other diseases, more organs are needed all the time. And when a patient dies with healthy organs and isn't enrolled, doctors won't push grieving families for organs."

The thought of donating organs or marrow freaks some people out. Like the needle-squeamish, they're just creeped out by it. But if we changed the law to "No Give, No Take," most would get over it -- and a lot of lives would be saved.

Lane Filler is a member of the Newsday editorial board.