By Andrew Rock

Around 21 Americans die each day waiting for transplants. In New York, over 10,000 people are currently in need of an organ transplant. Though exact numbers vary by state, approximately 45% of American adults are registered as organ donors. Given the life-saving capabilities of organs, and great demand for them, what prevents more people fr0m donating?

Experts have been examining the somewhat beguiling gap that exists between the number of people who publicly support organ donation and those that register as organ donors. For example, only one third of U.K. citizens are registered donors, though over 90 percent of the population supports donation in opinion polls. Researchers at the University of Geneva have conducted studies on why people fail to register, as well as why people refuse to donate organs to their next of kin. They discovered that many people have misconceptions about what brain death is, and many people mistrust medical professionals.

Mistrust of medicine and likelihood of donation are inversely related, according to various studies. Professor Brian Quick of the University of Illinois, explained, “There are a lot of people who subscribe to the belief that if a doctor knows you are a registered donor, they won’t do everything they can to save your life.” Television shows such as Grey’s Anatomy have had a negative impact on the public’s perception of the medical community. Religious convictions also play a role. While many religious declare organ donation to be a laudable act, others have misgivings about the process. Research shows that Catholics are less likely to donate than members of other religions.

Some are just plain uncomfortable with the notion of death, ascribing to the view that making such arrangements will bring about an untimely demise; only one in four Americans has made an advance directive. For many, the idea of donating their organs invokes feelings of repugnance. This has been an unexpected but significant barrier to donation. Researchers have found “a basic disgust response to the idea of organ procurement or transplantation” is inversely correlated to likelihood of donation. Those who possess a more “matter-of-fact” attitude are significantly more likely to donate.

Many advocate, such as Aisha Tator, executive director of the New York Alliance for Donation, for the establishment of a cultural norm of donation, comparable to “bike helmets and seatbelt interventions.” The youth, the elderly, nurses, DMV employees, and minority groups have all been targeted by campaigns due to their lower rates of donation. Others suggest an “opt-out” system of donation, similar to the system in Spain, which is “held up as the ideal” according to Eamonn Ferguson, a professor at the University of Nottingham. However, the Spanish system is very complex and may be difficult to replicate.

Systems of incentives and reciprocity have shown promise to be efficacious. For example, Israel recently established a system which prioritizes the distribution of organs to those with a history of donation themselves; from 2010 to 2011 the donation rate increased from 7.8 organs per million to 11.4. The law has had a hugely beneficial effect on organ recipients: “more than 35 percent of those who actually got organs after the law was passed got them because of the prioritizing system” according to Dr. Jacob Levee.

Though registering as an organ donor may be a rational decision, it can be difficult. Tator explains, “Unfortunately unless you’re personally touched by the issue, unless you have a child that gets a virus and suddenly needs a new heart, you don’t really think about it.”

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