“ENROLLING DONORS: THINKING OUTSIDEthe Box” was a more interesting talk than the clunky title had led me to expect. Raymond Sinclair—and the talk he gave—reminded me of Las Vegas: loud, flashy, and repellent, yet also equally fascinating. He began with a rapid-fire review of the history and growth of allograft transplants, transplants from dead bodies to living patients. First attempted a century and a half ago—a French surgeon transplanted skin from a fresh cadaver to a patient—allograft transplants had remained rare for decades but had soared during the second half of the twentieth century. By 2008 the number had risen to 1.5 million a year, and it was still rising fast. Surgeries that had once been risky experimental procedures—transplanting corneas and rebuilding knees with cadaver cartilage, for instance—were now routine; meanwhile, new transplant surgeries were being developed all the time.
“So when the number of tissue transplants reaches two million a year,” Sinclair said, “or five million a year, orten million a year—and trust me, that’ll happen in the blink of a laser-corrected eye—where will we get all those corneas and tendons and ligaments?” He paused to let the hundred people in the room consider the problem. “I’ll tell you,” he went on. “The government in Washington is gonna merge the IRS
and the FDA to create a new federal agency that combines revenue collection with medical oversight. And if you think you pay an arm and a leg in taxesnow …”
He left it unfinished, and as the joke slowly sank in, a few people laughed, and a chubby guy in the second row groaned.
“Hey, buddy, don’t piss me off,” Sinclair warned, “or I’ll tell my amputation jokes, and those are really, really lame.”
This time half the audience groaned, but the other half—and Sinclair himself—laughed at the outrageous political incorrectness. The bleary-eyed, jet-lagged crowd was warming to Vegas Ray. And then he turned on a dime. “Seriously, folks, how do we, as tissue banks, keep pace with the rising demand? The organ-procurement network has made huge progress on that front, by a very simple mechanism. Millions of people in the United States every year are now routinely asked the question ‘Do you wish to be an organ donor?’ when they renew their driver’s license. The number of people who’ve said yes to that question—the number who opt in—is incredible: eighty million.Eighty million people have said, ‘Yes, I do.’ If you’ve got a spouse or a son or a daughter wait-listed for a kidney, the suspense is pure hell. Still, at this moment hundreds of millions of human organs are flowing, at whatever speed fate decrees, toward the mouth of the donor pipeline. Isn’t that amazing?”
He looked around the room, and heads nodded, including mine.
“But.But, ” he went on, “even with all the public support for organ donation, it’s not enough. Thousands of people on the organ waiting list die every year for lack of a matching transplant. And whole-body donation faces far bigger challenges. People are good at denying the finality of death if they’re signing over just a few parts. But the clerks at the DMV don’t ask about whole-body donation, and—somebody correct me if I’m wrong—Hollywood isn’t rushing to make blockbuster movies about cadaver tendon or bone paste.”
Damn skippy,I heard myself thinking. It was an expression I’d picked up from Miranda, which I understood to mean “Amen, brother,” or “You got that right.”
“There are two things we absolutely must do,” he went on, “if we’re to have any hope of enlisting enough whole-body donors to meet the growing need for tissue. First, we havegot to do a better job of storytelling. People connect with human stories—stories of wrenching need, stories of inspiring generosity. If all we say is, ‘Give the gift of life,’ we’re doing a piss-poor job of educating the public about the importance of whole-body donation. It’s crucial that we tell the stories of real-life people—flesh-and-blood people—whose broken lives could be mended with tissue from whole-body donation.” He raised his arms and spread them wide, a gesture that reminded me of paintings of Jesus.
“We are modern-day miracle workers, folks: healing the sick, helping the lame walk, and making the blindsee. And we have a duty, to donors and recipients alike, to share those stories proudly with the world.” His fervor surprised me, and so did the enthusiastic applause it inspired. He nodded a couple times in humble acknowledgment, then held up a hand to quiet the room. “You might not feel so kindly toward me when I make this second point,” he said. “The other thing we’ve got to do, to start thinking outside the box, is to get more realistic and more creative about incentives for whole-body donation. Tissue Sciences, like many tissue banks, now covers the cost of cremation for whole-body donors. We harvest and process everything we can, we cremate the remains, and—if the family wishes—we return the ashes to the family. For people who are planning ahead, we offer the opportunity not just to help the sick but also to help their own families, by sparing them the cost of a funeral or cremation. For a grieving family, we lighten the financial burden of death. But that’s too little, too late. We need to expand the incentives we offer families who donate their loved ones…and we need to create substantial financial incentives for individuals considering becoming whole-body donors.”
Several hands went up at the phrase “substantial financial incentives.” He pointed to an attractive young blond woman in the center of the room, who asked, “Are you suggesting we pay prospective donors?”
“You betcha.”