How About a Voucher for an Organ Later If You Donate One Now?

A new system proposes a voucher system for the .S. that could increase organ donations.

Organ carrier
(NOSOROGUA via SHUTTERSTOCK)


On December 23, 1954, Richard Herrick received the first successful live-organ transplant, a kidney, from his identical twin Ronald. The surgery was performed by a team led by Dr. Joseph Murray and Dr. David Hume at Brigham Hospital in Boston. Since that time, countless lives have been saved through increasingly common organ transplants. Sometimes the organ comes from relatives or friends — entertainer and lupus sufferer Selena Gomez recently received a kidney from her best friend — but often they’re donated by good-hearted living strangers or the recently deceased. To encourage people to donate, a new system has been proposed that would give a person who donates an organ a voucher for an organ in the future to be redeemed by a loved one.

The Problem

It’s tragic that there aren’t nearly enough donated organs available, and people die all the time while waiting for a compatible one. United Network for Organ Sharing, or UNOS, a non-profit that manages the nation’s organ transplant system, says there’s currently a waiting list of 116,590 Americans in need of an organ, with 75,472 of those listed as active candidates. 23,091 transplants were performed between January and August of 2017.

(UNOS)

New Scientist reports that 93,000 U.S. patients are waiting just for kidneys and estimates that 12 of them die each day.

To meet this need, scientists have been allocating resources to the breeding of compatible animal organ donors, one example being the piglets recently cloned using CRISPR-Cas9. Some people feel that social engineering offers a more practical, less ethically questionable option, citing the success of opt-out donor systems in other countries that result in 90% of the population donating their organs at death. The U.S. currently has an opt-in system in which donation rates are under 15%. Says bioethicist L. Syd M Johnson of Michigan Tech, “Right now, there’s very little incentive or compensation for people who donate organs. The majority of Americans say they’re in favor of donating their organs, but a fraction of them ever get that donor card, and an even smaller number make the donation in the end.”

About the New Voucher System

Howard Broadman (UCLA HEALTH)

Retired California judge Howard Broadman came up with the idea in 2014. His then 4-year-old grandson Quinn Gerlach has chronic kidney disease and is likely to need a transplant in the future. “I know Quinn will eventually need a transplant, but by the time he’s ready, I’ll be too old to give him one of my kidneys,” Broadman says. He considered donating a kidney now as a kind of abstract karmic down-payment. “But then I started thinking ‘this is bullshit – I should get something for this.’” He approached UCLA, and he and surgeon Jeffrey Veale developed the voucher system.

Veale tells UCLA Newsroom why the idea is worth pursuing:

“Some potential kidney donors are incompatible with their intended recipient based on blood type; others may be incompatible based on time. The voucher program resolves this time incompatibility between the kidney transplant donor and recipient.” 

They published their plan in the September 2017 issue of the peer-reviewed journal Transplantation.

The program works like this:

  • A donor gives a kidney to a stranger on dialysis in exchange for a voucher.
  • The recipient’s family member or friend who is willing to donate but incompatible with the recipient donates a kidney and receives a voucher.
  • When a family member is in need of a transplant, the voucher is redeemed for a compatible organ if one is available. If not, they'll be moved up the waiting list.
  • This sets off a “donation chain” that allows the matching of incompatible donors with compatible recipients. Each person who donates an organ actually helps two people: the immediate recipient and the family member who gets the voucher.

    The National Kidney Foundation calls this a “Never Ending Altruistic Donor,” or NEAD™ chain (NATIONAL KIDNEY FOUNDATION)

    UCLA has been working with the US National Kidney Registry, which has already issued 21 kidney vouchers in 30 hospitals, each one of which initiated a donation chain that’s resulted in 68 new transplants. UCLA says their system has already saved the lives of 25 people.

    Some are skeptical of the voucher system. For one thing, it’s far more complicated than other nations' opt-out programs mentioned above, though it is less presumptive of a citizenry’s willingness to donate. Joy Riley of the Tennessee Center for Bioethics and Culture says that she’s skeptical about a system based on “trusting in a piece of paper with no guarantees.”

    There's also concern that the voucher system discriminates against those without a family member or friend willing to donate.

    On the other hand, says Johnson, “We currently have a system of donation that relies on people being altruistic and proactive about donating their organs after death. But most of us are far more motivated to donate a kidney to a friend or family member than to a stranger. Would more people say yes if doing so meant that they themselves, or a friend or another family member might get higher priority should they need an organ? That seems likely, and it could help not only with kidneys, but with all lifesaving organs.” she adds, “Countries that have created incentive systems, like Israel, have seen their rates of donation increase dramatically.”

    Iron Age discoveries uncovered outside London, including a ‘murder’ victim

    A man's skeleton, found facedown with his hands bound, was unearthed near an ancient ceremonial circle during a high speed rail excavation project.

    Photo Credit: HS2
    Culture & Religion
    • A skeleton representing a man who was tossed face down into a ditch nearly 2,500 years ago with his hands bound in front of his hips was dug up during an excavation outside of London.
    • The discovery was made during a high speed rail project that has been a bonanza for archaeology, as the area is home to more than 60 ancient sites along the planned route.
    • An ornate grave of a high status individual from the Roman period and an ancient ceremonial circle were also discovered during the excavations.
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    Are we really addicted to technology?

    Fear that new technologies are addictive isn't a modern phenomenon.

    Credit: Rodion Kutsaev via Unsplash
    Technology & Innovation

    This article was originally published on our sister site, Freethink, which has partnered with the Build for Tomorrow podcast to go inside new episodes each month. Subscribe here to learn more about the crazy, curious things from history that shaped us, and how we can shape the future.

    In many ways, technology has made our lives better. Through smartphones, apps, and social media platforms we can now work more efficiently and connect in ways that would have been unimaginable just decades ago.

    But as we've grown to rely on technology for a lot of our professional and personal needs, most of us are asking tough questions about the role technology plays in our own lives. Are we becoming too dependent on technology to the point that it's actually harming us?

    In the latest episode of Build for Tomorrow, host and Entrepreneur Editor-in-Chief Jason Feifer takes on the thorny question: is technology addictive?

    Popularizing medical language

    What makes something addictive rather than just engaging? It's a meaningful distinction because if technology is addictive, the next question could be: are the creators of popular digital technologies, like smartphones and social media apps, intentionally creating things that are addictive? If so, should they be held responsible?

    To answer those questions, we've first got to agree on a definition of "addiction." As it turns out, that's not quite as easy as it sounds.

    If we don't have a good definition of what we're talking about, then we can't properly help people.

    LIAM SATCHELL UNIVERSITY OF WINCHESTER

    "Over the past few decades, a lot of effort has gone into destigmatizing conversations about mental health, which of course is a very good thing," Feifer explains. It also means that medical language has entered into our vernacular —we're now more comfortable using clinical words outside of a specific diagnosis.

    "We've all got that one friend who says, 'Oh, I'm a little bit OCD' or that friend who says, 'Oh, this is my big PTSD moment,'" Liam Satchell, a lecturer in psychology at the University of Winchester and guest on the podcast, says. He's concerned about how the word "addiction" gets tossed around by people with no background in mental health. An increased concern surrounding "tech addiction" isn't actually being driven by concern among psychiatric professionals, he says.

    "These sorts of concerns about things like internet use or social media use haven't come from the psychiatric community as much," Satchell says. "They've come from people who are interested in technology first."

    The casual use of medical language can lead to confusion about what is actually a mental health concern. We need a reliable standard for recognizing, discussing, and ultimately treating psychological conditions.

    "If we don't have a good definition of what we're talking about, then we can't properly help people," Satchell says. That's why, according to Satchell, the psychiatric definition of addiction being based around experiencing distress or significant family, social, or occupational disruption needs to be included in any definition of addiction we may use.

    Too much reading causes... heat rashes?

    But as Feifer points out in his podcast, both popularizing medical language and the fear that new technologies are addictive aren't totally modern phenomena.

    Take, for instance, the concept of "reading mania."

    In the 18th Century, an author named J. G. Heinzmann claimed that people who read too many novels could experience something called "reading mania." This condition, Heinzmann explained, could cause many symptoms, including: "weakening of the eyes, heat rashes, gout, arthritis, hemorrhoids, asthma, apoplexy, pulmonary disease, indigestion, blocking of the bowels, nervous disorder, migraines, epilepsy, hypochondria, and melancholy."

    "That is all very specific! But really, even the term 'reading mania' is medical," Feifer says.

    "Manic episodes are not a joke, folks. But this didn't stop people a century later from applying the same term to wristwatches."

    Indeed, an 1889 piece in the Newcastle Weekly Courant declared: "The watch mania, as it is called, is certainly excessive; indeed it becomes rabid."

    Similar concerns have echoed throughout history about the radio, telephone, TV, and video games.

    "It may sound comical in our modern context, but back then, when those new technologies were the latest distraction, they were probably really engaging. People spent too much time doing them," Feifer says. "And what can we say about that now, having seen it play out over and over and over again? We can say it's common. It's a common behavior. Doesn't mean it's the healthiest one. It's just not a medical problem."

    Few today would argue that novels are in-and-of-themselves addictive — regardless of how voraciously you may have consumed your last favorite novel. So, what happened? Were these things ever addictive — and if not, what was happening in these moments of concern?

    People are complicated, our relationship with new technology is complicated, and addiction is complicated — and our efforts to simplify very complex things, and make generalizations across broad portions of the population, can lead to real harm.

    JASON FEIFER HOST OF BUILD FOR TOMORROW

    There's a risk of pathologizing normal behavior, says Joel Billieux, professor of clinical psychology and psychological assessment at the University of Lausanne in Switzerland, and guest on the podcast. He's on a mission to understand how we can suss out what is truly addictive behavior versus what is normal behavior that we're calling addictive.

    For Billieux and other professionals, this isn't just a rhetorical game. He uses the example of gaming addiction, which has come under increased scrutiny over the past half-decade. The language used around the subject of gaming addiction will determine how behaviors of potential patients are analyzed — and ultimately what treatment is recommended.

    "For a lot of people you can realize that the gaming is actually a coping (mechanism for) social anxiety or trauma or depression," says Billieux.

    "Those cases, of course, you will not necessarily target gaming per se. You will target what caused depression. And then as a result, If you succeed, gaming will diminish."

    In some instances, a person might legitimately be addicted to gaming or technology, and require the corresponding treatment — but that treatment might be the wrong answer for another person.

    "None of this is to discount that for some people, technology is a factor in a mental health problem," says Feifer.

    "I am also not discounting that individual people can use technology such as smartphones or social media to a degree where it has a genuine negative impact on their lives. But the point here to understand is that people are complicated, our relationship with new technology is complicated, and addiction is complicated — and our efforts to simplify very complex things, and make generalizations across broad portions of the population, can lead to real harm."

    Behavioral addiction is a notoriously complex thing for professionals to diagnose — even more so since the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the book professionals use to classify mental disorders, introduced a new idea about addiction in 2013.

    "The DSM-5 grouped substance addiction with gambling addiction — this is the first time that substance addiction was directly categorized with any kind of behavioral addiction," Feifer says.

    "And then, the DSM-5 went a tiny bit further — and proposed that other potentially addictive behaviors require further study."

    This might not sound like that big of a deal to laypeople, but its effect was massive in medicine.

    "Researchers started launching studies — not to see if a behavior like social media use can be addictive, but rather, to start with the assumption that social media use is addictive, and then to see how many people have the addiction," says Feifer.

    Learned helplessness

    The assumption that a lot of us are addicted to technology may itself be harming us by undermining our autonomy and belief that we have agency to create change in our own lives. That's what Nir Eyal, author of the books Hooked and Indistractable, calls 'learned helplessness.'

    "The price of living in a world with so many good things in it is that sometimes we have to learn these new skills, these new behaviors to moderate our use," Eyal says. "One surefire way to not do anything is to believe you are powerless. That's what learned helplessness is all about."

    So if it's not an addiction that most of us are experiencing when we check our phones 90 times a day or are wondering about what our followers are saying on Twitter — then what is it?

    "A choice, a willful choice, and perhaps some people would not agree or would criticize your choices. But I think we cannot consider that as something that is pathological in the clinical sense," says Billieux.

    Of course, for some people technology can be addictive.

    "If something is genuinely interfering with your social or occupational life, and you have no ability to control it, then please seek help," says Feifer.

    But for the vast majority of people, thinking about our use of technology as a choice — albeit not always a healthy one — can be the first step to overcoming unwanted habits.

    For more, be sure to check out the Build for Tomorrow episode here.

    Why the U.S. and Belgium are culture buddies

    The Inglehart-Welzel World Cultural map replaces geographic accuracy with closeness in terms of values.

    According to the latest version of the Inglehart-Welzel World Cultural Map, Belgium and the United States are now each other's closest neighbors in terms of cultural values.

    Credit: World Values Survey, public domain.
    Strange Maps
    • This map replaces geography with another type of closeness: cultural values.
    • Although the groups it depicts have familiar names, their shapes are not.
    • The map makes for strange bedfellows: Brazil next to South Africa and Belgium neighboring the U.S.
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