Figure 3 - from "Organ donation in the US and Europe: The supply vs demand imbalance"

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Sources: https://www.organdonor.gov/statistics-stories/statistics/data.html; https://statistics.eurotransplant.org/; https://www.odt.nhs.uk/statistics-and-reports/annual-activity-report http://www.scandiatransplant.org/data; https: //optn.transplant.hrsa.gov/data/view-data-reports/national-data/#. * Deceased Donor Type Organs for EuroTransplant include: Heart, Kidney, Lung, Liver (plus split liver), Pancreas (plus pancreatic islets). Living Donor Type Organs for Eurotransplat include: Heart, Kidney, Lung, Liver (plus split liver). For ScandiaTransplant only kidney and liver deceased and living donor data are included. US and UK data include: Kidney, Heart, Lun, Liver, and Pancreas both for deceased and living donors. > Deceased Donors include: DCD and DBD donors. © Living Organ Donors (LOD) for France, Italy, and Spain include kidney and liver transplants only. 4 EuroTransplant is an international collaboration between the following countries: Austria, Belgium, Croatia, Germany, Hungary, Luxembourg, the Netherlands, and Slovenia. © ScandiaTransplant is an international collaboration between the following countries: Denmark, Finland, Iceland, Norway, Sweden, and Estonia. Total donor type count by year and region. Table 2

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Contents Organ donation and transplantation remain the best and most cost-effective clinical solution for end-stage organ failure. Several agencies across the US and Europe provide legislative, regulatory, and humanitarian services to generate smoother applications in all transplantation processes and donor-recipient relationships. US and European statistics present nine types of grafts, with kidneys being the most transplanted organ worldwide. However, organ shortage, religion, underrepresented minority groups, difficulties in obtaining consent, lack of understanding, and general ethical concerns present challenging barriers to organ donation, reflecting the com- plexity of graft procurement and allocation. Breaking down these barriers to reduce the organ-supply imbalance requires an appropriate multifaceted approach. Some of the key areas include increasing the potential donor pool and consent rates, apt organ allocation, and improving organ health. Additionally, suitable policies and standard- ized guidelines for both donors and recipients, alongside educational initiatives, are needed to ensure patient safety and global awareness. Looking forward, novel and effective research plans and initiatives are needed if we are to avoid a colossal supply-demand gap. Keywords: Organ donation Organ donor Organ transplant Donation after brain death Donation after circulatory death Organ shortage

Fig. 1. Total number of transplants in 2019 for all US regions. “US Regions: Region 1: Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island. Region 2: D.C. Delaware, Marylan New Jersey, Pennsylvania, West Virginia. Region 3: Alabama, Arkansas, Florida, Georgia, Louisiana, Mississippi, Puerto Rico. Region 4: Oklahoma, Texas. Region 5: Arizona, Californi. Nevada, New Mexico, Utah. Region 6: Alaska, Hawaii, Idaho, Montana, Oregon, Washington. Region 7: Illinois, Minnesota, North Dakota, South Dakota, Wisconsin. Region 8: Colorad Iowa, Kansas, Missouri, Nebraska, Wyoming. Region 9: New York, Vermont. Region 10: Indiana, Michigan, Ohio. Region 11: Kentucky, North Carolina, South Carolina, Tennesse Virginia. **Deceased Donors include: DCD and DBD donors. Source: https://optn.transplant.hrsa.gov/data/view-data-reports/regional-data/.

Fig. 2. Total number of transplants in the US and Europe for kidney, liver, lung, heart, and pancreas in 2018. * Eurotransplant is an international collaboration between the following coun- tries: Austria, Belgium, Croatia, Germany, Hungary, Luxembourg, the Netherlands, and Slovenia. ** Scandiatransplant is an international collaboration between the following countries: Denmark, Finland, Iceland, Norway, Sweden, and Estonia. Sources: https://optn.transplant.hrsa.gov/data/view-data-reports/national-data/; https://statistics.eurotransplant.org/; https://www.odt.nhs.uk/statistics-and-reports/annual-activity-report/; http://www.scandiatransplant.org/data; http://www.transplant-observatory.org/.

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Angeliki Koukoura, Angeliki Koukoura

Organ donation in the US and Europe: The supply vs demand imbalance

Abstract: a r t i c l e i n f o Available online xxxx Keywords: Organ donation Organ donor Organ transplant Donation after brain death Donation after circulatory death Organ shortage Organ donation and transplantation remain the best and most cost-effective clinical solution for end-stage organ failure. Several agencies across the US and Europe provide legislative, regulatory, and humanitarian services to generate smoother applications in all transplantation processes and donor-recipient relationships. US and European statistics present nine types of grafts, with kidneys being the most transplanted organ worldwide. However, organ shortage, religion, underrepresented minority groups, difficulties in obtaining consent, lack of understanding, and general ethical concerns present challenging barriers to organ donation, reflecting the complexity of graft procurement and allocation. Breaking down these barriers to reduce the organ-supply imbalance requires an appropriate multifaceted approach. Some of the key areas include increasing the potential donor pool and consent rates, apt organ allocation, and improving organ health. Additionally, suitable policies and standardized guidelines for both donors and recipients, alongside educational initiatives, are needed to ensure patient safety and global awareness. Looking forward, novel and effective research plans and initiatives are needed if we are to avoid a colossal supply-demand gap.

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Organ Donation: Demand and Supply

Abstract: With its widening indications, the need for organ transplantation is growing globally. Currently, there is a crisis of organ shortage and a dire need to adopt ways and means to overcome it to save lives and improve the quality of life of patients with end-stage organ failure. In this regard, on the one hand, efforts should be made to eliminate the barriers to organ donation, such as people’s ignorance about organ donation and ethical and religious concerns. On the other hand, strategies should be implemented to enhance organ donation, which in the case of deceased donors, include accelerating the donation process, instituting a policy of presumed or mandated consent, and utilizing extended criteria for donors. In the case of living donors, these include accepting the paired donation and removing disincentives to donation. Organ donation can also be boosted by allowing restricted compensation or reward. Using social media platforms to educate people, facilitate contacts, and match with unspecified donors is also worthwhile. In the future, xenotransplantation is also showing some promise.

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Mirela Busic

Organ donation and transplantation: a multi-stakeholder call to action

Abstract: Although overall donation and transplantation activity is higher in Europe than on other continents, differences between European countries in almost every aspect of transplantation activity (for example, in the number of transplantations, the number of people with a functioning graft, in rates of living versus deceased donation, and in the use of expanded criteria donors) suggest that there is ample room for improvement. Herein we review the policy and clinical measures that should be considered to increase access to transplantation and improve post-transplantation outcomes. This Roadmap, generated by a group of major European stakeholders collaborating within a Thematic Network, presents an outline of the challenges to increasing transplantation rates and proposes 12 key areas along with specific measures that should be considered to promote transplantation. This framework can be adopted by countries and institutions that are interested in advancing transplantation, both within and outside the European Union. Within this framework, a priority ranking of initiatives is suggested that could serve as the basis for a new European Union Action Plan on Organ Donation and Transplantation.

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Abstract: A discrepancy exists between the demand for and the availability of solid organs for transplant. [1] This discrepancy represents a major public health concern, given the unnecessary loss of life associated with an inability to provide necessary organs. Change requires an increase in the number of registered donors, as well as the actual procurement of organs from potential donors. Organ donation is dependent on the existence of appropriate conditions at a series of steps from the individual, the family, the health professionals involved, and the policy context in which each of these factors exist. Several key barriers emerge at each of these steps, and effecting change could have synergistic benefits for rates of organ donation overall. The purpose of this commentary is to explore some of these issues in more depth and to identify possible future directions for efforts to tackle this problem.

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Robert Dingwall

A Question of Give and Take: Improving the supply of donor organs for transplantation. Kings Fund Research Report 18

Abstract: Final Report of a 1995 project commissioned by the Kings Fund to examine the law, ethics and practicality of presuming the consent of potential organ donors to the use of their organs in transplantation surgery. The conclusion was that this change was unlikely to increase the supply of organs and created ethical problems. It would be no more than a gesture that would disappoint potential recipients and could lead to conflict between some faith groups and the medical profession.

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Alex Capron, Alexander Capron

SIX DECADES OF ORGAN DONATION AND THE CHALLENGES THAT SHIFTING THE UNITED STATES TO A MARKET SYSTEM WOULD CREATE AROUND THE WORLD

Abstract: Since the beginning of human kidney transplantation six decades ago, and especially since the first heart transplant and the creation of deceased-donation programs forty-five years ago in the United States, the Western model for organ donation has been one of unpaid giving. Such a donation typically occurs for what are termed " altruistic " reasons, meaning that the organ donor is not acting for material gain. As transplantation has spread around the world, the model of unpaid donation has not uniformly followed it into settings that are socially, medically, and legally very different. Nonetheless, over the past twenty-five years, the principled stand of intergovernmental and professional organizations has come much closer to making noncommercial organ donation truly the universal ethical norm. But its hold remains tenuous, and hence the gains made in protecting vulnerable, desperate organ sellers against exploitation could be easily lost.

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