The decision
In addition to the stresses involved in getting or renewing a driver’s license, many Americans find themselves ambushed by an existential question under the harsh fluorescent lighting of their local DMV: Would you like to donate your organs after you die?
At once personal and civic, the question probes some of life’s most complex issues, including the existence of the soul, life after death, and the sanctity of the human body. A slim majority of eligible Americans (about 58%) agree to donate their body parts to those in need, admitting they won’t need their physical forms in the afterlife.
In just the last 50 years, organ donation has become an essential part of medicine. In the US there were over 40,000 transplants last year. But the need is even greater, with over 100,000 Americans on the waiting list for organ transplants at any given time. In fact, 17 people die each day waiting for an organ to become available.
Are you willing to donate a few minutes to learn more?
By the numbers
104,234: Number of people on the US organ transplant waiting list
17: People who die each day waiting for organs
42,000: Transplants performed in 2022
95%: Share of Americans in favor of organ donation
170 million: Americans registered to be organ donors, or about 58% of eligible Americans
0.3%: Share of Americans whose bodies, after their death, are suitable for organ donation
22%: Percent by which women are more likely to be organ donors than men
24%: Percent by which registered Republicans are more likely to be organ donors than Democrats
Explain it like I’m 5!
What happens when you actually become an organ donor?
Brain death: After nurses and doctors do everything possible to save a life, they will declare a patient brain-dead. At that point, the donor’s body becomes supported by machines.
Evaluation: Medical practitioners, employed by the hospital, evaluate the body to see if it is medically suitable for organ donation.
Consultation: If the body is suitable, the doctor will confirm that the patient is an organ donor in a state or national registry. If they are not a donor, the next of kin can give posthumous consent in most cases.
Placement: The appropriate authority will cross-check the patient’s data with the national organ donor waiting list, finding an appropriate match for harvestable organs.
Removal: The organs are surgically removed as soon as possible after death. The surgery is not always invasive, and an open-casket funeral is still possible in many cases. Though we have a podcast episode on green burials that may convince you to explore other options.
Notification: Most organ donation programs will inform the family of the deceased if and where their organs were donated in the weeks following the operation.
Origin story
Ancient organ transplants
The science of organ donation is often considered to have started with the biomedical boom of the 1950s, but speculation about the potential to harvest and transplant living organs goes back thousands of years.
The earliest known reference to the medical procedure comes from a 5th century BCE Taoist text written by the philosopher Liezi. The legend tells the story of an ancient doctor named Bian Que conducting a double heart transplant between a man with a strong will but a weak heart and a man with a weak will and a strong heart, restoring balance to their personalities.
There are other apocryphal accounts of organ transplantation. In the 5th century, a Catholic bishop with a gangrenous leg dreamed that two saints—Cosmo and Damian—appeared in his bedroom and took him to the site of a recently deceased Ethiopian man and switched their legs. When he woke up, his leg was miraculously healthy (and a different skin color).
Skin grafts—a form of organ transplant—started as early as the 16th century, with pioneering Italian surgeon Gaspare Tagliacozzi completing a rudimentary nose job as early as 1596. But, it wasn’t until the 19th century that the modern understanding of organ transplants began, when Nobel laureate Theodor Kocher used thyroid tissue—safely removed from a healthy boy— to transplant into a person suffering from a thyroid deficiency.
This miraculous feat was the basis of modern organ transplants, with the 20th century introducing hundreds of new and successful transplant surgeries—and many more unsuccessful attempts. In 1964, doctors at Tulane University placed chimpanzee kidneys into 13 human patients. All the transplants were initially successful, but the recipients all died within eight months.
Even early human transplants were not successful in the long term. The first recipient of a human-to-human heart transplant, which took place in Cape Town, South Africa in 1967, survived for only 18 days, but was able to speak to his wife and reporters during that time. It wasn’t until the advent of modern immunosuppressants—which allow the body to accept the foreign organ, instead of fighting to expel it—in the 1980s that recipients of these transplants were able to survive longer than a few weeks.
In the decades since this invention, organ donation has become a highly successful operation, making a steady supply of fresh organs from recently deceased donors all the more important.
Quotable
“Lord my body has been a good friend,
But I won’t need it when I reach the end.”
—Cat Stevens, in his song “Miles from Nowhere”
Pop quiz
What animal’s organ currently holds the record as the longest documented case of a successful animal-to-human transplant?
A. Pig
B. Caribou
C. Giraffe
D. The baboon from the 1993 film Untamed Heart who died so that Christian Slater could live
The answer to this anatomy quiz is at the bottom of the email, near your toe bone.
The kidney question
An in-demand organ
Most of us are born with two kidneys, one of which, when donated, can save someone suffering from double kidney failure. Kidney donation is one of the only operations that can be done while the donor is alive (the other is the liver, which can be partially harvested), and is largely safe, with only a 1% increased chance for future kidney failure caused by the lack of a spare organ.
And, according to the Mayo Clinic, Americans are happy to give their spare kidney away to someone who needs it. 84% of respondents to the (decade-old) poll said they would be somewhat or very likely to donate their kidney to a close friend or family member, while 49% said they would consider donating their kidney to a stranger.
This is good news, as kidneys are in demand, with 88,901 patients waiting for one organ on the national transplant waiting list as of January 2023. Still, only 25,498 kidney transplants were performed in 2022, not meeting the waiting list’s demand and meaning some Americans are exaggerating their willingness to donate.
Fun fact
Jerry Orbach, the famous Law and Order and Dirty Dancing actor, made headlines after his death for donating both of his corneas to New Yorkers.
Take me down this 🐰 hole
Religious beliefs about organ donation
Most religious organizations and representatives of major faiths allow adherents to donate their organs.
Major Abrahamic religions like Judaism and Catholicism actively encourage the practice as a final form of charity, while mainline Protestant faiths—as well as sects like Mormonism and Jehovah’s Witnesses—consider it an individual choice. Muslim organizations initially criticized organ donation after the practice became widespread, but in 1995 reversed course and issued a fatwa, or religious edict, encouraging (pdf) followers of Islam to donate their organs.
The vast majority of world religions, including Buddhism and Hinduism, have no official stance on the practice. The Romani people though, who believe the soul retains its physical shape for a year after the body dies, discourage organ donation.
Poll
Would you donate a kidney?
- Yes, to anyone who needs one
- Yes, but only to a loved one
- No, under no circumstances
Let us know, and we’ll keep your answer confidential.
💬 Let’s talk!
In last week’s poll about audiobooks, we asked if you lost something very stirring by walking upstairs to find your kids listening to Mark Twain on headsets. 47% of you said no, and that you would feel you had spawned geniuses; 38% of you were like, no, don’t you mean Minecraft?; and 15% of you are really sticklers for the written page.
🤔 What did you think of today’s email?
💡 What should we obsess over next?
Today’s email was written by Diego Lasarte, (an organ donor), and edited and produced by Annaliese Griffin (missing a kidney, spleen, adrenal gland, and gallbladder).
The answer to the pop quiz is A., Pig. A pig’s kidney lasted in a human body for about two months before it was removed last week at a predetermined date. That’ll do, pig.