Intended for healthcare professionals


Meeting the demand for donor organs in the US

BMJ 1999; 319 doi: (Published 27 November 1999) Cite this as: BMJ 1999;319:1382

It's time for bold public policy, such as mandated choice or presumed consent

  1. Ronald M Davis, North American editor (
  1. BMJ

    Personal view p 1445

    Walter Payton, the most accomplished running back in the history of American football, died on 1 November at the age of 45. In February he announced that he had primary sclerosing cholangitis. A liver transplant, it was said, was all that could save him. In contacts with the media and on his personal website (, Payton tried to raise awareness of the need for organ donation. Only after his death did his doctors reveal they had later diagnosed bile duct cancer, which made him ineligible for a transplant. Yet Payton's plight served as a vivid reminder of our failure to supply donor organs to those in need. More than 66 500 patients are waiting for a transplant in the United States,1 and about 4000 Americans will die each year while waiting for organs2—until bold policies are adopted to increase their supply.

    The most contentious policy debate surrounding organ transplantation in the US is the way in which scarce organs are distributed. Organ allocation is overseen by the Organ Procurement and Transplantation Network, a private sector system created by the US Congress in 1984. Currently matching organs are made available first to all listed patients in a local organ procurement area, then to patients in the same region (one of 11), and then nationally. Thus …

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