The development of organ transplantation is one of the greatest accomplishments of modern medicine. Unfortunately, supply is not meeting demand. Thousands of people die every year waiting for a life saving organ. According to NORS, the Nebraska Organ Recovery System, "every 16 minutes another name is added to the list of Americans waiting for life saving transplants." As of June 4, 2004, the Organ Procurement and Transplant Network reported 85,707 people on the organ waiting list, 408 of those are people in Nebraska. 206 Nebraskans are in need of a kidney, 130 need a liver, 15 are awaiting a pancreas, 25 need both a kidney and a pancreas, and 14 of those are waiting for a heart.

One organ donor has the potential to save seven lives. One tissue donor can help more than 60 people with their donation. In theory, there could be hundreds of thousands of organs available each year. Unfortunately, according to the Organ Procurement and Transplantation Network, there were only 25,459 organ transplants performed last year.

There are several factors behind the organ shortage. Only a small percentage of people who might serve as organ donors actually do so. The reason for this is that only a small amount of people die in circumstances that make organ donation possible. Other factors include: reluctance to become an organ donor, and family refusal to donate organs of a deceased loved one. Because such a small number of potential donors become actual donors, the question arises as to what kind of policies need to be instituted in order to increase organ availability.

The issue of organ donation also raises several ethical issues. Some feel that procuring organs without family consent shows a lack of respect for the grieving family. Others feel it is unethical to disregard the wishes of the deceased. Despite this ethical debate, the Nebraska legislature has passed LB138, known as First Person Consent, in an effort to increase organ donation. This law states that a legal document indicating an individual's desire to become a donor upon their death will eliminate the need for next of kin consent. This law ensures a person's wishes to be an organ donor will be carried out.

Nebraska residents can register online to become an organ and tissue donor. The Donor Registry will be considered legal declaration of an individual's desire to donate in the event they should die. Once the donor registers online, he or she will receive a notification card in the mail. The donor must sign it and return it to NORS to complete his or her registry. The family of the donor will be notified at the time of death, not for consent of the donation of organs, but instead to inform the family of the decision to be a donor. The family will be asked to provide information about social and medical history as part of the donation process.

Besides being opposed by some, there is another downside to First Person Consent. The Donor Registry is very complex and costly. Registries must make certain that names of registered donors are available immediately upon registration to organ procurement organizations. These names must be able to be accessed 24 hours a day, 7 days a week.

The positive side of First Person Consent is that it shifts the burden of decision-making during a very stressful time, away from the family. The decrease in refusal by donor families will increase the supply of donated organs.

With First Person Consent, a donor's wishes cannot be overruled by his or her family if that person has registered his/her desires with the Donor Registry. The donor's wishes will take precedence. Organ donation also brings up legal issues with autonomy rights. Autonomy rights are designed to protect the interest of individuals, allowing them to pursue interests that they find valuable. Prior to First Person Consent, the question arose as to whose rights and autonomy were being respected, those of the donor or those of the next of kin.

One of the biggest cited reasons for ignoring an organ donor card is fear of being sued. The Uniform Anatomical Gift Act, established in 1968, and adopted in all 50 states in some form or another, recognizes the right of the patient to donate over the family's right to refuse. Therefore, there is little reason to fear liability for acting on a valid donor card.

Without a doubt, there is a huge organ shortage. Medical professionals, lawmakers, and families of hopeful transplant recipients continue to search for a way to save thousands of more lives. To be a part of this effort, register to be a donor. If you choose to do so, be sure to share your wishes with your family. They will take comfort in knowing your wishes were clear and being honored.