How Can We Ethically Increase the Supply of Transplantable Organs?

The waiting list for solid organ transplantation in theUnited States now exceeds 92 000 persons (approxi-mately 67 000 of whom need a kidney transplant), and the list grows longer each year (1). In 2005, more than 28 000 solid organs, mainly kidneys (16 477 kidneys), were trans-planted (1, 2). Not surprisingly, given this gap between supply and demand, vigorous debates have erupted about how best to increase and to allocate the supply of trans-plantable organs. In May 2006, the Institute of Medicine (IOM) re-leased a new report, “Organ Donation: Opportunities for Action ” (2), prepared by a committee charged with studying how to increase the rates of (postmortem) organ donation. This committee, which I chaired, was established at the request and with the support of the Health Resources and Services Administration and the Greenwall Foundation. I