The huge demand for transplantable organs and tissues may not be solved by expanding the donor pool by adding whole new populations. Part One demonstrated how the quest to alleviate organ shortages has resulted in proposals to use persons as donors that, many argue, fail to make either practical or ethical sense. As a result some in the transplant field and in public policy have turned away from the search for new donor populations. Instead they are seeking ways to maximize the efficiency of the procurement system itself.
The steps involved in organ procurement have not changed drastically during the past few decades. Throughout much of the 1970s and 1980s, procurement policy attempted to address the organ shortage problem in two ways. First, extensive public education programs were launched to increase altruistic organ donation. Second, great efforts were made to increase the administrative efficiency of the existing procurement system. While these efforts did help, it became clear that the future of American organ procurement needed to take a whole new direction.
The fundamental failure of the system prior to 1986 was that the supply of transplantable organs depended solely upon "voluntarism"—altruistic donation which depended on the prospective donor's filling out a donor card. While such a policy made perfect ethical sense in terms of respecting individual autonomy, the huge gap between supply and demand for organs plus the perception that many potential donors were being missed prompted ethicists and policy makers alike to search for more effective laws and policies to increase the supply of organs and tissues.
Instrumental to that policy change were the writings of Arthur Caplan. He asserted that organ donation is a right either of the individual or the