E Pluribus UNOS: The National Organ Transplant Act and Its Postoperative Complications

Abstract

Thanks to George Orwell's dystopian novel, the year 1984 became a cultural reference point in Cold War America. When January of that iconic year finally arrived, Apple rolled out the Macintosh personal computer with an arresting Super Bowl advertisement, assuring viewers that "1984 won't be like Nineteen Eighty-Four." As the introduction of new technologies generated excitement and apprehension in the mid-1980s, increasingly sophisticated organ transplantation practices seemed to embody the promise and the perils of medicine's future. Orwell's novel remains a cultural touchstone in the twenty-first century, having outlived its immediate political context, and the first Macintoshes, though today considered technological dinosaurs, ushered in the era of personal computing. The National Organ Transplant Act of 1984 (NOTA) likewise left a cultural imprint that would transcend its immediate historical context. The Act's motives, its text, and even its name have largely receded from the public's consciousness, to the extent that they ever were a part of that consciousness. The human organ allocation system that it spawned, however, supplies the news and entertainment media with a steady stream of inspirational stories, suspicious incidents, and ethical conundrums. Amid a persistent scarcity of transplantable organs, salient aspects of organ allocation in the United States-patients waiting for transplantable organs, shocked next-of-kin being asked to consent to the donation of loved ones' organs, institutional protocols for allocating available organs, and the ban on organ purchases--continue to draw academic and public scrutiny. Policyoriented scholars are increasingly revisiting established features of the NOTA system, especially the provision of NOTA that prohibits commerce in human organs, and proposing various modifications. But before this renewed critical interest can develop into an informed policy discussion, a more complete understanding of what NOTA was intended to do, and what it actually ordained, is needed.