Becoming A Secret Santa

What if you had something that you didn't need and giving it to another person would save his or her life?

It seems an apt question in this, the putative season of giving, when it's become axiomatic that much of the holiday run-up consists of the joyless pursuit of something that may well be unwanted and unused.

By contrast, that gift that keeps on giving is something you already have. In other words, organ donation.

If you just thought "what a downer," listen to Roger Altman:

"It's the closest thing I've ever encountered to an authentic miracle. It's the supreme religious experience of your life. You don't say to yourself, boy, is that technology amazing. It's deeper than that, more of a spiritual experience than a physical one."

Altman is no touchy-feely past-lives guru. He's a former deputy secretary of the Treasury and the chairman of an investment-banking firm. Last year the holidays were tough on his wife and three children. His heart condition had deteriorated so much that doctors said his next attack might be his last. He spent five weeks in New York-Presbyterian Hospital, waiting. Then one day his doctors walked into the room and said, "We have a heart."

This is supposed to be an opinion column, but opinion is remarkably unanimous about being an organ donor. In polls the overwhelming majority of Americans agree it is a good thing.

Which makes it curious that in Pennsylvania, which has the highest donor rate in the nation because of a simple motor donor option when a resident gets or renews a driver's license, only about 40 percent sign on. Even that number wouldn't be so bad if it wasn't for an even more astonishing statistic: only slightly more than one out of every hundred people is found to be eligible for donation at the time of death. The organs of the rest can't be used because of the cause or manner of death or other medical issues.

What that means, statistically, is that while more than 80,000 people need transplants, only about 25,000 took place last year. Thousands of people have died waiting. Millions of new prospective donors would help.

One problem is that the education effort around this issue has not really jelled in the public mind, the way the ones around seat-belt use or drunk driving have. There's no good slogan: "Take my heart--please!" seems a little lighthearted, and "the gift of life" is vague. There should be more commercials, and educational programs in schools.

Ironically, the use of technology in a field that may represent its medical zenith is pretty lame. It's easier to buy a laptop on-line than to figure out how to sign up as an organ donor. There's no national database, which would make it simpler if, say, a Pennsylvania driver on the registry in that state wound up in a hospital in New York. And amid all those ubiquitous pop-ups on AOL, why aren't there ones about organ donation instead of mortgage rates?

But the biggest problem is a private one. It's disconcerting to realize, if you have agreed to become an organ donor, that the final decision likely will not be made by you. It will be made by family members standing at your bedside, whose permission will be sought even if you have already given yours. Last year, counselors for the New York Organ Donor Network were able to persuade only 40 percent of the families whose loved ones were suitable candidates. Out of every 10 people, six hearts that could have saved six lives were buried instead of transplanted.

"With few exceptions, when people have had the conversation beforehand, the family goes along," said Elaine Berg, the president and CEO. "But you have to have the conversation."

Not enough people do. Out of frustration there is now talk of compensation to donor families, funeral expenses and the like. But compensation might create more problems than it would solve. Sure, there might be some families, mostly poor, who might think harder if they had such help. And there might be fewer donors at the other end of the spectrum, first moved by altruism, then disgusted by a money motive.

If there is any situation in which altruism still applies, it ought to be this one. On Jan. 30, Roger Altman will celebrate a year with a healthy heart. And he thinks a lot about the fact that, on that same day, the family of a 51-year-old woman who died in Buffalo, N.Y., will be mourning a year without her. Through an intermediary he sent those people, whose name he does not know, a letter of thanks. So far, he has had no reply except for the beating of his heart.

So although it's been said, many times, many ways, herewith a public-service message: sign up to be an organ donor right now, and talk to your family about it. Think of it as a secret Santa gift to a stranger. Oh, and formal notice to those who love me: if the occasion arises, give it all away. I only wish someone could get my brain, so they could figure out where I left my keys.