The U.S. transplant system is celebrating a record high in organ donations, with a notable rise in donations after circulatory death (DCD). As the demand for organ transplants soars globally, a new concern is coming into sharper focus: whether the drive to increase transplant numbers might be compromising donor safety.

A recent investigation by The New York Times uncovered alarming cases in which donor safety might be compromised for the sake of transplant growth, with several case reports. The transplant teams in the U.S. are in a race against the clock to get the organ. However, an intensive push for increased transplants revealed the unfortunate side of the story: possible donors encountering rushed decisions and medical teams reaching their limits.

The federal government has outlined the performance metrics based on the number of transplants, thus putting the organ procurement organizations (OPOs) at risk if they do not deliver. Some insiders are of the opinion that this produces wrong incentives - showing the potential donors not as patients first, but as organs ready to be harvested. Supporters of the system argue that the process of donation is safe, necessary, and well-regulated. However, many ethicists and donor advocates point out that the broadening of DCD needs to be accompanied by drastic measures: waiting periods that are much longer, transparency that is much better, and safeguards that prevent rushed decisions. While over 43,500 DCD transplants have saved lives in recent years, any compromise in donor respect, consent, or safety threatens the ethical integrity of the program.