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Organ transplantation is like a game of musical chairs- except instead of too few chairs, there are not enough people donating organs. And the stakes are much higher.

An average of 4,000 Americans die each year before they can receive an organ transplant to replace their own sick organs. Transplant professionals are worried that these numbers will continue to rise as the gap between the number of organs available for donation and the number of people waiting grows.

Why is the gap growing? What can be done?

Esther Benenson, a spokeswoman for the United Network for Organ Sharing (UNOS), says it’s because “the waiting list has grown annually at a dramatic rate while the number of donors has stayed constant.”

As medical technology has advanced, organ transplants have become an option in more cases. Today, more than 58,000 Americans are awaiting organ transplants, compared with 16,000 10 years ago. Last year, fewer than one-fourth of those received organs.

It’s a tragedy that so many people die or become sicker while awaiting organ transplants. The problem is that transplantation is a “scary situation in many respects,” Benenson says.

Although living people donate organs, particularly kidneys (we each have two), in most cases organs come from people who have died. Usually, the people have suffered a stroke or brain injury and are declared “brain dead” (without brain function).

Family members will be asked to donate their loved one’s organs if major organs are healthy and still functioning. (Because artificial breathing and a beating heart must be maintained for organ retrieval, a brain-dead patient is kept alive on a ventilator.)

“We have two kidneys, two lungs, a heart, liver, pancreas, corneas, skin, bone, veins, heart valves and eyes that can be donated,” Benenson says.

Why become a potential donor? Ask yourself this, UNOS’s Ken Jenkins says: “If you were in the position to save someone’s life, wouldn’t you?”

A doctor’s request for organ donation can seem like an intrusion into a family’s grief. But Benenson sees it “as an opportunity to keep a loved one alive in some vital way.”

It can also give meaning to a meaningless act of violence. For example, the parents of 14-year-old Nicole Hadley, one of the three girls shot to death in the West Paducah, Ky., schoolyard last December, donated her heart, lungs, kidney, liver and pancreas. Her death gave five people a new chance!

Becoming a potential organ donor is easy. “The best way is to tell your family your wishes,” Jenkins says.

Anyone- even adults who agree to be donors by signing their driver’s licenses or donor cards- can have their wishes overruled by family members. So it’s important that you tell your family that you want to be a potential organ donor and discuss why.

And almost anyone can be a donor. Age is not an obstacle, and all major Western religions support organ donation. Because roughly 2,000 of those waiting for transplants are between the ages of 1 and 17, child donors are needed, Benenson says.

Nobody wants to think of his or her own death. But if tragedy strikes, wouldn’t it perhaps be kind of cool to leave a living part of yourself behind to make somebody else’s life worth living?

FOR BROTHER AND SIS, A REASON FOR SIBLING REVELRY

Billy Young has been counting the days till he can get behind the wheel of his shiny new Jeep.

The Barrington 16-year-old has been champing at the bit to start driver’s ed. Today, his waiting ends.

But for Billy the day is about much more than a quest for a driver’s license. It’s about living a normal life.

Billy was born with malformed kidneys and ultimately would need a kidney transplant to survive. But kidneys don’t grow on trees. A live donor must be at least 18, and a dead donor must be, well, dead.

For most of his childhood, Billy was unable to do many of the things most kids take for granted.

“I couldn’t eat salty foods like french fries or drink many fluids,” he recalls. “I had catheters (drainage tubes) hanging from my chest and spent a lot of time on dialysis” (a machine that helps kidneys function).

Because his condition stunted his growth, Billy was often teased by other kids.

“By 1st grade, things had gotten pretty hard,” he admits. “I didn’t want to go to school because kids mumbled (about me) in the halls.”

After Billy’s first kidney transplant at age 6, he hoped that he’d finally be like other kids. But his body rejected his new kidney after just six months, and Billy suffered life-threatening seizures and high blood pressure. (Rejection occurs because our immune system is geared to attack what it doesn’t recognize- like someone else’s kidney. That’s why it’s usually true that the closer the match between an organ donor and a recipient, the less likely rejection will occur.)

After his first transplant failed, Billy had to wait three years for another. When that transplant failed after seven years Billy was left a bit disheartened and, once again, resigned to waiting.

But then older sister Kelly made him an offer he couldn’t refuse.

Without his knowledge, Kelly had been tested to see if her kidney was a good match for Billy. Because by law, living family members can’t donate an organ until age 18, Kelly waited till her 18th birthday to tell Billy she was a match!

Today, a year after his third and, hopefully, final transplant, Billy is like any other teenage boy. He likes to play baseball and hang out with friends.

No one has to remind Billy who he has to thank for his good fortune. But, just in case he should forget, the license plates on his car serve as a constant reminder and a public thank you to a truly awesome sister.

They read: KEL IOU 1.

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For more on organ donation, call the Illinois Secretary of State’s organ-donor hot line at 800-210-2106. For a donor card, call the United Network for Organ Sharingat 800-243-6667.