Jorge Miranda needs a new liver. He knows it. His wife knows it. Their four kids know it.

And now drivers on the Tri-State Tollway near 95th know it.

The 44-year-old forklift driver from west suburban Berkeley is the "daddy" in a new billboard there that reads: "My Daddy Needs a Liver."

Miranda's own liver is being destroyed by hepatitis C, which he likely acquired from a transfusion nearly 30 years ago. He's on a waiting list, but in the meantime his family has gone public with the controversial billboard and a Web site that aim to get someone to donate a dead loved one's liver directly to him.

Such direct, public pleas are becoming more common, and are causing much concern in the transplant community. Ethicists argue direct solicitations unfairly place the patient ahead of people in more dire need, undermining a system designed to be fair.

"It's basically jumping the queue," said Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania. "Instead of trying to help the person who is going to die the next day, you're giving it someone up on a billboard who may live another year."

Family accepted offer of sign

Miranda and his wife, Laura, have heard the argument and know it well. But unlike others who have paid for organ-pleading billboards, they did not put up the sign themselves. Instead, a woman who read a weekly newspaper's story about Miranda's plight found an anonymous donor who put up what could be as much as $5,000 a month to rent the sign.

The Mirandas accepted the offer, and provided the photo and phone number for the sign.

"If you're hungry and someone handed you a loaf of bread, would you eat it?" asks Laura Miranda.

Said Jorge: "My personal opinion is, you have to be in this position to understand. We're on doctor No. 6, and you're just a number."

The Mirandas and their doctors have traced Jorge's battle to 1976, when his liver was punctured in what he describes as a "gang-related" stabbing. He received several blood transfusions, and likely contracted the hepatitis then, he said.

But he didn't know until 2001 when his wife found him passed out in the yard with their youngest son. An initial misdiagnosis buoyed their spirits at the time but delayed the truth: He was in the end stage of liver disease, and had at most five years to live.

Since then, toxins from his liver have gotten into his brain, making him confused at times and exhausted, his wife said. "He's much worse. I wouldn't think he would make it much longer, at all."

'A gift, not a transaction'

The debate over direct solicitations for organ donations gained widespread publicity last summer when the family of cancer patient Todd Krampitz, 32, put up two billboards in Houston seeking a liver. He got it in August, but his family noted it was not given specifically to him.

More billboards have gone up since, leading the United Network for Organ Sharing last week to formally oppose it -- and recommend that hospitals discourage it.

"Organ donation is a gift, not a transaction," said Dr. Robert Metzger, president of the non-profit, government-chartered network. "Transplant candidates rely on the public's trust in the fairness of the allocation system and support of that system through donation. Public appeals may jeopardize that."

But for Laura Miranda, who has become a vocal advocate for organ donation, her immediate need is right in front of her, dying.

"They shouldn't criticize until they're there," she said. "I pray that they never are, because it's a very dark, ugly place to be."