Tony Hamel learned of what he calls his "best chance of staying alive" through an e-mail.
Like anyone else, he could have free membership in LifeSharers, a group whose members get preference for one another's organs when they become available. In return, they must register as donors themselves, agreeing to give fellow members first dibs on their organs when they die.
For Mr. Hamel, any increase in his chances of getting a transplant is crucial. The Dallas man's chronic obstructive pulmonary disease led to a lung transplant four years ago, and the new organ has begun to deteriorate. He expects to need a replacement in about two years.
"Because I have COPD, I wouldn't be a priority on a [traditional] list for another lung unless I was almost dead," he said. "And by then, I probably wouldn't survive the operation."
Offering his organs to others seemed a reasonable trade-off for the hope of getting a lung sooner. "If you want to be a taker, you need to be a giver," Mr. Hamel said.
That is the central tenet of LifeSharers, which attempts to harness the power of self-interest to bolster the nation's inadequate supply of donor organs.
But Pam Silvestri, a spokeswoman for the Dallas-based Southwest Transplant Alliance, said the concept behind LifeSharers is a "slippery slope" that her organization doesn't want to traverse.
"For donation to work and to continue to garner public support, everyone on the waiting list has to have a level playing field," she said. "If those on this particular list get 'special access,' what's to stop dozens of lists from being created that allow special access based on other agendas ... race, religion, etc.?"
Dave Undis, who founded LifeSharers in Nashville, Tenn., said his group is both legal and ethical. And, he said, it's only fair that those who agree to be donors should get preference when they need an organ.
"There's nothing exclusive at all about LifeSharers," he said. "Anyone can join, and anyone can join for free. We don't discriminate on any basis whatsoever.
"We are simply trying to make sure that organ donors get their fair share."
Theoretically, if an organ isn't matched among members, it will be offered to those on lists outside the group. The process hasn't been tested, Mr. Undis said, because no one in the group has yet died in a way that would allow for organ donation.
For now, the debate is over the group is largely academic. LifeSharers has fewer than 3,000 members, 250 of them in Texas. But membership is growing rapidly – 38 percent in the last year.
Mr. Undis contends that 70 percent of donated organs go to people who have not agreed to donate their own organs when they die. He deduced that figure from a 1993 Gallup Poll in which about 30 percent of respondents said they had signed a donor card or indicated on their driver's licenses a willingness to donate their organs. (An additional 25 percent said they would be willing to donate but hadn't formally granted permission.)
Ms. Silvestri said Mr. Undis' justification for LifeSharers is faulty because it assumes the general population's attitude matches that of people whose lives depend on transplantation.
"I have never met an organ recipient who did not understand the value of the gift and who would not be willing to do the same for someone else, given the chance," she said.
Mr. Undis said he doesn't understand the resistance from traditional transplant organizations.
"We're on the same side," he said.
He started LifeSharers after reading about the shortage of donor organs and its result: people dying while waiting for transplants. LifeSharers.com went online in 2002 to encourage more people to agree to donation so fewer would die.
If the group practiced exclusionary membership, Mr. Undis said, he would understand the criticism. "But we aren't giving the organs to members of a Nazi organization or something."
Beth Garrison of Mesquite is all for the group.
"A person's organs are their own to give," she said. "Since the majority of people don't donate their organs at all, any organization that increases the donor pool is a step in the right direction."
Ms. Garrison is healthy, fit and doesn't expect to ever need a transplant. Still, the 54-year-old joined LifeSharers as soon as she saw an e-mail about it, and she persuaded her husband to join as well.
"She actually twisted my arm," said Ed Garrison, 60. "But I'm glad that she did, because people become complacent about things like this.
"We look at things we can do to help others. ... If you're not going to make it, do what you can to improve someone else's chances."
Mr. Garrison donates blood several times a year, and the couple recently completed a CPR course. They see membership in LifeSharers as a potential reward for their civic consciousness.
"It might increase our odds if someone in our family needs an organ," Mrs. Garrison said.
Ms. Silvestri said that despite its best intentions, the group could end up hampering the organ-donation process.
"We just don't want to go in that direction," she said. "The group has created an unworkable scenario which could lead to unfairness in organ distribution."
Organs, Ms. Silvestri insists, must go to those who need them most.
Requesting that an organ from a family member go to a friend or acquaintance in need is fine, she said, but confronting the hospital staff with a list of strangers who must get specific organs won't work.
"This isn't practical because the organs might not match anyone in the LifeSharer group," she wrote in a letter, "and the small number of people in that group likely won't ever be in a position to donate. And even if they were, it is unlikely that the others in the group will be on the wait list for an organ."
Mr. Hamel, who has worked with Ms. Silvestri to promote donor awareness, said he realizes any benefit to him from membership in the group may be in the distant future.
"But I think it's something that's going to be a benefit to a lot of people down the road," he said. "What the group proposes, I think, is only right.
"I agree with some of what Pam says, and it could be a problem, sure, but it's also definitely a solution."