Grateful he was able to help his brother, Epstein was also deeply sorry for the thousands of patients each year who do not get transplants in time.
``Why aren't there enough organs to save everyone's life?'' he asked.
The solution jolted him awake at 3 o'clock one morning about two years ago. The Bucks County man, who made his fortune in car sales and commercial real estate and retired at 37, conceived Project Donor as the answer.
The proposal is deceptively simple and controversial. First, create a national database of people who agree to become organ donors and then treat signed organ-donor cards as legal consent. Then have the federal government administer $10,000 life insurance policies payable to beneficiaries of organ donors.
Today Epstein, 59, is in Washington with the project's coauthor, veterinarian Alan W. Boessman, a liver-transplant recipient from Reno, Nev., hoping to pitch his plan to a congressional subcommittee.
``Somebody is finally going to listen to us,'' Epstein said. He said he had spent countless hours and as much as $50,000 of his own money developing Project Donor.
Epstein is bringing a check for $100,000 to pay the first 10 donors' beneficiaries under his plan. ``In my mind,'' Epstein said, ``it's the $100,000 I never had to use when I got the heart for Wesley.''
U.S. Rep. James C. Greenwood, (R., Pa.) said he would present Epstein's plan to the Health and Environmental subcommittee of the House Commerce Committee.
``I think you could make a pretty cogent argument that Gene's proposal could save the government money, especially treating those with long, chronic diseases,'' Greenwood said. ``The big issue is the ethical one.''
In current practice, organ-procurement officials say, virtually no surgeon or hospital will recover organs before the patient's family gives permission, even from someone who carries a signed donor card or a driver's license that says ``organ donor.''
Epstein calls the Pennsylvania driver's license registry, which has nearly 3 million declared donors, ``completely meaningless.''
Giving legal weight to what is now treated as just an indication of one's wishes would by itself save time and lives, he argues.
But the real gains, Epstein says, would come from the second part of his plan: a financial incentive - a free, $10,000 federally administered life-insurance policy - to anyone who agrees to become an organ donor. Payable to any named beneficiary, the benefit would kick in only if at least one vital organ - kidney, liver, heart, lung, pancreas or colon - were successfully recovered for transplant.
That idea disturbs many people.
``I believe you are more likely to get a punch in the jaw than a consent if you offer money for a child's heart or liver,'' said Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania.
But Epstein, the pragmatist, shrugs off that criticism.
``While all these experts are saying this is wrong, people are dying like flies,'' Epstein said.
``With this program, in 18 months we could make waiting lists obsolete,'' Epstein said.
Project Donor has drawn the support of about two dozen doctors, organ-procurement organizations (OPOs) and transplant support groups, Epstein said.
Others see mostly problems.
``There's not an OPO in the country that would want to face this test of removing someone's organ without family consent, even if the individual was on some registry,'' said Joshua Miller, a transplant surgeon from the University of Miami Hospital and president of the American Association of Transplant Surgeons.
That may not be entirely true in Pennsylvania.
Since March 1994, when Pennsylvania Act 102 created the driver's license donor registry, the organ-procurement organization for the western half of the state has taken that registry seriously. The group, the Center for Organ Research and Education in Pittsburgh, has treated a driver's license that says ``organ donor'' as the only consent it needs, executive director Brian Broznick said.
So far, Broznick said, they have not encountered a family that refused, after a representative explained that the deceased relative had chosen organ donation. If any family does refuse, Broznick said, it is the organization's policy to respect the donor's wishes.
There are other fears, that demand for organs will result in their sale, even from nonterminal donors.
``There are some people who won't even carry a donor card because they think they won't get aggressive medical care,'' Caplan said.
Those who look aghast at mixing money with transplantation overlook the fact that money is already a factor, Broznick said.
``Everybody gets paid but the donor family,'' he said. ``I get paid, my staff gets paid, the hospital gets paid, the surgeons get paid, insurance companies get paid. Why is the donor expected to do it for free?''
Project Donor coauthor Boessman called buying and selling organs ``vile and disgusting.''
He compared his plan to the dismemberment clause in a free insurance policy his credit card company offers.
``If Project Donor is payment for organs,'' he said, ``then Visa is offering me money to relinquish one of my limbs.''
Nathan Kolbes lives on the seventh floor of Temple University Hospital, in what he and his ward-mates call the ``Heart Failure Hotel.''
The 57-year-old Huntingdon Valley resident suffers from cardiomyopathy, a critically weakened heart muscle.
``When you get to this point,'' he said, ``you get a heart transplant or you die.''
Still, Kolbes said he was uneasy with the idea of financial incentives, even if it brought more donor organs.
Alongside the ethical concerns are the practical ones.
Critics point out that if all 5,700 donors in 1998, for example, had been enrolled in the program, paying out benefits would have cost $57 million.
Project Donor calls for the government and the insurance industry to co-fund the program, using money they save by getting those who need transplants off the waiting lists and onto operating tables.
``After a year, the numbers pay the government to get into this program,'' Epstein said.
Medicare records show that in 1997, the federal government paid out nearly $600 million to hospitalize people with kidney failure.
For those awaiting heart, lung, heart-lung and liver transplants, monthly medical costs average $8,900, according to insurance industry figures. The median wait time for a liver transplant in 1996 was more than 12 months.
Many in the transplant community, such as Kevin Sparkman of the Delaware Valley Transplant Program, say the answer is to educate people about the benefits of organ donation and persuade them to sit down with their families and discuss it.
``We have been trying that crap for 20 years,'' Epstein said. ``People are dying.''
