Should organ donor ship be assumed?

[legion]

As it stands at the moment (in the UK) one must carry a donor card or be signed up to the organ donor register (http://www.nikrf.org.uk/NODR.htm) before any of your organs or tissues can be retained for use after your death.

The British Medical Association would like to change the way organs are currently donated. They would like to see a system in which organ donor ship is assumed unless one has actively opted out of donating (http://news.bbc.co.uk/1/hi/wales/788737.stm).

What objections, if any, would you have if the BMA's suggested system were to be implemented?

[lee]

As it stands at the moment (in the UK) one must carry a donor card or be signed up to the organ donor register (http://www.nikrf.org.uk/NODR.htm) before any of your organs or tissues can be retained for use after your death.

The British Medical Association would like to change the way organs are currently donated. They would like to see a system in which organ donor ship is assumed unless one has actively opted out of donating (http://news.bbc.co.uk/1/hi/wales/788737.stm).

What objections, if any, would you have if the BMA's suggested system were to be implemented?

Some believe that for your body to remain alive after you die makes you a zombie. They have religious objections to this. It can be a nightmare for a family who believes this. There are other religions that believe that the body must remain intact for the afterlife. Again, the family that stay behind can be quite distressed by knowing their loved one will not be waiting for them in the afterlife.

[Ross]

Opting out would have to be made rather easier than giving blood - even using the internet it took me a good few years to establish where and when I could donate in Scotland. The organ donation scheme seems to have strong links with the blood donation one in the UK, so it's to be hoped their public relations sides will dramatically improve.

imho it should be assumed, but then I don't have any objections to donation anyway. I believe some religious groups object.

[sghoul]

Simple, make it so that in order to be considered for organ transplant (as a recipient) you need to have been a donor for X ammount of time. Seems fair. You want to have other people hand over their parts, you should be equally willing. I think that would spike the number of people who sign up.


On the reverse, you could make that the default, you simply need for the process of turning off that default be easy and advertised (so that everyone knows what the default is).

[My Darn Snake Legs]

I am not actually sure how organ donation works in the States. I think that it it up to the family of the person donating if they are no longer able to voice their opinion. I do think that it should be left up to the desceased or family thereof. A living will would be able to clear up the matter of donation or not.

I know that when I got my first driver's liscense they asked me and that when I got my second it was not even listed.

[MissTake]

I like the idea of being able to 'opt out', but otherwise becoming an automatic donor. I can understand religious beliefs keeping those from donating, but I'm going to take a guess and state that the percentage of those people wouldn't be terribly high.

We need to do something. Too many people are dying waiting.

[theR]

I am not actually sure how organ donation works in the States. I think that it it up to the family of the person donating if they are no longer able to voice their opinion. I do think that it should be left up to the desceased or family thereof. A living will would be able to clear up the matter of donation or not.

I know that when I got my first driver's liscense they asked me and that when I got my second it was not even listed.

It probably is still listed. My old license used to say "ORGAN DONOR" in big letters on the back, if I recall correctly, but my current license just has a little "Donor" with "yes" under it that is the same size as all the other information, like hair color, eye color, etc. I don't recall if they ask every time I renew my license or if it is assumed that you haven't changed, so maybe they forgot to ask you and it only lists something if you are a donor? I think it is typical to have the information on driver's licenses in the USA. If there is no information on a person's donor status available to the hospital, then I believe the family is asked.

[Bromley]

Well I'd be all for making it mandatory, but that's why the UK has elected officials and not me.

In the real world, I'm happy to settle for an assumed system. Organ anti-donor cards should be printed up in large numbers and made available at surgeries and at hospitals (where a religious (or indeed any) organisation would be able to pick up boxes of them for their members, if they wish).

Anti-donors should probably leave a card with their next of kin to avoid any problems if they're not carrying their card when they die. Ideally, your donation state could be changed online as well, but that would require you to know/find out your NHS number.

I like sghoul's idea - if you opt out, then you opt out of both ends of the process. Can't see anyone managing to push that through though.

[GorillaMan]

I'm all for an opt-out system.

As a passionate atheist (yes they exist :p ) ....I'd hate to think that anybody would worry that I 'might' have dislikes for such procedures, once I'm dead. At least my whole family would have no doubts about my expectations.

I do think the opt-out system is excellent. After all, if anybody is passionate enough to believe xyz about their afterlife, surely they have the commitment to fill out the form to say "no thankyou"? IIRC, Austria already operates such a system.

[Binarydrone]

[QUOTE=sghoul]Simple, make it so that in order to be considered for organ transplant (as a recipient) you need to have been a donor for X ammount of time. Seems fair. You want to have other people hand over their parts, you should be equally willing. I think that would spike the number of people who sign up...[QUOTE]
Sort of, but perhaps something a little less punitive.

What about this: You found an Organ Donors Club. In joining, you must agree to donate all harvestable organs in the event of your death. The benefit is that the members of this organization get first shot at any available organs in the event that they need them. There would be a special dispensation for minors, naturally, until they reach adulthood (in which case they get bumped to the back of the line like everyone else unless they join).

One big thing would be that this group would need to have a veritable legion of rabid lawyers so that it was quickly established that you just do not fuck with them. I am seeing, for example, in the event that the family tries to prevent the donation of a members organs (which would probably work the first few times with injunctions and delays and the like) that these lawyers figure out who would have received the organs and charge that family with wrongful death. I am talking about Uber-Lawyers with freaking laser beams here! They would need to behave as if time and money were not a factor in protecting the interests of the organ bank.

I would also add as a variant that in order to have a license to operate a motorcycle that being an organ donor be mandatory.

[legion]

Simple, make it so that in order to be considered for organ transplant (as a recipient) you need to have been a donor for X ammount of time. Seems fair. You want to have other people hand over their parts, you should be equally willing. I think that would spike the number of people who sign up.




Maybe not so simple for a doctor. I'm not sure they would appreciate being put in the position of telling someone, "What's that buddy? Now you want a kidney to keep you alive? Sorry mate, can't help you. Should have thought of that a bit earlier, shouldn't you?"

[John Mace]

I find the idea of an "opt out" plan to be abhorent.

The most basic tenet of a free society must be that a person owns his own body. I see no reason that this should change due one's death. In that case, the decision should fall to next-of-kin.

[Ross]

The opt out does not deny that one may own one's own body (otherwise you couldn't opt out). However by simply setting donation as the default if no opt-out is signed, it puts the balance in favour of the living rather than the dead. Which is also something a free society might find useful.

[kath94]

Can I join the argument? As much as I like the "opt-out" plan, I can see immediately how it can be abused. Can't reach the next of kin? Can't find an opt-out card on the patient? Those organs are up for grabs. What if the next of kin couldn't be found because the organs were needed? What if the opt-out card goes missing because of the urgency to transplant viable organs?

I personally like Binarydrone's Organ Donor's Club. I'm in! Then, again, I filled out my donor card and placed the pink "donor" dot on the front of my driver license (one of the ways it's done in the US) from the day I got my first one on my 16th birthday. If any bits of me can help anyone else once I'm technically "gone," all the better.

[John Mace]

The opt out does not deny that one may own one's own body (otherwise you couldn't opt out). However by simply setting donation as the default if no opt-out is signed, it puts the balance in favour of the living rather than the dead. Which is also something a free society might find useful.

I disagree. A free society would assume that one owns one's own body unless one agrees to "sell" it. The parallel I see is "legal unless the law says you can't do it" and "illegal unless the law says you can do it".

[John Mace]

Also, the "opt out" plan, when taken to its logical conclusion, would lead to "no will = your property belongs to the state". If a person dies without explicitly leaving his property to an heir, let's just take it and use it for the medical expenses of somone who "needs" it. Create a new list for people who can't aford some expensive, life-saving procedure. It's your lucky day when some schmo dies without a will.

No way would I agree to this type of system.

[legion]

Can I join the argument? As much as I like the "opt-out" plan, I can see immediately how it can be abused. Can't reach the next of kin? Can't find an opt-out card on the patient? Those organs are up for grabs. What if the next of kin couldn't be found because the organs were needed? What if the opt-out card goes missing because of the urgency to transplant viable organs?



In the UK there is a National Register (http://www.nhsorgandonor.net/cgi-bin/donor_register.cgi) of people who wish to make their organs available for transplant upon their death. No worries about looking for lost or "missing" donor cards, no need to question next of kin. A simple query of the register reveals whether you are a donor or not.

If organ donor ship were to become assumed, we just need a national register of people who do not wish to become donors.

[Zagadka]

Personal beliefs aside, ASSUMING to do anything with someone's body after they die is asinine. The only thing that should be assumed is to contact the spouse, next of kin and/or other designated parties. Organ donorship should be a wholly voluntary manner, not an opt-out manner.

What should be done is programs to educate people to volunteer for organ donation, not force them to bend over backwards to opt out of a program.

Why not ASSUME that everyone wants to be cremated, too?

There are enough medical mix ups with organ donorship as it stands for someone to, I dunno, die without their wallet handy, and be sliced and diced against their wishes. You can only harvest organs so long after the deceased has passed, you know - there isn't always time to conduct an in depth investigation of the person's belief structure.

Personally, I want them to rip everything useful out of me they can and burn me to cinders, but I wouldn't assume that anyone else wants similar services unless they asked for it.

[legion]

Can I join the argument? As much as I like the "opt-out" plan, I can see immediately how it can be abused. Can't reach the next of kin? Can't find an opt-out card on the patient? Those organs are up for grabs. What if the next of kin couldn't be found because the organs were needed? What if the opt-out card goes missing because of the urgency to transplant viable organs?


In the UK we have, in addition to donor cards, a National Register (http://www.nhsorgandonor.net/cgi-bin/donor_register.cgi) of donors. Should assumption of donor ship come about, we simply need a National Register of anti-donors. No missing/lost anti-donor card issues, no intrusive questioning of grieving relatives.

[legion]

Damn those hamsters!

[John Mace]

In the UK there is a National Register (http://www.nhsorgandonor.net/cgi-bin/donor_register.cgi) of people who wish to make their organs available for transplant upon their death. No worries about looking for lost or "missing" donor cards, no need to question next of kin. A simple query of the register reveals whether you are a donor or not.

If organ donor ship were to become assumed, we just need a national register of people who do not wish to become donors.

Surely you are aware of how easily a database error can occur. There is plenty to worry about in this type of system, especially if you're name is John Smith, Ganesh Singh, Anh Nguyen, or Pedro Gonzales.

[legion]

Surely you are aware of how easily a database error can occur. There is plenty to worry about in this type of system, especially if you're name is John Smith, Ganesh Singh, Anh Nguyen, or Pedro Gonzales.

Well, obviously, any national Register - be it of donors or anti-donors - is going to have more information than just your name. Information that would lead to, in most cases, a positive ID. No positive ID, no takee organs. No problem.

[Zagadka]

Here's another concept.

Let's have it assumed that on death, every person will donate their estate to the federal government out of interest to better the nation.

The concept of a "free nation" means that people won't always do the "morally right thing." That is the inherent risk of that thing called "freedom." Forcing people to give up their freedom in the interest of a supposed moral choice

[Zagadka]

Whoops, didn't finish that ;-)

Forcing people to give up their freedom in the interest of a supposed moral choice, even if they can opt out of it, is against the very principal of a free nation.

Why not assume that people are going to vote for the incumbant?

[GorillaMan]

We don't let dead people vote......


I guess the question is the rights of the deceased - any rights one has while alive are irrelevant. Are all the rights immediately transfered to the next-of-kin, or should other factors prevail?

[lavenderviolet]

I think opt-out would be a great idea. Liver failure is a horrible way to die and it is tragic that so many suffer and die while perfectly good organs go to waste simply because the deceased never bothered to get on the organ donor registry.

I don't think that an opt-out system would infringe on rights as long as the choice was there for everyone. The best analogy I can think of would be to CPR and "do not resuscitate" orders. Much like organ donation, CPR is a potentially traumatic procedure to perform on a body (broken ribs and brain damage from oxygen deprivation, for example), but yet it makes sense for hospitals to assume that you don't have a strong aversion to CPR if you haven't made your wishes known by getting a DNR. Likewise, I think it makes sense for hospitals to assume that if you haven't made your wishes to avoid donating organs known, you don't have a strong aversion to it.
The important thing is to give everyone a choice to opt out.

[Zagadka]

Increasingly hard to play devil's advocate here, but here goes... Sorry if it is half-assed.

Having your life saved and having your eyeballs ripped out can't be placed side by side and considered the same thing.

There is no social or legal precedent to require you to save someone's life. If someone is on fire, you aren't required to put them out - and the law does not assume that you would. Neither does it assume anything. You have to make a conscious choice to do something in the eyes of the law. The first time someone slipped up and someone had their eyes removed, or an individual was a John/Jane Doe, or was not informed of the practice (however silly that may seem), there would be legal hell to pay from the family of the deceased.

Secondly, many (most?) organs aren't removed and stored in vaults for years and years to be used at convenience. They have a relatively short life (er, death) span - generally, if a match happens to be found at the right place at the right time, there is a hell of a rush to get it to someone it can save. With the proposed system, there would be a vast surplus of available material that would not only swamp the system and possibly lead to more errors in transplants, but result in much waste.

Thirdly, paranoid as it may seem, doctors assuming that a patient will donate may be more likely to declare that patient dead in the interest of getting at a specific organ they need. In fact, this is a major cause of people to NOT donate organs. The last thing we need is more people being paranoid of the process.

What is needed is more education about the process or possibly rewards for donating.

[Ross]

It's just awful, horrible, AGONISING that that little one year old girl died for want of a heart donor, and of course it's hugely awful and appalling and heart-rending whenever it happens to anyone.

Assuming that the argument for personal freedom from this opt-out scheme stands, if it really HAS to be an opt-in scheme instead I hope the advertising gets a lot stronger. No more abstracts - I want minute-long interviews with bereaved parents, spouses, children. Relatives of those who died for want of a transplant organ, as well as those who survived because of one.

I'm sure I remember hearing something recently about how even if one carries a donor card, one's family may decide to refuse. It seems to be argued (here at least) that carrying the donor card and talking to your family about it is a way of convincing your family NOT to withhold that permission when the time comes.

If it is in any way defensible to reduce civil liberties in the name of the current "war against terror", is it not at least as defensible to do it in the name of the "war against premature death"?

[Zagadka]

That is assuming that it is defensible to deny rights for the "war on terror." I don't see how that enters into it in any case whatsoever - otherwise, the "war on terror" will be used to justify removing civil liberties of every type. What's next, censorship of anti-government ideas? I mean, after all, it is alright, because other liberties have been curtailed. How about a law forcing you to act to save someone's life? Would that lead to justified murders? Is it also not agonizing that thousands of children die of starvation every day? Should there be a law that forces us to give them food? In the "war against premature death", would insurance companies be legally responsible for not distributing medicine to every person, whether they could afford it or not? Why not assume that everyone wants to donate their body to medical science. After all, that can help to save other people's lives, in an indirect way.

[Ross]

That is assuming that it is defensible to deny rights for the "war on terror." I don't see how that enters into it in any case whatsoever - otherwise, the "war on terror" will be used to justify removing civil liberties of every type. What's next, censorship of anti-government ideas? I mean, after all, it is alright, because other liberties have been curtailed.
That was why I said "if" it's defensible. Someone clearly thinks it is. And I'm not entirely happy that the next step after a donor opt-out system is the censorship of anti-government ideas.

How about a law forcing you to act to save someone's life? Would that lead to justified murders?
I don't know, but is that in itself a reason not to have such a law? And anyway what's the good samaritan law? I always thought it did demand such actions but I may be wrong going by what you've said - could someone elucidate?

Is it also not agonizing that thousands of children die of starvation every day? Should there be a law that forces us to give them food?
Well... now you come to mention it... I wouldn't mind hearing the arguments against that, too...

In the "war against premature death", would insurance companies be legally responsible for not distributing medicine to every person, whether they could afford it or not?
No idea. Don't know anything about insurance, being the relatively healthy product of a socialised medical service, but I certainly think pharmaceutical companies should be legally (and morally) responsible for hampering distribution of medicine to those it could help in the name of profit.

Why not assume that everyone wants to donate their body to medical science. After all, that can help to save other people's lives, in an indirect way.
Not a bad idea. Not that I know anything about that either.

It's just that... what argument is there for denying the opt-out position that does not involve the symbolic withholding of life-giving organs for the sake of proving a point? Don't get me wrong, freedom and self-determination are IMPORTANT... but these deaths are pretty real too. Are there figures on how many actually die annually for want of a donor? That might make things clearer.

[Abbie Carmichael]

Awesome idea, I think. Those that are opposed to it can opt out, or their families can speak up and keep it from happening.

I think it sucks that the dead person's family can stop organ harvesting even if they said they wanted it :( (At least they can around here ...)

It seems so silly to me to die and take your organs with you for no reason. :(

[legion]

...Why not assume that everyone wants to donate their body to medical science. After all, that can help to save other people's lives, in an indirect way.

Aha Zagadka! Your efforts (admirable as they were) at playing devils advocate have led you full circle! The OP in a nutshell!

~ Pets fluffy white cat ~

[Zagadka]

hehe. Yea, well, I give up. I can only think of so many reasons why someone would be opposed to this, and I don't want to start repeating the same arguments over and over again. Unfortunately, I think that most people who read these forums are fairly educated, and are educated enough to be pro-donorship. I don't know if we'll find many people who would protest this too much, which is sad, because that is what we need for a debate. I just hate when things are one sided.

*shrugs*

I'd like to hear from, though, a) a lawyer re: good samaritan laws, and b) a doctor, re: shelf life of implants.

[jastu]

As a person awaiting a transplant, I am naturally very much in favour of the opt out system.

I have always been in favour of organ donation and I think approaching relatives for permission at the time of death, more often than not result in refusals.

Unfortunately there are precious few willing to donate.

[Abbie Carmichael]

Unfortunately there are precious few willing to donate.

WHY are they so unwilling, though?

Is it because they're too lazy to sign their driver's license and tell their family?
Does the thought of having their organs harvested bother them?
Are they just not educated as to HOW MANY lives they could save?

I can understand not doing it for religious reasons but I can't understand the "I just don't want to" reasoning.

[GorillaMan]

Thirdly, paranoid as it may seem, doctors assuming that a patient will donate may be more likely to declare that patient dead in the interest of getting at a specific organ they need. In fact, this is a major cause of people to NOT donate organs.
In the one situation I have detailed knowledge of, the discussion with the family over organ donation was done while the patient was still on life-support, once it was clear that recovery was possible. That way it was possible to arrange the logistics of making use of the organs, contacting potential receivers etc., before the machines were switched off. There was no reason for a doctor to declare the patient dead before rushing into organ issues.

[Broomstick]

In the United States, you can sign all the organ-donor cards you want, tell everyone you know you want to be a donor, and when you die (assuming you die in a manner that allows for organ donation) the docs will still go to your family and ask for permission -- and if the family says no, the donation doesn't happen.

But let's clear up a few things, shall we? First of all, not eveyone is eligible to donate, no matter how sincere their design to do so. Certain diseases - such as HIV, HepC, or CJD - means you can't donate because you'd pass the disease to the recipent. Cancer patients can not donate (except for maybe corneas). Very old people can't donate. People have volunteered to donate, then during the "harvesting" sometimes they're found to have undiagnosed kidney disease or something that eliminates their organs.

Second, your death has to meet certain requirements. Ideally, an organ donor is a young, healthy person with a massive, massive head injury. A gunshot wound to the abdomen might well eliminate your kidneys and liver from the list of donor candidates. So, ironically, as we reduce deaths from trauma we also reduce the pool of available organs for transplant. It's not enough to simply be healthy, you have to die in the proper way(s).

Third, even if all potential donor organs could be harvested it still would not solve the problem of people dying while waiting for an organ. You can't just randomly transplant anyone's organ into anyone else - it has to be matched for immune capatibility, blood type, and size. The heart of 6 foot tall 40 year old man may be a perfect immunilogical match for a 7 year old girl, but it's too big to fit inside her and thus can't be used by her. Some people are very difficult to match immunologically. Some are difficult to match because of their size. So even if we could "harvest" all usable organs, there's no guarantee we'd be able to match them all to needy patients, or that all needy patients would find a match.

Fourth, if you want to be an organ donor you don't have to wait until you're dead. Blood is an organ, and you can donate it while still upright and mobile. If you're really gonzo on the idea you can also donate bone marrow or even a kidney while still alive.

I guess what I'm trying to say here is that while the presumptive donor idea has merit, please do not think it will solve the entire problem.

[GorillaMan]

In the United States, you can sign all the organ-donor cards you want, tell everyone you know you want to be a donor, and when you die (assuming you die in a manner that allows for organ donation) the docs will still go to your family and ask for permission -- and if the family says no, the donation doesn't happen.
Also true in the UK.


I guess what I'm trying to say here is that while the presumptive donor idea has merit, please do not think it will solve the entire problem.
Actual experience of the Spanish opt-out system would suggest otherwise:

" The Organizacíon Nacional de Trasplantes (ONT), established in 1989, transformed Spain's transplant service from having a shortage to exporting surplus organs to neighboring countries.... In 1986, a law was passed that allowed obligatory donation unless a refusal was registered in the national computer. The ONT was formed to address the problem of declining donation rates and instituted a formal but flexible management structure. Their integrated approach ... led to a steady increase of organ donor rate from 14.3 pmp in 1989 to 22.6 by 1993. Spain's 43.8 kidney transplants in 1996 was achieved despite the fact that Spain also reached the largest reduction in traffic road accidents of the European Union during the last 3 years.
http://www.worldtravelcenter.com/jetstream/newsweather/newsletter/Aug00/organ.htm

[Ross]

I think perhaps one of the things that's made the issue such a hot potato in the UK was a recent scandal wherein a children's hospital (I think) was found to have been removing organs from loads and loads of cadavers, the bodies then being handed over to relatives for the burial or whatever. This was a huge story a while back, and lots of relatives went through new ceremonies of funerals and such. I don't remember whether any of the organs were actually reburied alongside the original corpse, I think they may well have been. And I don't remember particular religious issues coming up then either, it was lots of bereaved families just very upset that their relatives' bodies were faffed about with.

Not to downplay the feelings of the bereaved at having their losses needlessly rekindled, but after a while I started to think "let it go, stop torturing yourself." Probably there were threads about it on here. I think it was a hospital called "Alder Hey".

[GorillaMan]

Alder Hey is in Liverpool, so there will have probably been a fair bit of religious issues over the organ retention, having a large Catholic population.

I agree that the reactions seemed over the top. Claiming that it was traumatic - how? The process of second and third funerals seemed to me to be farcical. But then again, the religious issues aren't something I can empathise with - when I die, I'm going to rot away, and that's it.

[E-Sabbath]

The problem I have with it is a civil rights issue. It implies that the government owns the bodies of its citizens.

If one does not own ones own body, what does one own?

[GorillaMan]

We own nothing once we are dead.

If we die intestate, our possessions are dealt with according to set legal proceedings. We can choose to 'opt-out' of these by writing a will. Would an opt-out organ donation system not be comparable?

[Broomstick]

Actual experience of the Spanish opt-out system would suggest otherwise
Interesting.

However, Spain is (I think, not an expert on Spain) a much more genetically homogenous country than the United States. As a general rule, organ donation is easier within a particular ethnic group, or closely related groups, because of the higher chance of common genes. In a country like the USA or even more so Brazil, where there is a lot of genetic mixing of types from all over the world the problems of matching organs to recipients can become much more difficult.

Also, while that might work for doubled organs like kidneys, would it hold true for all organs?

[Black Train Song]

By John Mace:I find the idea of an "opt out" plan to be abhorent. I agree 100%

By abbie carmichael:Unfortunately there are precious few willing to donate.
Call me selfish but here's my reason:

Unless I can specify which organs I'm willing to donate and under what circumstances, I'm not gonna gonna do it.
I'll be damned if I try to do something good with my body and just end up providing skin to some lady who's getting a third facelift by a doctor who's lining his pockets with my good nature.

That's another reason, besides religious (which I am not) that an opt-out system would be bad. Corruption would run rampant.

I guess I could just be cynical.

[elfkin477]

Do they really harvest the organs of dead people? Perhaps I've been mislead by too many hospital movies and shows, but I've been given the impression that organs are most often taken from people who are brain-dead, not dead-dead because the organs aren't useful very long outside a living body. Maybe it's only a preference?

If this is really the case that they at least perfer to take organs from people who are still techically alive, I can see how there could be objections to this. To a doctor he might be saving someone else's life, but to a distraught loved one in denial about the patient's irreversable condition, removing the organs while the person is still "alive" probably looks a lot like murder, even though the patient has no hope of getting better.

Then of course, this would also lead to a slew of novels about ruthless doctors declairing people brain-dead, for revenge on the victims or money, when they're not...

[GorillaMan]

That's another reason, besides religious (which I am not) that an opt-out system would be bad. Corruption would run rampant.

Contradicted by evidence from fully functioning opt-outs in Europe. Doctors should obviously never stand to make any financial gain from procuring organs - and in any case I think you massively underestimate their professional behaviour.



Do they really harvest the organs of dead people? Perhaps I've been mislead by too many hospital movies and shows, but I've been given the impression that organs are most often taken from people who are brain-dead, not dead-dead because the organs aren't useful very long outside a living body. Maybe it's only a preference?
"There are two basic types of donation: organ donation and tissue donation.
Organs that can be donated are the heart, lungs, liver, kidneys, pancreas,
and small intestine. These can be taken only while the heart is still
beating, when the donor is 'brain-dead.' ...

Tissues (skin, bone, corneas and heart valves) can be recovered up to 24
hours after the heart has stopped beating."

http://www.transweb.org/qa/asktw/answers/answers9505/Harvesting.html

But I suspect that it's possible to keep many more patients on ventilation after brain-death than we would guess.

[Black Train Song]

GorillaMan ,

I really didn't mean it to look like I was questioning the integrity of doctors at all. Perhaps I should've worded it differently.
I would think that they have little to do with the actual obtaining of organs in the first place.

I wouldn't take issue with a burn victim getting my skin but it's unclear to me how organs and tissue are distributed.

The opt-out thing just seems creepy because by default my body shouldn't be treated like a stolen car at a chopshop.

[Ross]

Probably a good long meditation on just how astonishing and exhilarating the idea of organ donation is would change a good many minds on not wanting their bodies treated like "stolen cars". (I know you were only kidding!)

But, you know. What could be a more beautiful tribute to the deceased? Not to be cremated and sent curling skyward in a pattern of smoke and ash, or buried in a custom-built mausoleum for future generations to admire (neither of which is in itself bad, or denied the donor)... but... to actually have someone take hold of your very physical substance, and use it to give life to others? This is an opportunity and a privilege of cosmic proportions, and it's real, and it's happening right now. Heck, I'll be disappointed if I don't get used for spare parts!

[Zagadka]

I dunno, I want my relatives to drink me (http://www.montereyherald.com/mld/montereyherald/8267146.htm)

Seriously, take the money and use it for educational purposes. It would be better to let people make up their minds positively than to coerce them into it and gain their distrust and ill temper.

[mr_moonlight]

I've never understood what's so wrong about paying organ donors for their organs. There's high demand for a product that is in low supply. Higher prices fixes the problem.

Doctors get paid for performing the organ transplant. Hospitals get paid for their services and for procuring the organ. Everyone gets paid except the person who supplied the vital part. It doesn't seem right to me.

[Ross]

I was halfway through rattling off a response to the paying-for-organs proposal when I realised that I really couldn't muster much of an argument against it. "Distasteful" is probably the closest I can get, and that ain't much.

I daresay it might bring up issues like the poor always being the donors, and the rich always being the recipients. Which turns the poorer sectors of society into a kind of spare parts bank. But still, plenty of people objectify the poor anyway.

Hmmm. I think perhaps it should be considered. I am surprised to hear myself say so.

[Cat Fight]

I'm all for it. Yes, there will be objections on religious grounds but, um, isn't that where the 'opt out' part comes in? I think many people who don't fill out their cards or whatever aren't against donating but are just lazy.
With default-donation, everybody wins (any possible corruption aside, though I think that may be a little paranoid. Are there actual cases, TV crime shows aside, in which a patient was allowed to die for his/her organs?). If you don't want to give your organs up, for whatever selfish reasons, you have to make the effort to have your name removed. Jehovah's Witnesses can deregister in hordes with, most probably, the click of a button.
And yes, I do think most of the reasons people give not to donate are selfish. 'Waah, what if my liver goes to some drunk millionaire?' Well, what if it doesn't? And even if it did, YOU ARE DEAD. You are the dog in the manger, sitting on a bed of straw you absolutely no use for, still refusing to let the horses have any. Wouldn't it be nice waiting for a heart transplant, finding out that some people have refused to donate theirs AFTER THEY HAVE DIED (a time when the heart has, one would assume, ceased to be of any use to its owner) because they think it's plain creepy or just can't bear the thought of not being buried 'whole' (and I hope anyone who objects to removing of organs on religious grounds, believing this will prevent ascension to the afterlife, never has a loved one in a plane crash or eaten by a bear)? etc. etc.

[libwen]

Fourth, if you want to be an organ donor you don't have to wait until you're dead. Blood is an organ, and you can donate it while still upright and mobile. If you're really gonzo on the idea you can also donate bone marrow or even a kidney while still alive.

Don't forget the liver. They can take part of a living one and transplant it into an ailing person, and they both grow full-sized livers.

[mr_moonlight]

Many people here seem to think that there is no legitimate reason for not donating one's organs. That's because many of us, including me, have religious beliefs (or lack thereof) that bias us towards not seeing a downside. But here are some hypothetical scenarios that might give us an idea of why someone might object. Let's say that sometime in the future, the organ donation issue is moot due to technological advances. But in this future, there are far more doctors-in-training than there are cadavers for them to dissect. So to solve the problem, everyone by default is soaked in formalin upon death and given to anatomy labs nationwide.

Another future hypothetical situation: Organ donations are obsolete as above, but food shortages are rampant due to extreme longevity and overpopulation. Someone comes up with a way to safely recycle human remains as food. All dead bodies are diverted into this recycling program by default.

Certainly there must be some of you organ donors who would be repulsed at the thought of being eaten after you are dead, or being cut up and made fun of by smart alecks in an anatomy lab.

Even if these things are okay with you, I think that most of us can visualize a way that we would not want our bodies treated after we die.

If a person dies without an organ donor card or written instructions concerning what they want done with the body, it is up to the person's family to decide what to do with the body. Why is that? It's because we each own our own bodies, and when we die, all our possessions are passed to our heirs.

If our organs are donated by default as suggested by the OP, then that implies that our possessions are no longer given by default to our next of kin or designated heir, and thus our bodies are no longer our own, and we can fully expect to see Soylent Green in the supermarkets someday :D .

I don't see how the ability to "opt out" negates this argument either. Considering how many people die without a will, I think it's very likely for a person to die without getting around to opting out, even though that is what they intended to do. You shouldn't have to fill out a card or click on a website to claim your human rights.

The solution comes down to economics, or how to best confront unlimited demand with a limited supply. I have to bring it up again: Money for organs, anyone? Think of how much more incentive there would be to fill out a donor card if you got $500 for it (or even $50). Hospitals could solve shortages by bumping up their offer price. I don't see any losers, and I foresee the organ shortage completely going away while upholding the rights and dignity we all expect when we die.

[legion]

Another future hypothetical situation: Organ donations are obsolete as above, but food shortages are rampant due to extreme longevity and overpopulation. Someone comes up with a way to safely recycle human remains as food. All dead bodies are diverted into this recycling program by default.



Mmmm...Soylent Green (http://www.scifi.com/sfw/issue55/classic.html)...

[Kalhoun]

I am not actually sure how organ donation works in the States. I think that it it up to the family of the person donating if they are no longer able to voice their opinion. I do think that it should be left up to the desceased or family thereof. A living will would be able to clear up the matter of donation or not.

I know that when I got my first driver's liscense they asked me and that when I got my second it was not even listed.

The donor designation on your driver's license is not enough to get them to harvest your organs. It must be approved by a family member. I think this is wrong and we should work toward changing it. The surviving family members should have no right to go against what you want to do with your own body.

I'm for the "assumed donor" status. If you're against it, you should say so. There are so many things the body is used for after you die. I read somewhere (no cite...sorry) that up to eight people can benefit from one body.

[Cinnamon Girl]

The donor designation on your driver's license is not enough to get them to harvest your organs. It must be approved by a family member. I think this is wrong and we should work toward changing it. The surviving family members should have no right to go against what you want to do with your own body.
I agree. I should hope that my family (and I think they do--maybe it's time for a little chat!) respects my decision that when I'm no longer viable or dead I want to donate my organs, tissue or whatever is needed to:

(a) save a dying person, rich or poor, good or bad (it's about life & death, people; not the perceived value of that life!);

(b) enhance the quality of life for someone whose physical problems could be corrected by my organic material, which is no longer of use to me, i.e., my corneas to a blind person, my skin to a burn victim or even some poor schmoe who'd be happier (and maybe a more productive member of society) looking 20 years younger (after all, will it really make my family happier if the tissue just rots in a box or is burnt to ashes?); or

(c) facilitate the advancement of medicine via education of medical students (sure, even a little creepy to me, but worthy nonetheless) or to studies that might find cures for diseases that could benefit many generations to come (what a legacy to leave, huh?); or

(d) facilitate the advancement of any other science such as forensic science (yes, even creepier, but just as worthy), i.e., someone's corpse was responsible for helping scientists understand the clues left behind on victims of murder leading to more effective criminal investigation.

While I have to admit there are some areas in which I don't believe things should be done solely for the good of the many at the expense of an individual, I just can't rationalize why keeping it to yourself in death is valued so much more highly than life itself and quality of life for those who are still around. It really just seems damn selfish to me.

I'm for the "assumed donor" status. If you're against it, you should say so. There are so many things the body is used for after you die. I read somewhere (no cite...sorry) that up to eight people can benefit from one body.
I'll bet it's even more if you look at the various areas human organic material can be used (yes, that's all our bodies amount to after death; and if you don't believe that, have a look at the Body Farm (http://www.deathsacre.com/)). Thing is some people are so paranoid about uses of 'their' organic material that would offend them in life that they won't even consider taking a chance that they could change the world, even a very small part, for the better by giving up what they clearly don't need anymore. Even from a religious point-of-view, I can't understand what the usefulness is of the organic material in the afterlife? Maybe someone could ellucidate, but isn't the body a mere vessel for the soul? Does your soul really get buried with its vessel?

If you value the positive affect of your life on your familiy and all those who come in contact with you life, why can't you value the tremendous positive affect you could have on those you don't even know in death? Doesn't that give your life that much more meaning?

On the flip side, take a look at the Texas convict (convicted and executed for the murder of one man in a botched robbery) who selflessly donated his body to science saying that he wanted some good to come out of his death as his life went so wrong. Those wacky scientists chopped him up, took a bazillion pictures of every single part of his body and created the Visible Human (http://www.nlm.nih.gov/research/visible/visible_human.html) in order to better understand the human body for the advancement of many areas of medicine which is already happening (http://www.sciencedaily.com/releases/1999/09/990902075541.htm). This one guy, whom Texas saw as such a huge threat to society, may save thousands of people in the future. Can't everyone be as selfless in death as a convicted murderer?

On a side note (in case anyone brings up any controversy over opt-out plans in general), I don't even agree that opt-out plans work in all areas of life (I would obviously prefer to 'opt-in' for advertising), but in this case, I'm certain the benefits tremendously outweigh the detriments.

Nutshell: I'm for it! Don't like it? Say so!

[Ross]

Even from a religious point-of-view, I can't understand what the usefulness is of the organic material in the afterlife? Maybe someone could ellucidate, but isn't the body a mere vessel for the soul? Does your soul really get buried with its vessel?
I'm pretty sure the problem arises when the individual expects to be resurrected physically in the original body, say at Christ's return, and if anything's missing, well, you're not getting a new one. Personally I believe He's coming back, I just don't think he'll be bothered that I mislaid my liver - nonetheless I can see how there could be a real problem, if one couldn't get past the issue.

I think organ transplants are totally amazing and brilliant. Did I mention that? Oh, I did...

[Cinnamon Girl]

I appreciate the insight, but I'm still a bit confused.

I'm pretty sure the problem arises when the individual expects to be resurrected physically in the original body, say at Christ's return, and if anything's missing, well, you're not getting a new one.
Which begs the question, if you aren't resurrected before your body completely goes to dust, then how would you get everything back anyway? And, as someone else mentioned, what if your dumb luck was that you weren't buried with all your parts to begin with due to the manner in which you died?

Further, what about the poor schmoe who is missing parts because his went defective & was removed to save his life some time back? Is he just SOL too because the organ that was replaced is not necessarily the one he was born with? Goodness gracious, sounds like a Shelley nightmare.

Whoa, there fellah! That's not your liver! You're going to have to turn that in.

What's that, Mr. Schmoe? You say you gave your liver away? Are you insane?! Do you really think I'm gonna give you another one just because you thought someone else might need yours?

And you, Mr. F. Monster, I just can't for the life of me figure out what to do about you!

Alright, that does it! Who's the fool who had the gall to think my creations were Bionicles?
Personally I believe He's coming back, I just don't think he'll be bothered that I mislaid my liver - nonetheless I can see how there could be a real problem, if one couldn't get past the issue.

I'm amused and glad that you can see past the idea that you lose brownie points if your liver goes AWOL. I would also think the supreme being who's deciding the resurrection-worthy from the rot-in-hell-worthy would give you extra brownie points if your AWOL organ happened to be in the body of someone who was really, really resurrection-worthy!

[Zagadka]

I am drawn back to this thread for reasons I can not describe.

Making the argument that someone, "doesn't need their body when they are dead" is somewhat akin to saying, "if someone dies, they died, so what, get over it" which begs the argument, why are you worried about saving them.

Because someone "doesn't need their body when they are dead," should we do away with all the corpses? Maybe use them for fire practice and sexual perversions? Throw them into mass graves? Grind them up into hotdog meat?

I'm just curious where you are going with this argument.

[Cinnamon Girl]

I am drawn back to this thread for reasons I can not describe.
May I suggest that you have come to the conclusion that we may be able to educate, right here at SDMB, non-organ donors on the value of their organs to those who could get something of value out of them?


Making the argument that someone, "doesn't need their body when they are dead" is somewhat akin to saying, "if someone dies, they died, so what, get over it" which begs the argument, why are you worried about saving them.
It's true, I agree that if someone dies, they died (stands to reason). But I'm not saying "so what, get over it." I don't believe that donating organs is (a) saying so what (quite the contrary, it's like saying, "so what else?") and (b) saying "get over it" because donating organs is not the sole way one grieves over the death of a loved one, although it can certainly be a source of comfort to know that they "live on through someone else."

I'm not sure what you mean, though, by "why are you worried about saving them?" I don't think you meant saving the organs, because we already know why saving the organs is important. Did I miss something? If you did indeed mean saving the person then I don't understand why you think that saving someone's life via organ transplant wouldn't be preferred as to letting them die unnecessarily? Could they not possibly contribute something positive to someone by continuing their life? Even if they didn't, it's life itself that is valuable, is it not? (Which strikes me as an ironic statement considering I'm also contributing my opinion to an assisted suicide thread as well.)

Because someone "doesn't need their body when they are dead," should we do away with all the corpses? Maybe use them for fire practice and sexual perversions? Throw them into mass graves? Grind them up into hotdog meat?

I'm just curious where you are going with this argument.

Hmmm, do away with corpses... My thoughts immediately rested upon the thousands of acres of land dedicated to internment of corpses while breathing human beings are piled on top of one another in huge housing establishments. Never mind. Why should we use corpses for fire practice or sexual perversions when we actually do have quite reasonable uses for corpses already? You might even find actual accounts of a couple in my original response. Mass graves? Actually, barring other more useful solutions, my thought is that cremation is more environmentally-friendly. Hotdog meat? Well, considering hotdog meat is already pretty gross as it is, I don't think you could do much more damage. But then I don't think I'd really be all that interested, myself.

And the magical question, where am I going with this argument? At this point, my head is swarming and I see dead people, so I can't quite remember.

Oh yeah, sign up to donate your damn organs already. You really, really, really won't need them when you're dead! I promise!

[Ichini Sanshigo]

Because someone "doesn't need their body when they are dead," should we do away with all the corpses? Maybe use them for fire practice and sexual perversions? Throw them into mass graves? Grind them up into hotdog meat?

I think this sort of gets at the heart of the argument (also discussed in this thread (http://boards.straightdope.com/sdmb/showthread.php?t=111782&highlight=organ+donor) ). All cultures have built up a ceremony around death, be it burial, cremation, or whatever. The general thought is that even as one's spirit/soul leaves the body, there is something sacred about the body itself. To this end, the idea of desecrating a corpse (eating, screwing, or carving it up for organs) has acquired this air of repulsiveness. Yeah, you're dead, you don't care, but the idea that the body is sacred is so ingrained, and the idea that not leaving it intact is so gruesome, that many people just don't want to donate. It's visceral. It's also their right.

So how does this relate to an opt-out system? After all, as others have mentioned, if the idea is that appalling, you should take the time to fill out the form saying you don't want to donate, right? Well, there's the guilt trip involved - you have to go the extra step and, in the process actually confront the reasons you don't want to donate.

I'm much less concerned with that than with the fact that the opt-out set-up seems a bit, well, deceptive. It's like, "Shhh, let's not tell people they're donors - let's just take the organs and run". It sounds ridiculous, but it's still not a pleasant thought. Consent shouldn't be implied for something like this - it should be explicitly obtained.

[Zagadka]

May I suggest that you have come to the conclusion that we may be able to educate, right here at SDMB, non-organ donors on the value of their organs to those who could get something of value out of them?
Maybe that's it.

[/quote]Oh yeah, sign up to donate your damn organs already. You really, really, really won't need them when you're dead! I promise![/QUOTE]
I'm already all signed up, and ready for the rest of me to be cremated. You're preaching to the choir with me. I'm just trying to argue out the under-represented other side as I understand it. I seem to be doing a poor job, but meh.

I simply have reservations about implied organ donation. As Ichini Sanshigo points out, there are other arguments against this, including the use of coersion.

Scenario: A law is passed making organ donation assumed. Would money be spent to educate the people about their option to opt out?

[Cinnamon Girl]

So how does this relate to an opt-out system? After all, as others have mentioned, if the idea is that appalling, you should take the time to fill out the form saying you don't want to donate, right? Well, there's the guilt trip involved - you have to go the extra step and, in the process actually confront the reasons you don't want to donate.

First off, thank you, Ichini, for bringing us full circle. I had forgotten to relate my blabbering to the question in the OP. I think your idea makes sense. Those of us who have already chosen to be organ donors more than likely understand the benefits of it. But those who have not may benefit from bringing the subject to their attention by requiring them to make a choice as opposed to simply ignoring it. I don't think that's asking a lot. If you just don't want to know, DON'T read the brochure (become informed) & DO check the box that says, "No, thanks." Maybe requiring people to opt out may be preying on the lazy, forgetful, or indecisive, but it's not like it's set in stone as many have pointed out that your family may override regardless of what your driver's license says. And who knows, maybe there will be more organs available to those who need. Where's the damage? This is why I also support opt-out. In the event, someone could prove damage as a result of it, I might change my mind.

Personally, I'd prefer that people get informed and make the decision to do it without twisting their arm, but that's obviously not gonna happen. It's not really even that hard to do; it's less time-consuming and less intrusive to one's life than blood donation. Can it get an easier than that?

I guess since I'm not particularly religious and truly believe I'm simply really complex organic material, I cannot relate to and will likely never understand why someone could be against such an important contribution to humanity. I especially don't get why it's okay to give your mom one of your kidneys while you're alive, but not okay to give it to a complete stranger when you're dead. It boggles me why any god should care if you're doing so to promote life which is what he/she/it granted us in the first place. Oh well.

I simply have reservations about implied organ donation. As Ichini Sanshigo points out, there are other arguments against this, including the use of coersion.

Scenario: A law is passed making organ donation assumed. Would money be spent to educate the people about their option to opt out?

I would assume they would need to spend as much as they currently do (I have no idea how much), but more likely, a bit more to educate those who have already opted in as well as those who haven't, that the rules have changed. Personally, I don't think they spend enough on education about organ donation or at least I don't see it. Maybe we should add it to high school science classes right before kids start getting their driver's licenses. Maybe employers could get in on the act and have drives (like blood drives only for organ donation education). Maybe health insurance companies would be willing to give donor discounts to those who have signed up (like auto insurance safe driving discounts). Maybe someone could sponsor National Transplant Day and remind us about organ donation as we exchange chocolate hearts and livers (hehe- I can see the Hallmark card now: I really wanted to give you my liver...but I'm not dead yet, so all I got you was this creepy card!). Yeah, I'm all for education. Look at all the money they spend trying to educating people about drug abuse, sexually transmitted diseases, etc. At least organ donation education would be more of a: Hey do this! instead of Hey, don't do that!