# Opt out organ donation and relatives' wishes **URL:** \ **Category:** Great Debates\ **Created:** [July 2, 2013, 5:33pm UTC](https://boards.straightdope.com/t/opt-out-organ-donation-and-relatives-wishes/662463 "2013-07-02T17:33:03Z")\ **Posts on this page:** 20\ **Page:** 11
**Author:** ![Marley23](https://avatars.discourse-cdn.com/v4/letter/m/45deac/32.png) [@Marley23](https://boards.straightdope.com/u/Marley23)\ **Post date:** [July 4, 2013, 9:27pm UTC](https://boards.straightdope.com/t/opt-out-organ-donation-and-relatives-wishes/662463/201 "2013-07-04T21:27:28Z")
While I continue to oppose this idea, **Smapti** , I think you’re misunderstanding what “first do no harm” means. It applies to treatment and means the physician should be careful not to make things worse by intervening. My understanding is that it wouldn’t apply to declining to treat a patient, since there are already time physicians can say they don’t think treatment is appropriate. ---
**Author:** ![EverwonderWhy](https://avatars.discourse-cdn.com/v4/letter/e/ee59a6/32.png) [@EverwonderWhy](https://boards.straightdope.com/u/EverwonderWhy)\ **Post date:** [July 4, 2013, 10:51pm UTC](https://boards.straightdope.com/t/opt-out-organ-donation-and-relatives-wishes/662463/202 "2013-07-04T22:51:27Z")
> [@Smapti](#): > > Except, as demonstrated upthread, it _isn’t._ I don’t think that has been demonstrated at all. The physician who is determining death is NEVER supposed to be a member of the procurement team. They are not supposed to even be in the room. In the (questionably cited) story you linked to upthread, the physicians and hospital were acting clearly outside of the rules and protocols. [Surgeon Accused of Speeding a Death to Get Organs](http://www.nytimes.com/2008/02/27/us/27transplant.html?pagewanted=all&_r=0) > [@](#): > > Several months after the incident, federal health officials cited the hospital for a series of lapses, including failing to grant temporary clinical privileges to Dr. Roozrokh, who was under contract with the donor network. Last February, the United Network for Organ Sharing reprimanded the California Transplant Donor Network for breaking “established protocol” in the case. The donor network declined to comment. More here: [Doctor Cleared of Harming Man to Obtain Organs](http://www.nytimes.com/2008/12/19/health/19doctor.html) As for the WashPo article you linked, it was totally debunked. [Concerns Over New Organ Donor Guidelines Overblown](http://abcnews.go.com/blogs/health/2011/09/20/concerns-over-new-organ-donor-guidelines-overblown/) I think there’s a bit of confusion about organ donation after brain death (the majority of donations) and organ donation after cardiac death (relatively new and where the controversy resides). Cardiac death donations tend to be performed more locally (donor and recipient in the same hospital or geographic area) as they are more time sensitive (in order to maintain perfusion of the organs), therefore there is more potential for conflict of interests. I’m all for presumed opt-in for organ donation after brain death. As for cardiac death donation I think explicit opt-in is a reasonable compromise - since these represent ~6% of all organ donations (a very small fraction) and are more ethically fraught. I agree with **Broomstick** , if we go with a presumed opt-in system then distribution within the US healthcare system will need some reform to ensure equitable access for all, not just for who can afford it or has insurance coverage. [Organ Donation after Cardiac Death](http://www.nejm.org/doi/full/10.1056/NEJMp078066) > [@](#): > > **ELEMENTS OF PROTOCOLS FOR RECOVERING ORGANS AFTER CARDIAC DEATH** > > All organ-procurement organizations and transplant centers in the United States must develop and comply with protocols to facilitate the recovery of organs from donors after cardiac death, according to the Organ Procurement and Transplantation Network and the United Network for Organ Sharing (known collectively as OPTN/UNOS). Listed here are “model elements” that the protocols are required to address, as adopted by the OPTN/UNOS board of directors in March 2007; they became effective on July 1, 2007. > > “A patient . . . who has a non-recoverable and irreversible neurological injury resulting in ventilator dependency but not fulfilling brain death criteria may be a suitable candidate for donation after cardiac death. Other conditions [may] include end stage musculoskeletal disease, pulmonary disease, and high spinal cord injury.” > > **Donors** > > “The decision to withdraw life-sustaining measures must be made by the hospital’s patient care team and legal next of kin, and documented in the patient chart.” Depending on the circumstances, the “legal next of kin” may be a relative, a designated health care representative, or an appropriate surrogate. > The assessment of potential donors “should be conducted in collaboration with the local organ procurement organization and the patient’s primary health care team.” The medical director of the organ-procurement organization and transplant-center teams may be consulted. > > “An assessment should be made as to whether death is likely to occur (after the withdrawal of life-sustaining measures) within a time frame that allows for organ donation.” > > **Consent and approval** > > The legal next of kin may consent to the administration of drugs, such as heparin, or procedures, such as the placement of femoral catheters, for the purposes of organ donation. **“No donor related medications shall be administered or donation related procedures performed without consent.”** > Clearance from the medical examiner or coroner “must be obtained when applicable.” There should be plans for continued end-of-life care and immediate notification of the family “if death does not occur within the established timeframe after the withdrawal of life-sustaining measures.” > Withdrawal of life-sustaining measures > > “No member of the transplant team shall be present for the withdrawal of life-sustaining measures,” such as removal of an endotracheal tube or termination of medications for blood-pressure support. **“No member of the organ recovery team or organ procurement organization staff may participate in the guidance or administration of palliative care, or the declaration of death.”** > > **Pronouncement of death** > > "The patient care team member that is authorized to declare death must not be a member of the organ procurement organization or organ recovery transplant team. **The method of declaring cardiac death must comply in all respects with the legal definition of death by an irreversible cessation of circulatory and respiratory function before the pronouncement of death."** ---
**Author:** ![Voyager](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/voyager/32/133_2.png) [@Voyager](https://boards.straightdope.com/u/Voyager)\ **Post date:** [July 4, 2013, 11:03pm UTC](https://boards.straightdope.com/t/opt-out-organ-donation-and-relatives-wishes/662463/203 "2013-07-04T23:03:21Z")
> [@Smapti](#): > > To _anything?_ > > I guess you won’t be concerned when you die, then, and the state immediately seizes all your money and property and kicks your family out on the streets because it doesn’t belong to them. I have no rights. My heirs have rights - the still living one. If you die and there are no heirs, who gets the money? Hint - it is not buried with you. ---
**Author:** ![Voyager](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/voyager/32/133_2.png) [@Voyager](https://boards.straightdope.com/u/Voyager)\ **Post date:** [July 4, 2013, 11:08pm UTC](https://boards.straightdope.com/t/opt-out-organ-donation-and-relatives-wishes/662463/204 "2013-07-04T23:08:05Z")
> [@Smapti](#): > > You may want to have a word with **Voyager** about that, not with me; I forgot to mention trusts, which are still not the possessions of dead people. When my father died, I got full trusteeship of his trust, He and the trust are different, in fact the trust had to get a new taxpayer id, we couldn’t use his SSN. You can express wishes about what happens after you die - which is what opt out is all about - but you have no rights. Are you equally angry about relatives stopping a donation the deceased wished to make? ---
**Author:** ![MichaelEmouse](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/michaelemouse/32/101_2.png) [@MichaelEmouse](https://boards.straightdope.com/u/MichaelEmouse)\ **Post date:** [July 4, 2013, 11:14pm UTC](https://boards.straightdope.com/t/opt-out-organ-donation-and-relatives-wishes/662463/205 "2013-07-04T23:14:03Z")
> [@Voyager](#): > > I have no rights. My heirs have rights - the still living one. If you die and there are no heirs, who gets the money? Hint - it is not buried with you. But it ought to be! Because if it isn’t, then we’ll be living in a totalitarian country soon enough. Like Spain and Sweden. Free up the Streets for whitelabcoat Battalions. Free up the Streets for Organharvestmann! ---
**Author:** ![I\_Love\_Me\_Vol.I](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/i_love_me_vol.i/32/521_2.png) [@I\_Love\_Me\_Vol.I](https://boards.straightdope.com/u/I_Love_Me_Vol.I)\ **Post date:** [July 4, 2013, 11:35pm UTC](https://boards.straightdope.com/t/opt-out-organ-donation-and-relatives-wishes/662463/206 "2013-07-04T23:35:01Z")
> [@Sitnam](#): > > Why do soldiers in the united states and elsewhere risk so much to get back the corpses of their comrades? They’re just bodies, rotting. Why? Because they “opt” to do so. It is a choice. Similarly, if for some reason you care so very much about some carcass you can “opt” to make it unavailable for saving lives. Rather heartless and selfish, but it’d be your choice. But if you don’t care enough to bother opting out then---- well, then apparently you don’t care what happens to your leftover meat sack. ---
**Author:** ![Bozuit](https://avatars.discourse-cdn.com/v4/letter/b/edb3f5/32.png) [@Bozuit](https://boards.straightdope.com/u/Bozuit)\ **Post date:** [July 5, 2013, 12:42am UTC](https://boards.straightdope.com/t/opt-out-organ-donation-and-relatives-wishes/662463/207 "2013-07-05T00:42:43Z")
> [@Smapti](#): > > To be able to give someone an available and genetically compatible organ in order to save their life, but to refuse to do so because of political concerns, is to condemn them to death. > > To cause the organ to not be available in the first place is not. This is a silly distinction to make. If it makes things simpler, what if we were to say organs are automatically “not available in the first place” to those who opt out? Would that make it better? What if a group of people got together and decided they would use their undeniable rights to decide they will make their organs available for donation after death, but only to certain people. Surely that’s their right, right? So what if those “certain people” comprised members of that group? And what if that group were nationwide, including every person who is either unselfish enough (and yes, [you are selfish](http://boards.straightdope.com/sdmb/showpost.php?p=16442241&postcount=198)) to donate their organs or scared enough of needing one that they want to be part of this “organ pool”? I don’t know your politics but that would seem compatible with the individualistic attitude you appear to have. If you disagree, I’d be interested to know why. Reading your paranoid writings about “the state”, I’m really not sure if you misunderstand how the system works or if you’re deliberately creating misleading images. Assuming the latter, it really is not “the state” who is an actor here. “The state” might make the laws, but it is hospital staff who act according to them. “The state” doesn’t harvest your organs any more than it kills you if you’re shot legally by any other citizen according to some “stand your ground” law. Private citizens acting according to what the law permits is not the same as the state acting. You also seem grossly misinformed on the realities of death. You do realize there is no clear line between life and death, don’t you? When you are first “dead” you are rarely actually completely dead but simply dying and nothing can be done. Your cells don’t all simultaneously stop working at the moment of “death” and your brain may keep functioning at some basic level even when there is no consciousness and never will be again. Being kept on life support with no hope of regaining consciousness is as close to being alive as a cold corpse made to dance on strings is. ---
**Author:** ![Sitnam](https://avatars.discourse-cdn.com/v4/letter/s/6a8cbe/32.png) [@Sitnam](https://boards.straightdope.com/u/Sitnam)\ **Post date:** [July 5, 2013, 1:36am UTC](https://boards.straightdope.com/t/opt-out-organ-donation-and-relatives-wishes/662463/208 "2013-07-05T01:36:39Z")
> [@I\_Love\_Me\_Vol.I](#): > > Why? Because they “opt” to do so. It is a choice. Similarly, if for some reason you care so very much about some carcass you can “opt” to make it unavailable for saving lives. Rather heartless and selfish, but it’d be your choice. But if you don’t care enough to bother opting out then---- well, then apparently you don’t care what happens to your leftover meat sack. Ok. If I recall I was just presenting a scenario for marley23 where we can all agree a dead body has value regardless of it’s use as components for the living. ---
**Author:** ![Tequila\_Party](https://avatars.discourse-cdn.com/v4/letter/t/a6a055/32.png) [@Tequila\_Party](https://boards.straightdope.com/u/Tequila_Party)\ **Post date:** [July 6, 2013, 12:01am UTC](https://boards.straightdope.com/t/opt-out-organ-donation-and-relatives-wishes/662463/209 "2013-07-06T00:01:05Z")
> [@Smapti](#): > > I would personally prefer being “in a coma with no chance of recovery” to being _dead_, and I deny any assertion that the state has the right to make that decision on my behalf on the basis of my having neglected to check a box. This explains so much. There’s no more point arguing with someone who believes something like this. Enjoy your organs after your dead. ---
**Author:** ![Voyager](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/voyager/32/133_2.png) [@Voyager](https://boards.straightdope.com/u/Voyager)\ **Post date:** [July 6, 2013, 6:01am UTC](https://boards.straightdope.com/t/opt-out-organ-donation-and-relatives-wishes/662463/210 "2013-07-06T06:01:23Z")
> [@MichaelEmouse](#): > > But it ought to be! Because if it isn’t, then we’ll be living in a totalitarian country soon enough. Like Spain and Sweden. Come to think of it, come the zombie uprising, don’t give them brains, give them cash. That should satisfy them. ---
**Author:** ![DingoelGringo](https://avatars.discourse-cdn.com/v4/letter/d/9d8465/32.png) [@DingoelGringo](https://boards.straightdope.com/u/DingoelGringo)\ **Post date:** [September 11, 2014, 1:00am UTC](https://boards.straightdope.com/t/opt-out-organ-donation-and-relatives-wishes/662463/211 "2014-09-11T01:00:36Z")
> [@DrDeth](#): > > I think they are right. Organ Donation needs to be an “opt out” system And, on top of that, if you do opt out, it should mean a small surcharge to the drivers license fee- call it a “processing fee” and make it only $5. Or maybe the opposite, a discount of 5 bucks for donating your organs. ---
**Author:** ![clairobscur](https://avatars.discourse-cdn.com/v4/letter/c/839c29/32.png) [@clairobscur](https://boards.straightdope.com/u/clairobscur)\ **Post date:** [September 11, 2014, 2:43am UTC](https://boards.straightdope.com/t/opt-out-organ-donation-and-relatives-wishes/662463/212 "2014-09-11T02:43:27Z")
> [@Learjeff](#): > > I’m not a utilitarian. For one thing, it runs rougshod over what I think should be rights. But in this case, whose rights? You don’t have any right on your dead body, since you’re dead. It isn’t obvious to me that your relatives should have such rights. However, I’m going to mention something that has been pointed out in a previous similar debate : in the USA, apparently, people without a medical coverage can’t get a transplant (because the required lifelong follow-up isn’t possible). If this is correct, then it’s a strong argument against an opt-out system, in my opinion. If not everybody can benefit from the system, then it’s difficult to argue that everybody should make a donation. For the record, when France had an opt-out system 'in fact it might still be an opt-out system, for all I know), it still wasn’t implemented because doctors found highly difficult to impose it to a firmly opposed family. In fact it seems they they typically wouldn’t impose it even if the deceased had made his will to donate his organs clear, when the family was still opposed. They would argue, but not compell. ---
**Author:** ![bengangmo](https://avatars.discourse-cdn.com/v4/letter/b/50afbb/32.png) [@bengangmo](https://boards.straightdope.com/u/bengangmo)\ **Post date:** [September 11, 2014, 9:47am UTC](https://boards.straightdope.com/t/opt-out-organ-donation-and-relatives-wishes/662463/213 "2014-09-11T09:47:12Z")
When living in New Zealand it was opt in - you were explicitly asked during your driver’s licensing procedure if you wanted to donate (since most organs came from accidents it made sense) In Singapore we have HOTA (Human Organs Transplant Act). Organ donation was made the default a few years back, since then I have not heard one complaint. One thing we do have here, Malay Muslems are by default, opted out (yes, race is recorded at birth here, so it can be done), although there has been a campaign or two to get more to opt in. I support “opt in” being the default, whereby you must actively opt out. And there has been plenty of factual information provided here that opt out is the objectively the better, and preferred, option ---
**Author:** ![Kobal2](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/kobal2/32/20_2.png) [@Kobal2](https://boards.straightdope.com/u/Kobal2)\ **Post date:** [September 11, 2014, 11:37am UTC](https://boards.straightdope.com/t/opt-out-organ-donation-and-relatives-wishes/662463/214 "2014-09-11T11:37:44Z")
> [@Smapti](#): > > I deny any assertion that the state has the right to make that decision on my behalf on the basis of my having neglected to check a box. This seems at odds with your generally expressed notions that one should unquestioningly obey the state in all things. I guess the only moral kidney is my kidney or something. ---
**Author:** ![Damuri\_Ajashi](https://avatars.discourse-cdn.com/v4/letter/d/898d66/32.png) [@Damuri\_Ajashi](https://boards.straightdope.com/u/Damuri_Ajashi)\ **Post date:** [September 11, 2014, 2:40pm UTC](https://boards.straightdope.com/t/opt-out-organ-donation-and-relatives-wishes/662463/215 "2014-09-11T14:40:24Z")
What if you come back as a zombie and you want your organs? With that said, this argument is silly. We know the effects of opt out versus opt in (otherwise people wouldn’t be in a huff about this). We know that all the ethical concerns about organ donation disappear if most people become organ donors because organs are no longer rare enough for people to act unethically. We know that you only need one kidney to live here on earth so it reasonable to assume that you will not need more tahn one kidney to live in heavan. We know that the real shortage in organs is in kidneys. So making harvesting one kidney the default. You can opt out. You can also opt in to donating all the rest of your organs too. ---
**Author:** ![Budget\_Player\_Cadet](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/budget_player_cadet/32/205_2.png) [@Budget\_Player\_Cadet](https://boards.straightdope.com/u/Budget_Player_Cadet)\ **Post date:** [September 11, 2014, 3:08pm UTC](https://boards.straightdope.com/t/opt-out-organ-donation-and-relatives-wishes/662463/216 "2014-09-11T15:08:01Z")
> [@Damuri\_Ajashi](#): > > So making harvesting one kidney the default. You can opt out. Why? Why not call it a “death in this country tax”? ---
**Author:** ![Damuri\_Ajashi](https://avatars.discourse-cdn.com/v4/letter/d/898d66/32.png) [@Damuri\_Ajashi](https://boards.straightdope.com/u/Damuri_Ajashi)\ **Post date:** [September 13, 2014, 4:19am UTC](https://boards.straightdope.com/t/opt-out-organ-donation-and-relatives-wishes/662463/217 "2014-09-13T04:19:16Z")
> [@Budget\_Player\_Cadet](#): > > Why? Why not call it a “death in this country tax”? you can’t opt out of taxes ---
**Author:** ![Budget\_Player\_Cadet](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/budget_player_cadet/32/205_2.png) [@Budget\_Player\_Cadet](https://boards.straightdope.com/u/Budget_Player_Cadet)\ **Post date:** [September 13, 2014, 11:13am UTC](https://boards.straightdope.com/t/opt-out-organ-donation-and-relatives-wishes/662463/218 "2014-09-13T11:13:30Z")
> [@Damuri\_Ajashi](#): > > you can’t opt out of taxes My point exactly. We have a chronic kidney shortage. You’re not _doing_ anything with it after you die. Why _shouldn’t_ the government say “this is the tax for dying in this country”? ---
**Author:** ![btthegreat](https://avatars.discourse-cdn.com/v4/letter/b/f4b2a3/32.png) [@btthegreat](https://boards.straightdope.com/u/btthegreat)\ **Post date:** [September 18, 2014, 5:32am UTC](https://boards.straightdope.com/t/opt-out-organ-donation-and-relatives-wishes/662463/219 "2014-09-18T05:32:04Z")
This is simple. you need an incentive. The cremation/ burial costs are borne by whoever is grabbing and claiming the parts. there is a hell of a lot of money being made with transplants. The same statute that allows a hospital to harvest my kidneys, eyes, heart, liver, skin etc ( that is a ton of money) with an automatic ‘opt in’ automatically ‘opts in’ to cover the cost of a low end cremation or burial. Why in hell is the _family_ or the estate responsible for disposal, consistent with statutory requirements, when someone else is claiming the right to profit from the body? Save lives, sure, but you don’t get the right to a dumpster dive, unless you are willing to pay for the garbage pick-up. ---
**Author:** ![btthegreat](https://avatars.discourse-cdn.com/v4/letter/b/f4b2a3/32.png) [@btthegreat](https://boards.straightdope.com/u/btthegreat)\ **Post date:** [September 18, 2014, 5:44am UTC](https://boards.straightdope.com/t/opt-out-organ-donation-and-relatives-wishes/662463/220 "2014-09-18T05:44:35Z")
(I am going to have real trouble with this five minute rule for editing) when I say a ton of money, I am talking tens of thousands of dollars in health care profits from these transplants. [Previous page](https://boards.straightdope.com/t/opt-out-organ-donation-and-relatives-wishes/662463.md?page=10) [Next page](https://boards.straightdope.com/t/opt-out-organ-donation-and-relatives-wishes/662463.md?page=12)