Opt-out Organ Donation

First of all, to clarify, any and all statements I make are with the basic assumption that a system of universal healthcare exists. It is the state of affairs I am used to, and I realize it probably has a non-insignificant impact on my opinion on the matter. Notions such as paying a medical professional to help me are alien and revolting to me on their face. Healthcare is a basic right that should be entirely independent of financial means, as I see it - and where I live, it thankfully is.

Now, here is what I am struggling to reconcile, Smapti: I cannot reasonably see how you can consider organ donation morally reprehensible enough that you are not willing to participate in it even after death (where, quite frankly, your physical body is of very little use to you, and not long for this world anyway) and reconcile that with the willingness to receive an organ. It reeks of special-casing to serve one’s own interests to me, although I will gladly be convinced otherwise by a cogent argument.

Either organ donation is so revolting a concept to you that you are neither willing to receive nor give an organ under any circumstances (a position I can respect, if begrudgingly), or you somehow value your own bodily integrity post-mortem over the lives of others whilst at best indifferent to theirs when your own life is concerned. I do not see how the second position is internally consistent, and I do not see how someone who refuses blankly to donate their organs after death can be entitled equally to an organ as someone who does so willingly.

No, the medical professional says, “You are last on the recipient list due to a variety of factors. These factors include age, overall health and the impact on ability to accept a donation, and your unwillingness to be a donor yourself. Because there are not enough organs to go around, the state has set guidelines for the waiting list.”

Why should you receive a donation you are unwilling to make yourself? Note the key word - unwilling, not unable. That is why your arguments were strawman.

For more information on thoughts, here is a short paper on the subject of donations and opt-in:

It’s like refusing to pay insurance premiums whilst still expecting cover in the event of accident

Because that’s what a donation is - an act of charity given without expectation of benefit to oneself. When you start telling people you’re going to let them die unless they “donate”, it stops being an act of charity and starts being extortion.

I don’t have any objection to people choosing to donate their organs. I object to the idea that anyone is obligated to make their organs available for donation or that people should be rewarded or punished for choosing whether to donate or not.

I refuse to be an organ donor because I don’t trust the medical industry to prioritize protecting my life over cutting corners and declaring me “dead” so they can profit off the sale of my organs. If that’s a gamble other people are willing to take, then I have no objection to them taking it. If I need an organ, and someone wishes to give me one, I will accept it. I have no right to say “I need an organ - you there, give me yours”.

No, it’s like paying insurance premiums, getting sick, and being told that the bean-counters have decided not to cover me because I smoke / drink / am LBGT / ride a motorcycle / engage in any other form of activities that they’ve decided are immoral or make it “my own fault” that I’m sick.

Much as I appreciate the sentiment it won’t make any difference, because the need for an organ is in the future, and fairly unlikely. In the US 401 K participation rates when they were opt-in were low and the need for money when you retire is a lot more sure than the need for organs. The whole point here is that we behave in irrational ways, and opt-in versus opt-out is an example of this. If we are going to “nudge” people let’s do it in a socially useful way.

While I do not hold any such beliefs myself, it is not inconceivable that someone may reject the concept of organ donation based on religious or philosophical views. Of course one would expect such a person to also reject receiving an organ donation - alas, once their own life is at stake people might feel inclined to rethink their philosophy. That is a form of weakness and if you find that reprehensible, I will not argue. However, I would not want to deny such a person the medical aid s(he) needs. I just do not feel that it is my place to pass that kind of judgement.
If you disagree, ask youself this: Would you deny a convicted murderer or rapist an organ donation?

An act of charity involves giving up something of value to you. When you are dead your organs are no longer of value and thus donating them is not charitable. (Unless you plan on letting your family eat them or something.)

Yet you are against opt-out plans where there is no coercion.

See what I was talking about, people? Since donations from living people require active consent, that is not an issue here. If you say “I need an organ - you there, give me yours” you are talking to a corpse which is rather odd.
I have no objection to you actively opting-out for whatever reason. Many do it for religious reasons. I do object to public policy based on paranoia though.

Not necessarily. My understanding is that some Jews object to autopsies out of a belief that eventual reincarnation will be of the body as it is buried. if you believe that you might not want to donate while be willing to accept an organ from someone who has no objection.
None of this has anything to do with opt-out versus opt-in. I’ll have to look at my chart, but what is Germany’s donation rate? I thought it was much lower than some countries with opt-out policies. The US opt-in method is even simpler than what you described - just checking a box - but we still have low donation rates.

It potentially means giving up my life - which is of great value to me - if the people in charge of deciding when I’m “dead” enough decide to play fast and loose.

I object to it being the default because I believe nobody should be put in danger of being killed for their organs unless they’ve actively decided that’s a risk they’re willing to take.

And there, I think, Smapti, we have the source of our fundamental disagreement on this matter. I am, as previously stated, not used to anything other than universal healthcare, and the idea of for-profit healthcare revolts me on a fundamental level. I can certainly to some extent understand misgivings about and mistrust of a healthcare system in which the large majority of providers exist expressly for their own profit, and not solely for the common good.

I trust my healthcare provider implicitly to serve my interests and my interests alone insofar as they are not incompatible with the interests of society on a whole - and in conjunction with this also consider myself morally obligated to donate, and to not expect any sort of priority were I to refuse to donate/acquire lung cancer through smoking/etc - but I suspect in this regard I may be of the minority opinion.

Edit: To answer your question, Hiker, I would not outright refuse them an organ if one were available - nor do I think a convicted murderer or rapist should receive organ donations with the same priority as a perenially law-abiding citizen.

While I respect your choices, it seems to me that you are ill informed. I do not know what country you live in, but I very much doubt that anyone in your country gets to sell the organs you donate for profit. Nor do I know of any reported cases where medical staff have “cut corners” - i.e. declared someone for dead who could actually have been cured - in order to harvest donor organs.

The idea is, I believe, rather like abortion - the right is not contingent upon being able to justify its use in someone else’s eyes.

Draft-dodgers are protected by the military. Felons are protected by police. Illegal immigrants get emergency care.


PS - I am an organ donor, blood donor, a legal citizen, have no criminal record, am pro-choice, and was 4F.

Do not get me wrong - I was not advertising the German approach, just introducing it. It makes for a too low donation rate. But since it is the approach that we have for now, I thought I’d jump at the chance to maybe motivate someone to get a donor card.

I think then we have identified the core of our disagreement. I believe that medical care should be handed out independent of the moral evaluation of the person in need of it.

In truth, not a notion I find disagreeable in theory, but not one I find practicable, either.

In an ideal world with unlimited resources and no need for at times painful prioritization, I am fully in agreement. In practice, in a world where available organs are limited, available funding for healthcare is limited, etc, I fully believe it is defensible to prioritize those who actively contribute (i.e, people who have not actively opted out of donating) and do not actively detract from society (i.e those who are not convicted, and more importantly, unreformed, criminals) above those who do not.

I realize this invites a host of slippery-slope arguments, and I would certainly be less amenable to the idea if I, say, lived in a society where I was worried that discrimination based on sexual orientation, financial circumstances, or race was likely. As it stands, however, I do not see how it is morally defensible to prioritize a convicted and unrepentant murderer over a law-abiding citizen, all other things being equal. The former should not actively be denied care, but I certainly believe that when choice is mandated they are less entitled to it than the latter.

Organ transplants sure ain’t free.

There’s been more than one case of people being declared “dead” and prepped for organ harvesting before waking up and proceeding to continue living.

I completely understand and sympathize with the motivation of wanting an opt-out system, along with the major benefits of having more organs available to save a lot more lives; however, I have a major ethical objection to the implications that an opt-out system inherently implies. Namely, it’s a question of who owns the body of the deceased? Does it belong to the dead person, his/her family, next of kin, or whomever it may have been willed to? Or does it belong to the state? The only way I see an opt-out system working is if the latter is true, and the idea of the state owning the bodies of the citizens is something, frankly, I find kind of scary.

Also, there’s other potential issues that could arise. If it’s opt-out by default, just as someone might forget to opt-in now, what if someone has objects but is unaware or fills in the form incorrectly? Maybe they have religious beliefs that organ donation would seriously violate, they failed to opt-out correctly, now the family has to sue the state to keep that person’s organs? Even if the state wins, in the time it would take to do so, either the organs are worthless, or there’s been a lot of expense in keeping them alive and lives that might have been saved could already be lost. And, while it’s obviously extremely rare and goes against all of the medical ethical codes, yet as it is, there’s already notions that sometimes they let people die “for parts”. I don’t believe that happens, but I’m sure there are some people that would and, thus it could potentially make it worse. Maybe it would scare those people into opting out for fear of becoming “spare parts” so they’d actually get their lives saved.
Frankly, I think the best way is to keep it as it is and have more ways of publicizing it and making it easier to opt-in. And maybe start modifying the forms so it’s not opt-in or opt-out, but just MUST specify. I think last time I filled out my DL the organ donation field was optional and, if not filled out, assumed opt out. Why not just make that a required field, must explicitly opt-in or opt-out and not allow it to default one way or the other? Hell, that seems like it fixes potential issues with either opt-in or opt-out.

Blaster Master, the article originally posted by Algher summarizes quite well why an opt-in system with mandated choice may in fact be counterproductive in terms of total number of donated organs and achieve the exact opposite of the intended effect - assuming I did not mis-read it, at any rate.

I would also argue that a system cannot realistically be constructed on the assumption that people will be lax/careless about their strongly-held beliefs. Forgive me if I sound overly cynical on the matter, but if someone objects strongly on religious or philosophical grounds, I would expect them to fill out forms pertaining to such matters with extreme care - and I would expect their family to object vehemently and repeatedly in the case of a mistake.

Thank you for providing those links.
I was aware that organ transplants are not free. What I was questioning was the assertion that someone gets to sell your donated organs for profit. The link you provided seems to list the cost involved in performing the procedure. Unsurprisingly it does not come cheap, but I see nothing that would indicate a motivation for doctors to let a patient die in order to harvest their organs. Arguably the procedures involved in saving the patient would not be cheap either.

The two other links you provided mainly demonstrate an incredible amount of incompetence on the part of some hospital staff. If there is anything in these stories that suggests the staff would have acted differently, if the patient had not been a donor, I fail to see it.

Just let the police harvest the organs. Since they’re never wrong there won’t be any problems.

You’re welcome.