If this is so, it represents a violation of the Hippocratic oath. “To do no harm” must be a fundamental tenet of medicine.
At the same time, I’d like to see a “flat line” clause in “presumed consent” so that people who have sustained irreparable damage and are without brain function for a certain period become eligible. I myself have requested “no heroic measures” in such circumstances. I’d rather know that my body was harvested (yes, harvested, I’m a capitalist, get over it) while it could do some good as opposed to wasting away for a year while someone quibbles over just how flat my electroencephalogram is.
doctordoowop, there is one major flaw in your anecdote. To my knowledge, not very many organs from an adult can properly serve an infant. A partial liver transplant is one of the few I’m familiar with. Most other adult organs are of incorrect dimensions for transplant into the very young. The entire Baby Fay case involving the use of baboon organs dealt with this exact issue. Please elaborate on your personal experience with this.
Finally, thank you, Necromancer for bringing up the ultimate solution. A combination of stem cell research and new “scaffolding” techniques are rapidly evolving to obsolete transplant medicine almost permanently. The current administration’s foot-dragging on stem cell research is almost criminal when one considers the alleviation of impediment and suffering it can bring about. Recently, a human zygote or fetus (can’t find the cite) was produced using stem cells. Scientists are growing not just organs but skin, teeth and nearly every human biocomponent imaginable. This is a medical grail in the making and any interference with it guarantees the needless suffering of thousands or more humans due to the least delay.
As I type these words, I have a friend in hospital who desperately needs new kidneys. He is literally dying a little more before my eyes each time I visit him. Another good friend’s wife will soon need a liver and neither of them have much hope of a timely solution. All of these problems are ones that can be made to go away by throwing money at them. America is the wealthiest nation on earth and has little or no reason for not bringing this technology to fruition. A functional and adequate organ donor program is mouse nuts compared to the complexity of stem cell research. We have no excuse.
Zenster-you are absolutely correct- my example was medically wrong. I should amend that to a teenager of about 15 years. I have talked to nurses who swear staffs don’t go the extra yard, if the donor sticker is on a license. I know all accounts will be anecdotal, but doesn’t it make sense? I have NO personal experience- don’t do hospital work anymore. Nurses seem to run most things in hospitals, they don’t have the Hippocratic oath, but I’m sure they have their own version.
Sorry doctordoowop, but I find your antecdote hard to believe. Why would they not go the “extra yard” to save someone who has agreed to be an organ donor.
If they go the “extra yard”, which is standard medical procedure after all, then they may save the injured potential organ donor. So you’re saving a life.
If they go the “extra yard” and the person dies, then they can still donate the organs.
If they DON’T go the “extra yard” and use the donated organs for people waiting for transplants, it is by no means certain that these people will survive. They may not survive the surgery, or the organ may be rejected. There are many variables.
So basically, I don’t see the incentive for hospital staff to NOT save someone who might become an organ donor. The best policy (for EVERYONE) is to try to save them, and donate the organs if they can’t. There’s no point in letting the person die (when there’s still a chance they could live), if there’s no guarantee that the organ receipients will live.
On the topic of the OP though, I’m not really sure if I’d be for providing organ donation incentives. I’d be more in favor of the presumed consent model.
But then again, I don’t feel comfortable with payment for blood/plasma donation. I know this occurs in the US, but I’m not sure about other parts of the world. (I’m from Canada, FWIW)
I’d hope that organ donation is done for more altruistic reasons, and only those with good reasons to opt out of donation should do so.
Payment for blood donation is becoming less and less common, and many blood services will not accept blood where the donor has been paid.
Plasma is a little different - it’s more of a bother to the donor so maybe it’s justified.
Someone who, for example, donates a kidney or blood marrow as a living donor is supposed to have their medical expesnes for the procedure paid for.
I suppose, as a parallel, providing some cover for funeral expenses for cadaver donors wouldn’t be completely out of line.
I do have problem as soon as the donor’s family starts to profit from the transaction. We gave up selling whole living people some time ago in this country, I don’t think we should sell people parts, either.
Waenara- I can’t tell you specifically the nurses’ or staffs’ reasoning. Obviously you need a dead body for organs to donate. The staffs must “feel” more like saving one patient’s life than another. Happens all the time in traige, in ERs. Obviously, no one will admit to this, for obvious reasons.
But wouldn’t this be an argument for “presumed consent”? With that, you don’t have the “donor sticker” which marks certain patients who - by your theory - would then be treated less.
Besides that, I have a question: Don’t you have a central agency in the US which controls distribution of organ transplants? I would be surprised if you have not.
With that, wouldn’t it be very unlikely for the medical staff to know both the donor and the hypothetical teenage recipient?
Fair enough - but it isn’t an issue here (Canda), as all of those medical expenses are already covered. In a country with private health insurance I wouldn’t have any problem with living donors having medical expenses covered. In fact, I’d lobby for it if it wasn’t already being done. Given the cost of medical coverage, not paying the medical expenses would be a huge disincentive for people to donate.
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I wouldn’t have a problem with this either. The incentive mentioned earlier in the thread was along the lines of $5000 dollars. I’m not sure exactly how expensive funerals are, but I understand they can easily be in this price range.
I definitely agree with you. And I’d hate to be totally mistrustful of the donor’s family, but the funeral coverage incentive might be open to abuse if you just give them $5000 to spend. What if they stick uncle Jim in a $500 pine box and keep the rest of the money? But I don’t think I’d like to start demanding receipts from a grieving family. Tough situation.
Yes to both questions. In order for the hypothetical case to happen, the donor and the recipient would have to be in the same hospital and the donor would have to be a match for the recipient, unlikely to begin with. Then a doctor or nurse would have to know that the dying person was a match for the recipient(how would they know that before hand?), and then blatantly and willingly withold measures that would otherwise be used. (Asking for a lawsuit and too risky for most to even think about, I would assume). Otherwise, you would have to assume that doctors are allowing would-be-donors to die on the chance they might be a match for another (in their opinion more deserving to live? Why?) person somewhere, which I find highly unlikely. If this has ever truly happened, I would guess it is a rare, rare occurance and is not, in my opinion, a valid or even reasonable reason to not be a donor.
Also, since (I think, I could be wrong) many donors are accident victims and they are often given emergency care to save their lives, are the performing surgeons or caregivers even aware of their donor status? That is, when a Dr. is giving care to a patient do they know if he/she is even a donor or not? Isn’t it usually brought up only after all other choices are exhausted and there is no hope for recovery?
Without a cite, I am very skeptical of claims that this goes on. Even if people are hiding it, a case would have been brought out somewhere if it was significant.
As for incentives, I don’t know what would make people more likely to donate. Maybe more education / awareness? I think a lot of people don’t even think about it at all. Money could help, but if the money is given to the surviving family who specifically would be the person to decide? What if one parent wants to consent and the other doesn’t? Also, does this assume that the donor has already given consent, or does the family override? If the donor has to consent also, I don’t see how a promise of a few thousand dollars to the surviving family would make much of a difference - maybe a bonus should be given to the donor for signing consent in the first place? I don’t know how, but maybe you could get a tax deduction or something if you are a donor.
I think maybe the “donor by default” option is the best idea. I think that is a lot of the problem - people just aren’t proactive enough to sign up on their own, but if it was more common and an accepted social norm people wouldn’t be so afraid of it.
Another excellent argument for the “presumed consent” structure.
I also feel that education is one of the most important methods of increasing donation rates. I feel that a film about Nicholas Green should be mandatory viewing at all public schools. Nicholas Green was from Bodega Bay in California. While touring Italy with his family, he was shot and killed by car bandits. The family immediately donated his organs to Italian children, many of them near death because, even now, Italy has one of the lowest organ donation rates in the world.
PBS broadcast a program about the family’s decision and the dozen or more Italian children whose lives were touched by them. There was a dramatic uptick in Italian organ donation following the incident. This phenomenon is now known as The Nicholas Effect. I cannot think of a more fitting tribute to this young boy and his family’s noble choice. A video about him is available from CPI.
Evidently, a significant percentage of American families are unaware that brain death is irreversible. According to the Partnership for Organ Donation it is a major contributing factor to the paucity of donors. It is obvious that significant changes must be made in how people perceive organ donation and their understanding of medical terminology and procedures.
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Finally, there is one critical factor that needs to be addressed. I believe that in order to receive an organ donation, you must be a donor yourself. Once you receive a donation, you do not have the right to retract your commitment. This was brought to light in the recent case of a blood type mismatch during a transplant into a teenage girl.
Disregarding the fact that the girl was in the United States illegally, I was astounded to find that after untold hundreds of thousands of dollars were spent on operations for this individual her parents declined to donate her organs after she succumbed to transplant complications. I am also amazed that her parents were not instantaneously struck by a thunderbolt once they announced their decision not to permit harvesting from their daughter. This sort of garbage needs to end immediately.
A multi-pronged assault on the problem must be launched right away. The Nicholas Green video should be mandatory viewing in all public schools, accompanied by a homework assignment that requires parental participation. All transplant recipients must be willing to donate their organs as well. A federal campaign to increase public awareness must be funded without delay and philanthropic foundations should be recruited to accelerate this entire process.
I thought that organ recipients were actually ineligible to donate due to medical reasons. A transplanted heart or lung rejected by a recipient will be far too damaged to be used by another, and I wouldn’t be surprised if other organ damage occured. Maybe corneas could be used… I don’t know.
In any case, I wouldn’t come down on that girl’s parents too hard - they’d had a horrifically traumatic experience (even a succesful transplant can be traumatic and stressful) and I think their refusal was a combination of not wanting another family to suffer as they had, and a desire to be rid of the entire matter, to just escape. Yes, the first impulse is to think of them as selfish jerks but when I tried to empathize with them I came to the conclusion their reaction isn’t as wacky as it first appears. Their child did suffer horribly both waiting for the transplant and after the procedure, and they weren’t in a situation conducive to rational thought and logic.
It sort of like people who don’t want their relatives autopsied because they don’t want them “suffer” any more. It’s not a rational train of thought, but people aren’t always rational in these situations.
Exactly.
That’s another reason I’m glad that the relatives’ consent is not required in my country. They’re simply not asked. It’s the same with autopsies.
I just don’t see a dead body as a property the relatives can dispose of.
That’s the reason I don’t like the idea of financial incentives. I suppose it’s merely an emotional thing, though.
Your two statements conflict. If the market sets prices for blood and organs, some people will have to wait for an organ transplant simply because some people will not be able to afford the market rates.
I like markets, but they are not the best way to handle everything.
While the transplanted organs are very likely to be impaired beyond any possibility of reuse, a human body contains square yards of tissue (skin), corneas (as you noted), bone marrow and a host (sick pun) of other medically useable material. If anything, a transplant recipient’s body should be made available to science for thorough forensic investigation in order to promote better understanding of this technology. I am beginning to agree with those who advocate that a deceased body is no longer the property of surviving relatives. This would divest them of any control over the disposition of the remains.
I fully comprehend that there is a large religious component of society that regards both post-mortem vivisection and burial of an incomplete body as blasphemy. Witness the profound lack of organ donation in Italy, DESPITE Papal dispensation for the practice. I am also beginning to have little patience with the backwards mentality of society as a whole. As seen in my previous post, there are many non-donation and (even) donation oriented people who believe that brain death is reversible. It is precisely these sort of ill conceived notions that are contributing to the problem at hand.
While I would prefer to live in a society that fully respects individual religious practices and all other philosophies, there is a limit to the NEEDLESS human suffering I am willing to watch go on. Again, to remove any decision from the surviving family as to the deceased’s donation of organs (especially when the deceased is on record as an organ donor) may well be the best approach.
Even though I am a devout capitalist, there is still an element of inequity that pervades the notion of free-market transaction of human organs and tissues. There would be a profound and deleterious leveraging of survival rates for the economically advantaged that would only serve to widen the gap between poor and rich. This is readily observable in the “digital divide” phenomenon involving economically deprived children and their access to computers and appropriate education pertaining to them. Casting aside any moral repugnance regarding the sale of human bodies, living or not, medicine needs to serve all equally. While I am vividly aware that rich people can afford themselves a better degree of medical care, it remains crucial that people of nearly all walks of life should have equal access to basic corporeal survival.
This access does not extend to permanently incarcerated prisoners of the judicial system. I feel it may also be necessary to extend discretionary powers to doctors (or at least panels) to determine if an individual’s past conduct makes them eligible for transplantation. A chronic alcoholic who has never sought treatment for abuse nor displayed any ability to mitigate their intake should be disqualified for a liver transplant. A life long tobacco smoker who is in need of a lung transplant should similarly be rejected. Certain forms of physical self abuse that automatically result in a predictable need for transplantation must be considered by the medical community in prioritizing their list of recipients. Addicts who self inject would be another similar category of disqualified individuals.
Only after all legitimate existing cases of need are met on a routine basis would I be willing to accept permitting these proscribed individuals from qualifying for a transplant. If sufficient advances in stem cell research can be made, such discrimination will be obviated for all of the right reasons. Until then, headlines proclaiming how some lifer is receiving a transplant that could have enabled a productive member of society to survive will continue to revolt me beyond words.
Zenster, I was recently at a convention for liver transplant patients (my mother in law is a recipient); and one of the marvelous advancements in transplant technololgy is that now, people are able to donate a lobe of their liver. UCSF has initiated this wonderful “Living Donor Program,” which you can read about at their website (sorry…looking frantically thru the palm and not finding…).
However; as a healthcare worker, I can verify that there has been a certain ambulance company (living in the Bay Area, I’m sure you read about it) whose crews did, indeed, not try quite as hard as they should have, because there was a donor sticker on a patient’s license. The crew was fired, fined, and jailed, and the ambulance co. is now in chapter 11…
YOu are bringing up an entirely DIFFERENT issue, but that is why we have medicaid, medicare, blue cross, and other health insurers. The problems of people not affording, or choosing not to purchase health insurance, has nothing to do with this topic.
The fact that some people do not have health insurance is a separate topic unto itself, and we dont need to get off on that tangent.
The fact of the matter is , that if we we to legalize the buying and selling of organs, and institute a free market, then those with health insurance, those with jobs, and those who are very poor and on welfare, will easily get new organs very quicky, and that is the point of this topic. A free market system is the only system that allows everyone to get needed organ transplants in a timely manner.
Huh? How is commenting that not everyone can afford things at “market value” a comment about health insurance?
Insurance doesn’t cover transplants now. Why would that change?
Except not everyone will be able to afford the organs. Lots of people “with jobs” would not be able to afford organs if they were priced attractively enough to get people to donate. I doubt I would be able to afford it, and I have both a job AND insurance, and even a small savings account.
And even with money, there may not be enough suitable organs to go around.
Insurance sure as heck won’t make such organs affordable. I’m not sure why you’re even bringing insurance into the picture.