Should "dead donor" rules for organ donation be revised?

Reader’s Digest March 2016 has an article titled “The Shocking Limitations on Organ Donation” in which the author, a medical doctor, tells of a patient who is dying of ALS (Lou Gehrig’s disease) and wants to donate his organs but is unable to do so because his organs are expected be too oxygen-depleted by the time he succumbs to his illness. The article proposes relaxing the “dead donor rule” that stipulates that taking organs for donation must not cause the death of the donor; it proposes that doctors be allowed to sedate a terminally ill donor and remove organs when the patient’s condition is so poor that “death is imminent.” I’m not squeamish about organ donation - I’m in favor of opt-out donation - but I think that’s crossing a line that shouldn’t be crossed.

I’ve got no problem with it. Your body your rules I don’t see this as any different then suicide - make sure they’re sane then do what they want.

ALS does not prevent organ donation; this man was an organ donor when he was declared brain-dead after his ventilator accidentally became disconnected one night. The movie about him has aired a number of times on PBS and is definitely worth watching.

I do agree with the OP that it’s a slope we shouldn’t go down.

I realize the greatest need is for organs, but an ALS patient whose organs are unusable can still donate corneas, and bone and skin for graft.

If we could convince more healthy people to be donors, and inform their families of their wishes, we wouldn’t need to go down this slope.

I’m curious about another situation some parents took some real heat for-- I don’t know them, I know about the situation from a relative who was supportive, but many family members weren’t, which seems kind of a shame to me.

Anyway, and 11-year-old boy was dying of cancer, and like a lot of 11-year-old boys, he wanted to do something he thought was “cool,” that many adults balked at, which was to donate his skeleton to a medical school. He saw being a skeleton hanging in a lab for generations of medical students as a kind of immortality, and also, just very cool. All his friends thought it was cool too. His parents thought of it as a chance of him doing something good with a life the potential of which would never be realized-- he’d be a tiny piece of hundreds of medical careers.

Apparently, real human skeletons are very valuable to medical schools, and it’s a big deal when someone agrees to donate. A juvenile is even harder to come by. I don’t know what kind of cancer he had, but it didn’t preclude him from donating his skeleton. His parents let him. I guess he was pretty persistent in the request. Anyway, the parents took heavy criticism from family for his not having a “decent burial.” They did get back the ashes of his soft tissue, and bury that, so he has a grave, but some family was still mad. I say it’s no one’s business but the kid and the parents. I certainly understand the desire of grandparents and other relatives of wanting a funeral and a grave to visit, but ultimately, they had that.

When people donate their bodies to science, this is often what’s done with them.

Many years ago, I worked with a woman who had had a miscarriage at 4 1/2 months, and the baby was so perfectly formed, they wanted to put it on display at a medical school, and they consented to this. :slight_smile: Most of the people to whom I’ve told that have thought it was disgusting, but I disagree. How could somebody NOT do that? :smack:

That is a step down a slippery slope.

When you have people literally dying for lack of organs, this sort of thing can invite unethical behaviour.

I think the answer is to have one kidney opt out and opt in of you want to donate everything else. I mean if one kidney is enough for a living human being, one kidney ought to be enough for a dead one. And IIRC, this will virtually eliminate the need to wait over a year for an organ.


If it’s only the doctor making the decision, i would have a problem, but if the terminally-ill patient is determined to be of sound mind, and makes the decision, then i think it’s fine.

Of course, in most places, this would effectively require writing new laws not only for organ donation but for assisted suicide. But i’m in favor of assisted suicide laws as well, so i have no problem with that.

Most people who are candidates for assisted suicide, as it exists now, have cancer or some other disease that does preclude organ donation.

People who want to be organ donors can specify any organs or tissues that they do not want removed. The most common is the heart, and like it or not, the surgeon must respect this wish.

That sounds interesting - I’ll keep my eyes open for it.
However, the Reader’s Digest article is about a different person. They don’t give his name - they just call him D.W. - but he is still alive (or was at the time of printing). He had volunteered to donate a kidney but was told the risks were too great since he’s already sick, and the article also says his other organs would be poor candidates for transplantation if he ultimately dies of ALS. (If I recall and understand correctly, he is expected to die of asphyxiation when his lungs stop working.)

I’m not sure whether you’re objecting to opt-out rules or the imminent death standard from the article; but in either case, I think I should clarify my position. I think it’s a bit spiteful to bury organs that could save lives, but I think that decision should be respected (or at least not contravened). I think opt-out rules achieve that end, but I don’t have a strong opinion in the opt-in/opt-out debate. I only mentioned it to emphasize that I’m not against organ donation per se; I do think it needs to be handled carefully to avoid conflicts of interest, but I don’t give credence to all the lurid tales of organ theft circulating the internet. Nor do I have a problem with the examples given in posts #4 and #5.

I worry that things like this article unintentionally put pressure on people to hurry up and die. The decision to donate organs is hailed as “brave” “this final act of heroism” “courageous”; people who want to use their own organs to stay alive for what little time they have left don’t even get faint praise. There’s a pair of sentences with a downright Orwellian tone. (This would be on page 105, middle of the second column, right under the heading A Dying Wish)

Um… redefine harm??
Of course, I wouldn’t put it past Reader’s Digest to have edited the soul out of a more nuanced quote from the original article; but that’s the danger in delicate matters like this.

I would probably do that, but in Judaism, a 4 1/2 month fetus isn’t a life, or a person, and isn’t formally mourned, and actually, neither is a full-trm stillborn, or even a baby who dies shortly after birth. (I had some friends who lost a baby, and were hounded by the staff at the hospital to name it and have a funeral, and their rabbi had to talk to the hospital director to put a stop to it). Different faiths have different approaches, and I can see how other people would have different feelings. I wouldn’t want my name on it, because I wouldn’t want the phone calls.

Sure. At one time, it would have been unthinkable to amputate a healthy limb, but now, people with certain kinds of injuries or neurological disorders have had healthy limbs they can’t control well amputated in favor of prostheses that will work better. It’s a very narrow constrict, but it happens. And women with the BRAC genes have has as yet still healthy breasts prophylactically removed. That would have been unthinkable as recently as the 1970 (or maybe even the 1980s). 100 years ago, reconstructive surgery was brand new. Elective surgery was a redefinition of harm. Removing a healthy kidney from you certainly harms you, but if it’s to save someone else, and you have consented, it is something that is done fairly frequently. Bone marrow transplants are painful for the donor, and have a non-zero risk, but they are done. Sometimes people with terrible infections are given antibiotics that will harm them, but it is judged to be a lesser harm.

So, actually, doctors do harm all the time. Blood draws are painful, and have a non-zero risk, but are balanced by a benefit. That’s the trick in redefining harm-- asking what good balances it out, and does the good outweigh the harm. You could probably write a graduate thesis on the redefinition of harm over the centuries.

I am against the imminent death standard and I am in favor of opt out rules.

I just said to hell with it and donated my whole carcass to a med school. I don’t suppose I will live to see if that solution works. (ಠ⌣ಠ)

I have no problems with removing organs from an almost dead donor. I scoff at the fear of escalation. What doctors are going around killing people just so they can rush off to do a 10 hour surgery, or mail a frozen organ halfway across the country for another doctor to transplant? It doesn’t pass the smell test that some people apparently believe there are legions of doctors eagerly waiting in the wings to kill someone and take their organs. Its not even organs for themselves, which would make sense, but organs for other people who they don’t know.

Let people sell their organs. Problem solved. What other extremely valuable, life saving items do we expect people to just give away for free? We don’t even do that with food, shelter and water.

Organ transplants are extremely lucrative operations. We’re talking half a million to a million dollars per transplant. You don’t think that’s an incentive for the surgeon? Why shouldn’t the donor get a piece of that pie?

Frankly we need to do a better job with death planning for terminally ill people. We have birth plans - we need death plans.

Should death plans - considering the possible course of the disease and making plans about your future possible choices - not that you can’t change your plans - would go a long way.

And if that is the case, and the terminally ill patient has consistently said “at point X, if my organs are still viable and you need to take them out to save someone else - don’t ruin my organs so I can have another six days” or whatever.

But I do agree with the point - for a lot of terminally ill patients, their organs are pretty damaged.

I’ll admit I don’t know how a doctor gets paid for some specific procedure. The rules of medical billing seems byzantine and obtuse to me. Are doctors generally paid a straight percentage of the cost of the operation? Or are they more salaried and get paid a certain amount whether or not they do some specific procedure or not?

One simple thing: make organ donor a “opt out” instead of a Opt in.