Presumed consent in organ donation

[Doreen]

Yeah. Must think of the dead corpse before the "will die without donation" patient. Anyone who doubts the necessity for organ donation should work for one week as a volunteer in accident and emergency.

So you would not allow religious/spiritual reasons to be respected, for example?

I think you are confused if you think that everyone not comfortable with this proposal 1) does not know the importance of organ donation 2) even has a problem with organ donation.

I simply don't think that the state has rights to what is a person('s) and his or her family's, unless one specifically makes an objection.

And if you want to 'save lives', you could, instead of the vast expenses of that operation, feed a village whereever there is a food shortage somewhere. Donate all that money to AIDs medicines for those somewhere where they cannot afford them, etc.

 

[Doreen]

Anyway, what does everyone think of such a proposal? For or against?

Let's extend the core idea. If you die what is yours goes to help strangers unless you have specifically objected to this.

Thus, if you have not written a Will, your property will be sold and the proceeds will go to feeding the poor, paying for medical care for those who cannot afford it...and so on.

 

[Randwolf]

Thus, if you have not written a Will, your property will be sold and the proceeds will go to feeding the poor, paying for medical care for those who cannot afford it...and so on.

Fascinating, although the will would play the part of "opt-out" in the thread topic.

My question though, relates to those who have no will and no living relatives when they die - what happens to their estate? A sidebar, I know...

I tried (briefly) to track this answer down to make some obscure reference in this very thread - I find it interesting that you would raise a similar issue in the same thread... (Albeit from an undoubtedly different perspective)

Do you by chance know the answer to my query?

 

[Doreen]

Fascinating, although the will would play the part of "opt-out" in the thread topic.

My question though, relates to those who have no will and no living relatives when they die - what happens to their estate? A sidebar, I know...

I tried (briefly) to track this answer down to make some obscure reference in this very thread - I find it interesting that you would raise a similar issue in the same thread... (Albeit from an undoubtedly different perspective)

Do you by chance know the answer to my query?

I think the answer is...
eventually the State. (I can't remember where you're from, so I went to my own country)

Though I would assume creditors would get a shot at it - not that I am sure.

Here's how it can run down in one state...

http://www.kaiwesselslaw.com/PracticeAreas/What-Happens-If-There-Is-No-Will.asp

And I wasn't really suggesting what I said about instances with no will, but I think the same logic put forward by people for organ donation holds for my suggestion about Wills. IOW I was trying to convert.

 

[Tiassa]

Take 'em, or she'll slip one to me

If that fails, then pick up the other Twilight Zone script where the overly strung businessman tries to give up smoking, and they cut off his wife's fingers when he won't stick to the schedule. Carrot and stick.

That might work for an opt-in scheme: Sign up for organ donation, or we'll cut off your wife's fingers.

Which might lead to a new wave of "Henny Youngman" divorces.

And can you imagine the brief from the respondent? "If she wasn't slippin' me one every other Tuesday ...."

Okay, I admit, this probably isn't helpful.

 

[milkweed]

Hi Milkweed...

Would you not agree that many of the "majority" make their choices based on remnants of religious imprinting? IOW, what is your opinion on the affect of education, specifically secular education?

I dont know what the majority make their decision based on.

Aside from the general concept of "master of my own destiny", even after death, what dire consequences do you foresee stemming from an "opt-out" system?

Define dire consenquence. Do I think they will rush to pull the plug. It is possible. Do I think families will be left with more questions regarding information given to them via opt in? Yes, absolutely. When a family member checks the box themselves, there is little room for doubt in the surviving families minds.

My step dad donated his organs, so its not like I havent seen parts of what its about. Personally, I was surprised he was a donor, I had not expected that from him. But he checked the box himself so I know that is what his intent was. Without that being checked I would not have known and would have assumed his morality would require him to say no (you have no idea what kind of life my step dad lead). Personally, I thought his donation was a risk to the person, but in the end, due to the cause of his death (unknown amount of time of heart stoppage), there was limits on how much of his body could be used and no major organs qualified. Something I did learn, the skin and tendons have a much longer usage period and are not beating heart dependent. I think his eyes were used also, but cant remember for sure.

After all, the results from countries experimenting with this system appear mixed at best, with an apparent upswing of donations in those nations utilizing the "opt-out" method:
Opt-in vs. opt-out

So there ya go. Mixed at best. I know each time I renew my DL I am asked about the organ donation question. So ever four years I make that decision. Now, question for you. Do you know what the requirements are for organ donation and your DL? By this I mean, if I Opt-in and say they find out I have Hep C or luekemia, or so other type of cancer, am I required to get a new DL and opt out? Should I even if there is no requirement to Opt out because of an illness? If I am told I have stage two or three cancer, do you think I am going to remember to change my auto Opt In on my DL? Do you think it would be one of my priorities, just in case I get in an accident on the way to my chemo treatment (ok so maybe it was a trip to the grocery store).

If one is to believe the apparent trend towards more donations per-capita in "opt-out" states, presumably leading to more lives saved, how do we balance the two dissenting points of view?

Is it a trend or is it people forgetting to opt out, or is it people who dont care one way or another (and note, if they dont care one way or another, are they going to opt out under hep c or cancer or other health issues that might exclude their donation). Do you want the increased donations to also increase the risk to the transplant person?

Personally, if it weren't for the superstitious myths surrounding the subject, plus its general "creepiness", I would think "opt-out" would be the obvious solution. Frankly, I'm somewhat surprised at your disagreement - especially if it is mostly based on some sort of "herd mentality" where the majority seem to head one direction - simply because the popular weather-vane blows in a certain way. Not saying that this is the case, merely requesting clarification....

I am surprised you are surprised.

I can see the herds pov and the herd is not always wrong.

 

[CheskiChips]

How about this instead.

You're automatically an organ donor unless your drivers license or records state otherwise. However, if the person doesn't have guaranteed identification they are assumed a non-donor?

 

[Randwolf]

I dont know what the majority make their decision based on.

I am aware that you don't "know", I was asking for speculation. Sorry for the ambiguity. So - speculation?

Define dire consenquence.

In this case I would leave the interpretation to you. What constitutes "dire" in your vocabulary?

Do I think they will rush to pull the plug. It is possible.[

I agree - possible. Not likely, we seem to come up with fences to keep us from falling down that slippery slope...

Do I think families will be left with more questions regarding information given to them via opt in? Yes, absolutely.

Presumably, you meant "opt-out", as "opt-in" is the current standard. I know that families will be left with questions - they always are. That doesn't address the underlying issue. Why do people question this practice, when clearly organ donation provides a service, whereas "opting-out" does... what? Offers solace for the survivors? At what cost - the potential death of another human? And why? I keep offering vestigial religious / spiritual superstition. Do you have a better reason?

When a family member checks the box themselves, there is little room for doubt in the surviving families minds.

Peculiar how that "little" doubt can grow though, isn't it? Absolute certainty is nearly impossible to achieve. As was your father's, my mother's death was complicated and fraught with doubts and difficulties. She professed to desire DNR, yet I was the one that had to make the actual call in the E.R. - I had about 3 seconds while everyone stopped to await my decision - interesting 3 seconds...

My step dad donated his organs, so its not like I havent seen parts of what its about. Personally, I was surprised he was a donor, I had not expected that from him. But he checked the box himself so I know that is what his intent was.

You think you knew what he desired, at the time he checked the box. Hence, that little niggling doubt...

Without that being checked [his opt-out form] I would not have known and would have assumed his morality would require him to say no (you have no idea what kind of life my step dad lead). Personally, I thought his donation was a risk to the person, but in the end, due to the cause of his death (unknown amount of time of heart stoppage), there was limits on how much of his body could be used and no major organs qualified.

Something I did learn, the skin and tendons have a much longer usage period and are not beating heart dependent. I think his eyes were used also, but cant remember for sure.

I wonder how the recipients think of your dad, the donor, today? Especially if this gift allowed someone to see the sunrise or walk the streets unaided... Good stuff, eh?

So there ya go. Mixed at best. I know each time I renew my DL I am asked about the organ donation question. So ever four years I make that decision.

And? What if you had to opt in/out every four years? Would that be so very different?

Now, question for you. Do you know what the requirements are for organ donation and your DL?

Yes

By this I mean, if I Opt-in and say they find out I have Hep C or luekemia, or so other type of cancer, am I required to get a new DL and opt out?

No

Should I even if there is no requirement to Opt out because of an illness? If I am told I have stage two or three cancer, do you think I am going to remember to change my auto Opt In on my DL? Do you think it would be one of my priorities, just in case I get in an accident on the way to my chemo treatment (ok so maybe it was a trip to the grocery store).

This is not your responsibility, anymore than when you donate blood. Do you think the Medical Profession hasn't thought of this? Do you really think there are no biopsies taken? Besides which, we are often talking about life or death for the recipient - when slip-ups do occur, which they will, what exactly has the patient risked? But again, I am assuming safeguards would be in place to justify the risk / benefit ratio.

Is it a trend or is it people forgetting to opt out, or is it people who dont care one way or another (and note, if they dont care one way or another, are they going to opt out under hep c or cancer or other health issues that might exclude their donation). Do you want the increased donations to also increase the risk to the transplant person?

Again, see above. Are you assuming that every transfusion of Hep C infected whole blood results in multiple secondary infections? Please - I know you are smarter than that. Organs (and other body parts, including blood) are screened prior to implantation. This is, IMHO, a very weak argument against Opt-out.

I am surprised you are surprised.

That's two of us!

I can see the herds pov and the herd is not always wrong.

Nor is it always right - but it is often overwhelming...

 

[Kernl Sandrs]

I used them as another example of how people can become pawns of the system . Since they do not have anyone to watch out for them they could be at risk for those wanting organs from them without telling them what is really going on.

You realize of course that an organ cannot be used in a hospital if it is not properly tagged? It makes organ harvesting impossible. The hospitals can't just use any kidney that shows up on the doorstep. It's all heavily regulated to ensure safety to the recipient. Wouldn't want a new Liver from a heavy alcoholic, or a heart from someone with cholesterol-related diseases, would you?

In the United States, tissue transplants are regulated by the U.S. Food and Drug Administration (FDA) which sets strict regulations on the safety of the transplants, primarily aimed at the prevention of the spread of communicable disease. Regulations include criteria for donor screening and testing as well as strict regulations on the processing and distribution of tissue grafts. Organ transplants are not regulated by the FDA.

 

[Kernl Sandrs]

In China 95% of their organs come from prisoners. Why don't we do that? God knows we have enough of them. Maybe if people knew their organs would be harvested when they get to prison, they would be less inclined to commit a crime in the first place...Nah, we're too nice over here to do something like that...We're too soft...

 

[madanthonywayne]

I was not suggesting we should follow Larry Niven's story line. Quite the contrary. However, it made for an interesting story theme.

Something else makes me wonder, though. If such a policy was implemented for enough generations, what impact would it have on human evolution?

If we so completely wipe out the criminal classes, are we breeding a naturally law abiding human? OK, I know this is off topic, but the idea interests me.

If the penalty for all crime is death by organ donation, why leave any witness to your jaywalking? If someone sees you shoplifting, pull out your automatic weapon and start shooting, because if you're caught, you're a dead man anyway.

 

[Doreen]

How about this instead.

You're automatically an organ donor unless your drivers license or records state otherwise. However, if the person doesn't have guaranteed identification they are assumed a non-donor?

That's an improvement, especially if one must specifically check yes or no. Leaving it blank is an incomplete form.

 

[S.A.M.]

So you would not allow religious/spiritual reasons to be respected, for example?

I think you are confused if you think that everyone not comfortable with this proposal 1) does not know the importance of organ donation 2) even has a problem with organ donation.

I simply don't think that the state has rights to what is a person('s) and his or her family's, unless one specifically makes an objection.

I'm a believer in the greater good principle. Show me a religious person who needs an organ and refuses it. Maybe you can find some where you live but Indians are singularly pragmatic [Hinduism considers organ donation an act of charity, while Islam requires that organ donation be free and willing, without expectation of reward or return, so both culture and religion possibly dictate my opinions]. As long as those who opt out of organ donation never receive an organ, I am alright with such brand of ownership

 

[Big Chiller]

I'm a believer in the greater good principle. Show me a religious person who needs an organ and refuses it. Maybe you can find some where you live but Indians are singularly pragmatic. As long as those who opt out of organ donation never receive an organ, I am alright with such brand of ownership

Wait a sec even if one opts out of organ donation one wouldn't donate his/her organs until after death so how does that justify not receiving an organ?

 

[S.A.M.]

Because opting out is also pre-mortem? One could make it a two-in-one form. Opt out of one and you immediately disqualify for the other.

 

[Doreen]

I'm a believer in the greater good principle.

I'm a believer that most people have hubris around their ability to estimate. And oddly, and conveniently, you quoted me with the portion where I directly addressed the greater good priniciple. The entire transplant process costs an incredible amount of money, energy and effort, all of which could probably save many more lives if aimed at poor people elsewhere. The greater good principle would consider most transplant operations something the priviledged people are doing instead of helping a much larger number of people in equal need.

Second, greater good arguments can be used to harvest organs in living people. We could, in many cases, save many lives with one 'body'. But we don't because of feelings about how wrong that would be. We have a rule and we don't try to figure out greater good. IOW we take a deontological stance. Humans are affected by things in very complicated ways and because of this it is not always clear how to 'add up the bodies' which is how I think people are approaching this issue.

Further SAM, I find it odd that a Muslim is backing a greater good principle. The little I know of Islam it is more flexible with its rules and thus more conducive to utilitarian ethics than its Abrahamic peers, but still, it is a deontological system. There are rules that cannot be broken regardless of the consequences.

Last, one can, like the Chinese, justify abortion along greater good lines. But deontologists, many religious, see utilitarianism, in this case, as not justified. They often do when it comes to war, but not here.

Show me a religious person who needs an organ and refuses it.

I would be surprised if most Christian Scientists do. It seems at least some Muslims are against it.
http://www.themodernreligion.com/misc/hh/organ-transplant.html

and note here....
http://www.organdonation.nhs.uk/ukt...ectives/leaflets/islam_and_organ_donation.jsp

Consent

The consent, or lack of objection, of those closest to the patient is always sought before organs can be donated. This is why it is so important for people to discuss their wishes with their loved ones. Donation is an individual choice and views differ even within the same religious groups. Many families who agree to organ donation have said that it helps to know some good has come from their loss.

IOW this group of Muslims would be against the proposal in the OP, since the family of the dead person is not giving consent.

Do you want to pass legislation that overrides this?

Maybe you can find some where you live but Indians are singularly pragmatic [Hinduism considers organ donation an act of charity, while Islam requires that organ donation be free and willing, without expectation of reward or return, so both culture and religion possibly dictate my opinions].

See above.

As long as those who opt out of organ donation never receive an organ, I am alright with such brand of ownership

We wouldn't know what many of them would have done if they had needed an organ. We would by default assume that they and their families have no say at that point because the individual failed to say no earlier.

 

[stateofmind]

I'm not trying to thread jack here... but I remember reading an article where there were these underground facilities in China that steal people and would extract organs for a VERY profitable organ market over there... Does anyone know what I'm talking about?

 

[milkweed]

I am aware that you don't "know", I was asking for speculation. Sorry for the ambiguity. So - speculation?

I do not feel like speculating on this issue. My answer remains. I do not know whether religion is the driving reason.

I agree - possible. Not likely, we seem to come up with fences to keep us from falling down that slippery slope...

Well the wiki link you posted tells a different story under scandal. And heres another:

"In the most dramatic story, an Oklahoma man recovered four hours after doctors had pronounced him "brain-dead" and were preparing to harvest his organs. Zach Dunlap, 21, sustained severe head injuries after a car accident last November [2007]. Since he was a registered organ donor, his parents gave permission for his organs to be used. No brain activity was evident on a PET scan. Fortunately, relatives noticed small signs of life just as his tubes were being removed. Despite a grim prognosis, he walked out of a rehabilitation unit. Four months later he was well enough to appear on the NBC Today show in New York -- where he claimed that he heard the doctors pronouncing him dead.

http://www.bioedge.org/index.php/bioethics/bioethics_article/8081/

hmm, relatives noticed movement but the trained med staff did not. Human failing driven by the donation program. Greater good and all. It does cloud judgments. Or was it the money.....

Blackmarket donor compensation:

http://online.wsj.com/article/SB10001424052970204886304574307932274150934.html

The slippery slope is assuming everyone wants to be a donor. Opens up too many issues with doctors ignoring the opt-out option under "well I didnt see that part, or we missed it". With Opt-in (I have to check the box for organ donation) if I do not, the hospital can still talk to my family to make sure that was my/their wishes. Opt-out (where I must state no donation) leaves that slippery slope open. Docs do ignore patient wishes on DNR. EMTs ignore patient DNR instructions. And they will ignore Opt out wishes. They cant now, its auto assumed the answer is NO unless specifically stated. That is a big difference.

That doesn't address the underlying issue. Why do people question this practice, when clearly organ donation provides a service, whereas "opting-out" does... what? Offers solace for the survivors? At what cost - the potential death of another human? And why? I keep offering vestigial religious / spiritual superstition. Do you have a better reason?

I dont need a better reason. Its their reason. I dont agree that it is a service, its a money making machine for everyone but the transplant receipent and the donor. And to be on the reciepent list you have to have the money or insurance. I already fund the insurance industry (well not currently because I dont have health insurance). So one can argue that by not donating organs, your reducing health care costs.

http://surgery.about.com/od/beforesurgery/ss/TransplantPay.htm

Typically more than $30K a year for anti-rejection drugs. And thats for the rest of their lives.

*note, I am not suggesting that organ donations should be banned. But dont tell me its a service, it is a cash cow for the hospitals and for the drug companies.

Absolute certainty is nearly impossible to achieve. As was your father's, my mother's death was complicated and fraught with doubts and difficulties. She professed to desire DNR, yet I was the one that had to make the actual call in the E.R. - I had about 3 seconds while everyone stopped to await my decision - interesting 3 seconds...

I had no doubt my step dad wanted to donate. He checked the box himself. There was no questions about his wishes simply due to the fact he had to request being put on the donor list. That would not be true with an auto Opt-in.

My doubts were not based on his basic nature, my doubts were in his motivation without comprehension of what happens to the person getting his organs. He lived a hard life. He drank heavy for MANY years. He used steroids for a while (body building kick in his mid life) and other things not meant for public viewing. Do you wonder why the OP link talks about the person needing a second transplant? I do.

Real life and recent example. An aquaintance (friend of a friend) kid donated a kidney to her friend against family advice. Why did this kids friend need a kidney? Well the docs had changed his transplant meds for the newer OH so much Better drug being promoted by a major drug company. Guess what? the new drugs killed the kidney donated by the mom. Make matters worse the aquaintance kid has had nothing but trouble since donating. Hospital introduced infection. You got it. Drug resistant. And the time frame of the drug company push is very close to when the OP needed the second kidney. But that is just a question. Transplanted Kidneys do fail for various reasons. I just happen to know of a real life case where it was the change over (and the kid didnt want to change meds, there were no issues prompting the change other than lookie, a new more better drug).

This is not your responsibility, anymore than when you donate blood. Do you think the Medical Profession hasn't thought of this? Do you really think there are no biopsies taken? Besides which, we are often talking about life or death for the recipient - when slip-ups do occur, which they will, what exactly has the patient risked? But again, I am assuming safeguards would be in place to justify the risk / benefit ratio.

"A handful of medical conditions will rule out organ donation, such as HIV-positive status, actively spreading cancer (except for primary brain tumors that have not spread beyond the brain stem), or certain severe, current infections."

http://www.unos.org/qa.asp#donLimits

So yes, as a Donor, If I am diagnosed with cancer, I do have an obligation to remove myself from a donation list.

"Alex's liver went to a 52-year-old man. His pancreas to a 36-year-old woman. His kidneys went to two different men, one 46 and the other 64.

A month later, an autopsy revealed that Alex never had meningitis. He had a rare and fast-moving lymphoma cancer -- one that was now working its way through the bodies of four other people."

http://www.cbsnews.com/stories/2008/04/01/eveningnews/main3987994.shtml?source=mostpop_story

Now for the record Alex and his family did not know he had cancer. It was not with intent or negligence. But there is a push to allow more cancer survivors onto the donation lists and its wrapped around "we need more donors".

Alex's family feels horrible that their donation caused two patients to die and caused the other two to have to undergo treatment (may or may not work).

Are you assuming that every transfusion of Hep C infected whole blood results in multiple secondary infections? Please - I know you are smarter than that. Organs (and other body parts, including blood) are screened prior to implantation. This is, IMHO, a very weak argument against Opt-out.

Dont talk down to me. You assume much. Fact is its become more obvious some cancers are spread via disease (HPV). You know Hep C causes liver damage and cancers. It doesnt matter if its via blood transfusion or liver transplant. Add in the auto-immune represent drugs and there ya go. There was a man (transplant receipent) who died of ovarian cancer, recently in the news (less than a year). IIRC it was 4 months AFTER the transplant that they discovered the disease in the donor. Must have been a backlog in testing. Note on Alex case, it was a month after the transplant that they discovered the cancer. And these are a few cases.

This has been going on longer than you suspect. Before they used to blame the recipent (predisposition) or their anti rejection drugs. Thats become harder to do now. But not impossible.

Nor is it always right - but it is often overwhelming...

As far as the herd, right or wrong, it should be a choice they consciensiously make, not an assumption by the state on your DL (or ID) to feed an unrelated field.

 

[Anti-Flag]

It's a great idea. Now when someone I care about needs an organ there's a much higher chance the person I kill will be a donor.

 

[Doreen]

It's a great idea. Now when someone I care about needs an organ there's a much higher chance the person I kill will be a donor.

You just wrote a thriller.