Presumed consent in organ donation

[Dywyddyr]

Or his charge sheet.

 

[Anti-Flag]

Or his charge sheet.

In one sentence? I'm not a sweet old lady you know.

I would of course presume in reality any organs from a crime scene are not to be re-used prior to a completed investigation. So the trick is not to make it look like a crime, or to bribe the coroner.

Ok sensible time:
Regardless of whether or not a dead person needs their organs, they're technically still their organs, and taking without consent should be considered theft. It's why we don't use presumed consent when it comes to taking someone elses car for a drive. I know a lot of people are just too lazy to sign the consent forms, but presumed consent just seems wrong to me. It should be a conscious decision made by the donor, we just need to encourage it better and make it easier for people to opt-in.

 

[Norsefire]

It's a disgusting idea and would just be another abuse of government power.

 

[Tiassa]

You underestimate Islam

Second, greater good arguments can be used to harvest organs in living people.

Are all principles applied generically, or does circumstance carry any weight? In the case of the latter, is there a significant difference, as you see it, between a living person and a dead one?

Further SAM, I find it odd that a Muslim is backing a greater good principle.

The greater good underpins the entire concept of the ummah. To the other, the mullahs and imams are not the final word in Islam; that authority belongs to Allah. If any Muslim is mistaken in their understanding of that authority most high, they will have their day of reckoning. As with any faith, Islam's significance is individual; how each person experiences the divine and understands Its instructions is entirely their own. We tend to forget or overlook this in these fearful days of war and terror, but history teaches this result nonetheless. Ana al Haqq. What was heresy to the authority of its day persists nonetheless, because it is a truth that cannot be objectively refuted.

When we restrict people to contemporary definitions centered around immediate perceptions, we tend to identify them too narrowly, and thus wrongly.

As such—

... Islam requires that organ donation be free and willing, without expectation of reward or return ....

—we might also say that those who are not willing will also have their day of reckoning with Allah. The underlying question of societal obligation seems hard enough, but one thing about religions critics often underestimate is their flexibility over time. It is not impossible that Islam can be reasonably interpreted to instruct the faithful in such a manner that they would be willing.

 

[S.A.M.]

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.

And this is where market forces come into play. Why do you think power plays such an important role for organ donations? Why is the kidneys of poor people which are sold with greater frequency than those of the idle rich?

Second, greater good arguments can be used to harvest organs in living people.

And indeed they are. Blood, bone marrow to name a few.

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.

I am approaching the issue from a pragmatic viewpoint. We are not talking about giving consent for organ donation. We are discussing a procedure to opt out of it. We already live in a society where prima facie if a doctor is faced with two bodies in the ER, one which is medically dead and the other which requires an emergency transplant to survive, it is the second which will have priority as a patient. At that point, if I were the medically dead, it would be ridiculous [and medically impossible] to ask me if I want to take my organs with me, rather than offer the choice of survival to another - my family or the law may prefer to keep me attached to machines a la Schiavo without my consent. I have seen cases in the ER where people have watched their family, their children suffer and die because so many dead people would rather take their organs with them to the compost heap. If we live in a society where we cannot trust the doctors medical opinion because he is looking at his profit margin [or that of the insurance industry] we have only to look at ourselves why the society is biased/based in such a fashion. A self centered individualistic society cannot be one that looks to the society at large.

If we now want to establish ownership than we are bartering organs and our own organs should be on the market place if there is to be an equitable market

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.

Islam is all about choices and motivations. You make your choices and face the consequences. Thats utilitarian enough. Personal responsibility should be equivalent to personal rights.

How many people would opt out of organ donations if it meant they could never even receive a blood donation from someone else?

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.

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

Indeed and I would ask any of these Muslims if they would too refuse a donation which was the blood, marrow or organ of another.

Or direct them to something like this:

“This question is very much debated by the jurists in past two decades. The Supreme Council of `Ulama in Riyadh (in their resolution no. 99 dated 6 Dhul Qi'dah 1402) has allowed both organ donation and organ transplantation in the case of necessity.

The organ can be taken from the body of a living person with his/her consent and approval and also from the body of a dead person. In the case of a living person, the jurists have stipulated that this donation should not deprive him/her of vital organs. It should also not cause risk to his/her normal life.

The Fiqh Academy of the Muslim World League, Makkah also allowed organ donation and transplantation in its 8th session held between 28 Rabi'ul Thani- 7 Jumadal Ula, 1405.

The Fiqh Academy of the Organization of the Islamic Conference in Jeddah, during the year 1408, and the Mufti of Egypt Dr. Sayyed At-Tantawi also allowed the use of the body organs of a person who has died in an accident, if the necessity requires the use of any organ to cure a patient, provided that a competent and trustworthy Muslim physician makes this decision.

It is important to note that most of the jurists have only allowed the donation of the organs. They do not allow the sale of human organs. Their position is that the sale of human organs violates the rules of the dignity and honor of the human being, and so it would be haram in that case.

Some jurists suggest that because people have become too materialistic and it may not be possible to find a free organ, under necessity one can purchase the organs, but a Muslim should never sell his/her organs.”

http://www.islamonline.net/servlet/...nglish-Ask_Scholar/FatwaE/FatwaEAskTheScholar

Ultimately, its a personal choice.

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?

I've already offered my suggestion. If you opt out of organ donation, you should disqualify for one.

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.

Again, all opt out forms should disqualify the opt-outer so that there are no misunderstandings

 

[Pandaemoni]

I am in favor of an opt-out system. The problem is that people do not decide to opt in or opt out rationally, We *think* we do, human beings are not rational in a strict sense and typically take the default outcome in these situations no matter what it is. There is a "framing bias" in cases like these.

See for example, this video where the discussion of organ donation starts about 5:05: http://www.ted.com/talks/dan_ariely_asks_are_we_in_control_of_our_own_decisions.html

The whole video is worth watching and tends to back Hume's belief that "Reason is, and ought only to be the slave of the passions, and can never pretend to any other office than to serve and obey them."

 

[Doreen]

And this is where market forces come into play. Why do you think power plays such an important role for organ donations? Why is the kidneys of poor people which are sold with greater frequency than those of the idle rich?

Sure that's a benefit. More organs lower, but no doubt still appealing, prices on organs. But this doesn't really address my point. At this point organ donations are not working for the greater good, nor will they be after this legislation. We are still talking about a misappropriation of funds and other resources once the situation of poor people is brought into play. Yes, more organs would be available and this would drive down prices, but they would still be high for many non-westerners. However the operations themselves will still be prohibitive, and by the standards of many, perhaps most world citizens, hysterically high, and many more could be saved if instead of the operation issues poor people deal with were tackled first. A consistent greater good approach would remove organ donation, at least for the near future, from the table. The issue is moot now.

And indeed they are. Blood, bone marrow to name a few.

Did you really not understand what I meant? Further bone marrow is not 'an organ' and while sometimes the blood IN TOTAL is considered an organ no one donates all their blood, so they have not given you 'an organ'.

I am approaching the issue from a pragmatic viewpoint. We are not talking about giving consent for organ donation. We are discussing a procedure to opt out of it. We already live in a society where prima facie if a doctor is faced with two bodies in the ER, one which is medically dead and the other which requires an emergency transplant to survive, it is the second which will have priority as a patient. At that point, if I were the medically dead, it would be ridiculous [and medically impossible] to ask me if I want to take my organs with me, rather than offer the choice of survival to another - my family or the law may prefer to keep me attached to machines a la Schiavo without my consent. I have seen cases in the ER where people have watched their family, their children suffer and die because so many dead people would rather take their organs with them to the compost heap. If we live in a society where we cannot trust the doctors medical opinion because he is looking at his profit margin [or that of the insurance industry] we have only to look at ourselves why the society is biased/based in such a fashion. A self centered individualistic society cannot be one that looks to the society at large.

Not quite a response to the issue I raised. General good arguments can be made for harvesting organs from, for example, prisoners on death row. One killer could save five people, restore sight to at least one more and so on. But we do not do this. Most people do not fully work from greater good principles and generally they don't because of human feelings.

Islam is all about choices and motivations. You make your choices and face the consequences. Thats utilitarian enough. Personal responsibility should be equivalent to personal rights.

I tend to agree, however it seems that there is some controversy within the Muslim community about organ donation and the family of the dead person's right to withhold consent.

How many people would opt out of organ donations if it meant they could never even receive a blood donation from someone else?

Irrelevent.

Indeed and I would ask any of these Muslims if they would too refuse a donation which was the blood, marrow or organ of another.

Sure, but the point is that what is happening is that a significant minority of religious people do and will have objections to the proposed law. After you have convinced them with your arguments, we will be in a different situation. Further you keep missing one point. The proposal means that we will have situations where a dead person is presumed to be available. We cannot at that point, in most cases, see if they were consistent in their beliefs.

I've already offered my suggestion. If you opt out of organ donation, you should disqualify for one.

Right and I have some respect for that idea, though I could see pacifists running into problems with that kind of logic. Since they can be seen, often, as reaping the benefits of soldiers, it seems they could have certain rights stripped in and after wartime.

 

[S.A.M.]

Sure, but the point is that what is happening is that a significant minority of religious people do and will have objections to the proposed law.

Hence my "opt out and disqualify yourself" suggestion.

there is some controversy within the Muslim community about organ donation

No there isn't. I don't know of any Muslim community that bans organ donation, do you? There may be individuals with opinions which are not mainstream, but then, there always are. I doubt that Leicester, UK qualifies as one of them.

Right and I have some respect for that idea, though I could see pacifists running into problems with that kind of logic. Since they can be seen, often, as reaping the benefits of soldiers, it seems they could have certain rights stripped in and after wartime.

That does not need a change in law to happen. Like the draft or the patriot act.

 

[Tiassa]

A Hippocratic Hitch?

Opt Out/Disqualify: A Hippocratic Hitch

Presumably, if few enough people opt out, there would eventually be more organs available in the U.S. than needed. Thus:

A doctor receives a patient who is critically ill. The patient requires a new liver. There is one available; the operation can begin within a matter of hours. However, the patient is one who opted out of organ donation. Should the doctor refuse to perform the transplant?​

We can presume that the transplant organ is not needed anywhere else at the moment.

What I'm asking about, specifically, is the position such a scheme puts doctors in. There are, foreseeably, times when doctors would be expected to deny lifesaving treatment as a matter of public policy. We presently have enough problem wrangling with the issue of treatment denied by insurance companies, and what a doctor should do in those times. Generally speaking, we support those doctors who fulfill their oath, criticize those who do not, and revile the institutions that put the choice in front of them.

Would I deny the patient, was I a doctor? No. And if they came for my license, so be it. Of course, ask me again if I'm ever a transplant surgeon facing the loss of my practice for such a decision.

 

[Randwolf]

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

Your prerogative, of course. I have seen conflicting information regarding "official positions" of various religions, sects and churches on organ transplantation.

For example:

No religion formally forbids donation or receipt of organs or is against transplantation from living or deceased donors. Only some orthodox jews may have religious objections to “opting in.” However, transplantation from deceased donors may be discouraged by Native Americans, Roma Gypsies, Confucians, Shintoists, and some Orthodox rabbis. Some South Asia Muslim ulemas (scholars) and muftis (jurists) oppose donation from human living and deceased donors because the human body is an “amanat” (trusteeship) from God and must not be desecrated following death...

By the way, I have seen the "Orthodox Jewish" objection pop up several times, but if you check "official sources", it appears to be a myth, at least according to public statements.

Judaism - All four branches of Judaism (Orthodox, Conservative, Reform, and Reconstructionist) support and encourage donation

Nonetheless, the Judaism objection is still alluded to, even from reputable sources - Mayo Clinic Facts:

Myth: Organ donation is against my religion.
Fact: Organ donation is consistent with the beliefs of most religions. This includes Catholicism, Protestantism, Islam and most branches of Judaism

(Emphasis mine.)


More frequently, I see references to resistance from "the masses" based on their interpretation of "God's will" and the sanctity of the human body. The articles don't seem to cite the source of this conjecture, but this "objection" is mentioned numerous times in articles regarding implementation of legislation. Hence - speculation, at least at this point.

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.

And one for you:

...let me just offer a couple of statistics. In its seminal 1999 report on the subject, To Err is Human, the Institute of Medicine estimated that as many as 98,000 American patients are killed each year by medical error. Hospitals are such complicated places, the ways that care givers can blow are almost too numerous to count. A doctor can accidentally perforate a patient's colon during a colonoscopy, leading to infection. Surgeons leave devices or sponges inside wounds and stitch patients up. One intensive care unit that tracked near misses reported 1.7 errors per day per patient, about 30 percent of which could have been serious or fatal.

Surely you are not advocating that people avoid hospitals because doctors make mistakes, right?

The Mayo clinic seems to address your concerns, directly on point:

Myth: Maybe I won't really be dead when they sign my death certificate.
Fact: Although it's a popular topic in the tabloids, in reality, people don't start to wiggle their toes after they're declared dead. In fact, people who have agreed to organ donation are given more tests (at no charge to their families) to determine that they're truly dead than are those who haven't agreed to organ donation.

Maybe you consider this an appeal to authority, but I highly doubt that the error rate is greater than (or even approaches, IMO) that of the overall percentage of "oops" as mentioned above per the Institute of Medicine as quoted by CBS News. People screw up, doctors are people, doctors screw up, people die. This can not be used as a be all, end all reason why opt-in is better than opt-out.

Or was it the money.....

I doubt this - can you back up the implication? If we were talking about harvesting of black-market organs, in the sense mentioned below, I would wholeheartedly agree with you. In this case, assuming absolute veracity in the relating of the story, it still sounds more like an (unfortunately) all too common, yet mundane, screw up - similar to those mentioned above.

From your "Blackmarket donor compensation" link:

The illicit organ trade is booming across the globe. It will only recede when the critical shortage of organs for transplants disappears. The best way to make that happen is to give legitimate incentives to people who might be willing to donate.

Emphasis mine. If you are contemplating paying people, directly or indirectly, with money or some other compensation, don't you think that approach is going to pour some water on the "slippery slope" and put in a little quicksand at the bottom for good measure? Perhaps we should first try making the "opt-in" approach a little easier, there seems to be some difficulty in this area (USA Today):

Last year, for example, more than 64% of driver's license and state ID applicants in Colorado signed up as donors, the best rate in the nation. Meanwhile, New York and Michigan couldn't hit a measly 13%.

The difference? In Colorado and seven other states with signup rates of more than 50%, motor vehicle department workers are required to ask applicants whether they want to sign up, according to Donate Life America, a non-profit advocacy group. In six states with some of the most abysmal rates, employees are not required to ask. In New York, for example, the question is merely on a form. In Michigan, it's even worse: Applicants have to volunteer that they want to be donors.

Prompting people to answer, especially verbally, is a powerful tool. Organ donation is an intimate subject, one people don't typically think about as they head for the DMV. Forms are easy to ignore. A little human interaction can go a long way toward promoting selflessness

The slippery slope is assuming everyone wants to be a donor.

I could mention unfounded speculation, but that would be counterproductive. I welcome your thoughts. Specifically, why do you hold this to be true? I've offered religious beliefs, I concur with the possibility of corruption, others have mentioned "no more governmental intrusion". What is your opinion? All I see, and perhaps my sight is dimming, is a greater likelihood of mistakes. A valid concern, but as I have already pointed out, I doubt the rate of "mistakes per donor" would be any higher than the normalized rate of potentially lethal "mistakes per patient" that I cited earlier. In fact, a case could be that the ratio would be lower.

As an aside, I ran across this perspective in USA Today as relates to governmental intrusion:

Ironically, the passage of live-saving legislation requiring seat belts, "hands-free" driving, child safety seats, motorcycle helmets and banning smoking in public places was not accompanied by the 90%-plus levels of support seen for organ donation. Furthermore, no citizen was allowed to "opt out" of such laws. In contrast, presumed consent provides the perfect "win-win" scenario: We can save hundreds of lives by eliminating the waiting list, while fully respecting anyone's decision not to donate.

Opens up too many issues with doctors ignoring the opt-out option under "well I didnt see that part, or we missed it".

Couldn't the same be said about "ignoring" or "missing" the opt-in option? Mistaking "Opt-in" would only (potentially) cause someone's death, as opposed to the converse - after all, missing the "Opt-out" might result in the desecration of a corpse. Hmmm...

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.

I missed the part about where we discussed limiting relatives' input on the decision. As you pointed out, doctors "routinely" ignore DNR requests, I'm quite sure that the family will still have a say in overriding an "Opt out" - probably more so than with an "Opt-in". Don't you agree?

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.

(Emphasis mine) They can't? Why not? "Uhhh, I misread the chart, could've sworn the "opt in" box was checked, you know, kind of like that DNR I, ummmm, "misinterpreted" last week?" Please. Explain why a doctor is more likely to misread "Opt-out" vs "Opt-in".

I dont need a better reason.

True. You don't need any reason at all to hold an opinion, I just expected more from you. Not sure why at this point, but I feel like I am touching a personal nerve here. I apologize. I won't ask for future substantiation of your opinions on this issue.

Its their reason.

Sure it is. No requirement that you should state your own reason(s).

I dont agree that it is a service, its a money making machine for everyone but the transplant reciepent [sic] and the donor.

That would be dependent on your definition of "service". Now wouldn't it? Plus, read what you wrote - it's a money making machine for everyone except the two most important participants. One (in many cases) received the gift of life, the other (in many cases) was already dead. If you object to transplant teams making money, or as much money, than address that problem. Don't hide behind fallacies disguised as "Opt out" arguments.

And to be on the reciepent [sic] list you have to have the money or insurance.

I call bullshit. Here is a partial list of funding sources for transplants in the US. There are other private foundations in existence to help with the costs as well. These sources may not cover every penny, may be difficult to be accepted in, but they definitely invalidate your assertion.
* insurance
* Medicare and Medicaid
* charitable organizations
* advocacy organizations
* Veterans Administration
* fundraising campaigns
* prescription drugs assistance programs
* TRICARE (CHAMPUS) and the Veterans Administration (VA)

I already fund the insurance industry (well not currently because I dont have health insurance).

Irrelevant.

So one can argue that by not donating organs, your reducing health care costs.

That argument is so spurious as to be laughable. Please expound or retract.

*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.

Lots of "services" are "cash cows" for hospitals and doctors. Look at MRI's, etc. Are you suggesting the medical establishment should not receive a return on their investment in education, technology, brick and mortar, time invested etc.? Does this attitude extend to the whole of capitalism, or do you just have a hard on for people in the medical field?

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.

Lovely - errr, not really, I would like to express my sympathy here. I can only relate in the form of reiterating and expounding on my Mother's situation - different facts, yet similar doubts on my part. It was quite clear that she thought she wanted her DNR wishes complied with - they were in writing, she wore a med-bracelet, she told my sister an I numerous times - for God's sake, the woman had a sticky note on the inside of her front-door's window - the message began with: To any EMS or other medical team... You can imagine the rest. None of that mattered during the 3-4 seconds that a 12 person trauma team came to an abrupt halt in the E.R. and all eyes were on me. Did she mean what she said? Did she know what she was saying? 4,3,2,1 - we need to know now! I followed my heart...

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 sort of thing happens with many new drugs - remember Thalidomide and the "flipper people"? I do not believe we can let fear determine our choices and advancements in the medical field. (Or other fields for that matter). This first-hand anecdote does offer enlightenment into your personal views however, and I thank you for sharing.

"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."

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

I'm sorry, I thought you meant "legal" obligation, it now appears that you are referring to a "moral" obligation. In which case I would agree with you.

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".

Geee.... I wonder whatever could be done to alleviate that need for more donors...

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.

...

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.

Wow. Geez, you need to calm down. In fact, I got the same perception from your responses as applied to me. However:

Milkweed, I'd like to end by apologizing for any condescension that you may have perceived. It was unintentional, I assure you. I responded to your original post specifically because of the interaction we have had in the past and I respect your opinion.

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.

No offense, but f**k the herd. I do believe in informed democracy, and I also believe we will get to Opt-out at some point, when we join Singapore, Austria, Belgium, Denmark, France, Italy, Greece, Norway, Switzerland, Spain and Sweden in leading the world to a more rational view of organ donation.

"The rights of the living outweigh those of the dead"

Finally, I recommend the following article - it addresses many statistics related to the issues we have raised:http://www.firstcoastnews.com/news/health/news-article.aspx?storyid=158094&catid=10

 

[S.A.M.]

Opt Out/Disqualify: A Hippocratic Hitch

Presumably, if few enough people opt out, there would eventually be more organs available in the U.S. than needed. Thus:

A doctor receives a patient who is critically ill. The patient requires a new liver. There is one available; the operation can begin within a matter of hours. However, the patient is one who opted out of organ donation. Should the doctor refuse to perform the transplant?​

We can presume that the transplant organ is not needed anywhere else at the moment.

What I'm asking about, specifically, is the position such a scheme puts doctors in. There are, foreseeably, times when doctors would be expected to deny lifesaving treatment as a matter of public policy. We presently have enough problem wrangling with the issue of treatment denied by insurance companies, and what a doctor should do in those times. Generally speaking, we support those doctors who fulfill their oath, criticize those who do not, and revile the institutions that put the choice in front of them.

Would I deny the patient, was I a doctor? No. And if they came for my license, so be it. Of course, ask me again if I'm ever a transplant surgeon facing the loss of my practice for such a decision.

An opt out works like a DNR [do not resuscitate]. Any organ transplant surgery requires consent from the patient or the his/her family. For that matter any treatment requires consent and yet people ignore this when it comes to A&E in the ER. A pre-rearranged form opting out of organ donation is how doctors would know that this particular patient is not available for harvesting [no matter how many are dying in the vicinity for lack of organs]. Similarly if opting out disqualifies a patient from donation [which would obviously require INFORMED CONSENT on the form] then it would act as an a priori consent form to deny organ transplant, as much as a DNR would.

 

[Randwolf]

Hey SAM, Tiassa and others...

You raise good points, but I am somewhat fatigued over the debate with Milkweed. I put over two hours into researching and writing Post 70. I hope he shows back up.

Meanwhile, should the rest of you wish to comment, please feel free. At least all that work won't go to waste...

Thanks...

 

[S.A.M.]

You've made pretty good points overall, so I am not sure what kind of comments you need me to make.

 

[Randwolf]

You've made pretty good points overall, so I am not sure what kind of comments you need me to make.

That one works great, especially from you SAM! :bravo:

 

[Tiassa]

Boundaries, functions, and, possibly, semantics

An opt out works like a DNR ....

I see a functional—or perhaps it's merely semantic—difference between a DNR and the opt-out. Specifically, the doctor looks at a patient in a state of arrest and says, "Do not resuscitate, according to patient order."

With the opt-out, though, the doctor looks at a patient who is alive and says, "Palliative care only, according to public policy."

There are certain roles people undertake in life and society that transcend questions and judgment of who deserves what. A doctor has long been considered one of those.

Theoretically: Would I have operated to save the life of a Nazi? Yes. One of the Americans who coordinated or abetted the internment of Japanese-Americans? Yes. Ariel Sharon? Yes. Shah Reza? Yes. Triage priority for any of them? Standard, according to need. This is what I've learned about how doctors are supposed to function. Perhaps it is factually mistaken. Perhaps in a real circumstance, I would balk at one or another patient for personal reasons. But I would, theoretically, try my best for history's great villains. How could I turn away from someone who refused organ donation after his death? Compared to humanity's great monsters, he's not even a petty crook.

It's not that I don't see the logic of the opt-out/exclusion proposition. Rather, it is my understanding that doctors function beyond that boundary, and my belief that they should.

 

[milkweed]

Snipped unrelated content and religion speculation.

The Mayo clinic seems to address your concerns, directly on point:Maybe you consider this an appeal to authority, but I highly doubt that the error rate….snip

It is an appeal to authority. I posted links to people who narrowly avoided having their organs harvested. And the oklahoma case states he heard the talk about organ donations before he could respond. While we can wonder if that is an accurate reflection of what occurred in this hospital, its not the only case of a coma like person waking up and describing conversations going on. Once they take your heart/lungs/kidney there isnt a turning back point. So while there is no proof it happens, there is proof they missed the signs and they were wrong about this brain dead teen in a rush to harvest.

I doubt this - can you back up the implication?

It was a question, not an implication. A fair question when the typical start (testing for need) to fininsh of the transplant (not including after care drugs) is 1/2 million. $500K

comment quote from another article:

john201054 (10 months ago)

My Dad died from a pulmonary embolism 6 days after emergency back surgery, in the hospital, right after a dye injection. SNIPPED CONTENT What struck me as wrong, is that as my Dad was an organ donor, donating just limited organs due to radioactive dye and blood clots, that is, bone marrow, eye and skin tissue, the hospital earned $47,000 handling those limited organs. The hospital bill was only $11,000, less than 1/4th what the hospital made handling the 'donated' organs. That hospital had one gigantic financial motive to let people die. Over the years after, I watched the obits and someone about his age died every COMMENT ENDED I assume due to comment space limits.

http://www.cnsnews.com/news/article/53534

http://www.newsweek.com/2009/01/09/not-just-urban-legend.html

I will guess the next argument will be, if we have more dead people donating, this will remove the living donor quest.

No it wont. In the newsweek article (and in others I have read just this past two days), your survival length of time is twice as long for living donor kidney vs cadaver kidney. There is motivation for finding a live donor.

From your "Blackmarket donor compensation" link:
“The illicit organ trade is booming across the globe. It will only recede when the critical shortage of organs for transplants disappears. The best way to make that happen is to give legitimate incentives to people who might be willing to donate.

But the proposal isnt a legitimate incentive to people who MIGHT be willing to donate, it is presumed consent. I have no quarrel with the DL office asking me each time I renew if I want to be an organ donor (and they do). If I do, I say yes, if I do not, I say no. But there is no presumed consent. And if they forget to ask, it is presumed no. As it should be. You have no idea if the person at the licensure bureau didnt read the card and check off his status. Or has been diagnosed with some aggressive cancer and isnt aware that he/she shouldnt be a donor, (remember ovarian cancer kills men in transplants too) Or didnt hear the question. Or was distracted by other things and not paying attention.

Or worse yet, was under the impression you were, the screening catches these issues.

It seems to me you are exactly what Cass Sunstein target projects:
“To ensure that people’s decisions align with the government policy of more organ donors, Sunstein and Thaler counseled that governments should follow the state of Illinois’ example and try to influence people by making organ donation seem popular.”

I could mention unfounded speculation, but that would be counterproductive. I welcome your thoughts. Specifically, why do you hold this to be true?

My state asks each time I renew my DL. It has not always been that way and honestly I cannot remember if there was a check box the first time I became licensed. I have no quarrel with that as long as it is presumed no. I can tell the DL people "I dont know" and they tell me answer yes or no. If I wont answer, they mark NO. That is the requirement and its a good one. They are not in a position to answer detailed questions about organ donation. Simply put, if I dont know, I am not informed enough about the issue to give consent.

“With mandated choice, renewal of your driver’s license would be accompanied by a requirement that you check a box stating your organ donation preferences,” the authors stated. “Your application would not be accepted unless you had checked one of the boxes.”

“Recall that people like to do what most people think is right to do; recall too that people like to do what most people actually do,” they wrote. “The state is enlisting existing norms in the direction of lifestyle choices.”

As an aside, I ran across this perspective in USA Today as relates to governmental intrusion:

Rocco F. Andriola is a co-founder of Save Lives Now New York and a former chairman of the New York Organ Donor Network. Not quite an unbiased opinion there.

Couldn't the same be said about "ignoring" or "missing" the opt-in option? Mistaking "Opt-in" would only (potentially) cause someone's death, as opposed to the converse - after all, missing the "Opt-out" might result in the desecration of a corpse. Hmmm...

QUIT with the religious rhetoric! You have no idea if the reason is desecration of the body. You assume that is the motivation.

I missed the part about where we discussed limiting relatives' input on the decision. As you pointed out, doctors "routinely" ignore DNR requests, I'm quite sure that the family will still have a say in overriding an "Opt out" - probably more so than with an "Opt-in". Don't you agree?

I don’t believe you missed it, I believe you’ve never looked further than opinion columns that support your idealism/morality. The fact is the DL opt in is a binding contract and doctors can ignore the families wishes. The only place that does not apply is in states whos laws specifically require the family must also give consent. In my state, they do get the families consent also. This is why so many organ donation FYI sites specifically say list organ donation in both a living will and a DL, so families are clear they were your wishes. Of course, this protects the doctors/hospitals if they harvest the organs against the families wishes too.

“Where the laws are enacted, the hospital and the organ procurement organization has a legal right to follow a deceased person’s written organ donation wishes and does not require them to approach the deceased person’s family for permission to remove the organs.”

Page 33 http://www.ahc.umn.edu/img/assets/26104/Organ_Transplantation.pdf

It is talked about in the cnsnews link above. Peer pressure. Guilt trips. Awe common, if your family member wanted out he would have said so. Or maybe he never told his family he has been exposed to hep c. Maybe she didn’t understand that bad pap smear and HPV is early stage cancer. Maybe he/she didnt know it was an organ donation issue. Nope, the donor should make a conscious choice to mark Yes, not the other way around. And potential donors should be aware of the rules/best practices of organ donation before donating their tissue to already sick people, who will be additionally stressed by the anti-rejection drugs.

Spending time on the net with a few nurses and docs discussing helmet issues (in the past) the joke comes out... You know what we call bikers who dont wear helmets? Organ donors. That is the mindset. Head injury sucks. The chances of survival can be very limited. It is likely when a doc sees this situation, in a mandated organ donation state (OPT-in) their first reaction is going to be "call the organ donor network, we have a candidate", and actually, after reading some links, this seems to be the law (in some states). They begin to prep your body/your family member for transplant within minutes in some cases of death (state dependent again).

“The family is contacted and approached regarding donation as a matter of course should there be no donor card, but meanwhile ALL preparations proceed as if consent has been given....short of yanking the organs out.”

http://allnurses.com/certified-registered-nurse/organ-harvesting-anesthesia-258257.html

It is the odds and knowing how important it is to get the organs to the patient does influence their bias's. This is normal human behavior. The recommended wait time between brain death declaration and organ transplant is only 6 hours in the USA. I don’t believe this is a law, it is a AMA type recommendation. Families are pressured to react quickly to a diagnosis of brain death and that diagnosis is fallable, as I have shown in previous responses.

You don't need any reason at all to hold an opinion, I just expected more from you. Not sure why at this point, but I feel like I am touching a personal nerve here. I apologize. I won't ask for future substantiation of your opinions on this issue.

The stats used to promote auto Opt-in are Lookie approx 90% support it [organ donation idea]. I support the idea. I am not a donor. My mom was fine with her husbands donation. She is not a donor either. We have both spent many hours weighing the pros and cons and decided the obligation was to not donate organs for transplant. So it is misleading to promote the idea that because 90 % support the idea this automatically means they think its a good idea to use their organs. This is not true.

That would be dependent on your definition of "service". Now wouldn't it? Plus, read what you wrote - it's a money making machine for everyone except the two most important participants. One (in many cases) received the gift of life, the other (in many cases) was already dead. If you object to transplant teams making money, or as much money, than address that problem. Don't hide behind fallacies disguised as "Opt out" arguments.

Yes, it is subjectively my definition of service, just as your definition of ‘service’ is subjective. To argue that it is a fallacious argument on presumed consent is false.

I call bullshit. Here is a partial list of funding sources for transplants in the US. There are other private foundations in existence to help with the costs as well. These sources may not cover every penny, may be difficult to be accepted in, but they definitely invalidate your assertion.
* insurance
* Medicare and Medicaid
* charitable organizations
* advocacy organizations
snipped other funding sources.

If you didnt need funding, they wouldnt have so many .orgs raising money to fund transplants would they?

BTW, I did see this stuff and thought about mentioning that I do fund transplants via my taxes paid to medicare and medicade. But I dont have insurance so I would need x-% up front before I could be on the list. A fact that is missing from your response and these potential funding sources. Basically, your response is a fallacy. It does not prove that no funds doesnt exclude you from transplant. It only points a direction to possible (not guaranteed) funding sources.

May 2008 Minnesota heart transplant patient confirms, no money, no listing:

http://bobsnewheart.wordpress.com/2008/05/21/pay-up-or-die-no-money-no-transplant/

From link within blog:
“That's because under federal law a potential recipient must show the ability to pay for surgery, life-long follow-up care and anti-rejection medicines before he or she can be placed on the United Network of Organ Sharing's national wait list.”

http://smu.edu/newsinfo/excerpts/cardiac-donation-ethics.html

Lots of "services" are "cash cows" for hospitals and doctors. Look at MRI's, etc. Are you suggesting the medical establishment should not receive a return on their investment in education, technology, brick and mortar, time invested etc.? Does this attitude extend to the whole of capitalism, or do you just have a hard on for people in the medical field?

And I have to choose to partake in those 'services'. I have to agree to take part in those services. Informed consent. Interesting that you bring up MRI's as I was just in a discussion about that with a friend. Her husband had one and the insurance papers came in. Normal cost of MRI, $5000 Insurance negociated the cost down to 800 something, it was close to 900 dollars. What pissed her off was her 40 year old son lost his part time job and does not have health insurance. Why should it cost him more to get the same treatment from the same hospital? On top of that shes questioning why she has to pay almost $600 a month (for the two of them) if they are reducing costs to less than 1/4. Why is this related? Because I fund medicare/medicade so I am paying for transplants. So is she. So is her husband.

But her son wont get on a waiting list if he needs a transplant because he doesnt have insurance. $47 K to take the eyes, skin and bone marrow from the deceased. Its not really a donation of life, its a profit taking harvest. Soylent green anyone?

This sort of thing happens with many new drugs - remember Thalidomide and the "flipper people"? I do not believe we can let fear determine our choices and advancements in the medical field. (Or other fields for that matter). This first-hand anecdote does offer enlightenment into your personal views however, and I thank you for sharing.

Yes. Guinea pigs for the cash machine of US healthcare. Mandated Opt IN!

Geee.... I wonder whatever could be done to alleviate that need for more donors...

Get rid of mandatory seat belt laws. Quit protecting the kids from accidental death. Ride free, Die hard.

The 'shortage' of organs is twofold. First, more people qualify for transplants than before and second various laws (and improved trauma care) have kept more people from being in death assured accidents.

http://www.upenn.edu/ldi/issuebrief2_5.html

No offense, but f**k the herd. I do believe in informed democracy, and I also believe we will get to Opt-out at some point, when we join Singapore, Austria, Belgium, Denmark, France, Italy, Greece, Norway, Switzerland, Spain and Sweden in leading the world to a more rational view of organ donation.

"The rights of the living outweigh those of the dead"

Finally, I recommend the following article…

Yeah. And the surviving family has a right to decide what happens to their kin. Not some senator from New York, not some doctor whos hospital will gain organ recovery funds. The surviving family wishes trump outside wants.

From the article:
"People are dying in New York this week because we have failed to create a system that maximizes the opportunities to keep them alive,"

No. People are dying of organ failures, some of them accidents, some of them genetics and some of them from a lack of money to afford getting on the lists.

The author of the bill has self interests. His daughter inspired his legislative efforts not his altruism. Yes it is often a personal crisis which inspires a change of heart. So, where is the legislation for those who cannot get on the list because of money? Its not about organs for those who need them, its about organs for those who can afford them. See, we do sell organs in this country.

It is an altruistic donation, the donor families gift. And that is the only piece of this that is altruistic. So its not about the 'greater good'. This new york senator just didnt like the fact he had to wait on the altruism of people. And he wants to take that away. Do I blame him for his emotional reaction to the potential death of his child? No. Absolutely not.

Let him mandate the NY DL bureau asks you Yes or No on donor on licensure renewal/issue rather than relying on whether the applicant has read the card. But if the applicant does not know or isn’t sure, then its auto no. The applicant is obviously not in a position to give informed consent and the DL bureau people are not trained in organ donation screening and therefore not qualified to answer important questions about the issue. Allow Donor info during drivers edu (part of MN drivers training now) but make damn sure you include the issues of not acceptable organs so if some 16 year old finds themselves Hep C positive at 24, they know they should not be a donor. Those are things with a real potential for passage. But auto opt in? forget it. Its not based on informed consent.

 

[S.A.M.]

I see a functional—or perhaps it's merely semantic—difference between a DNR and the opt-out. Specifically, the doctor looks at a patient in a state of arrest and says, "Do not resuscitate, according to patient order."

How is opting out of an organ donation [to/for] a matter of public policy?

It's not that I don't see the logic of the opt-out/exclusion proposition. Rather, it is my understanding that doctors function beyond that boundary, and my belief that they should.

Doctors are highly individualistic. There are many who would ignore DNRs just as there are many who would see a near fatal accident victim and choose to convince their near and dear to give up organs for transplant. Its usually up to the administrative and legal departments to protect the doctors from their tendencies to want to abide by the Hippocratic oath.

 

[Stryder]

To be honest I have a concern in regards to "Causality" (Cause and Effect), I guess this could be seen similar to a religious concern but if I became an organ donor, it means I would have to have died (or been led down a dark alley way to have my organ stolen). It can be taken further, afterall for someone to have an organ replace means they would of had an organ fail.

There is also the other factor that some people like Alcoholics go out of their way to drink, replacing their organs when they get damaged doesn't give them a second chance at life as for the most part they keep drinking destroying the replacement organ.

Organs when replaced also have a high probablity of failing over time, afterall they aren't genetically compatible and to stop them "desyncronising" with the rest of the body requires a lifetime supply of drugs.

Ontop of all this I'm pretty sure I would be classed as a Transhumanist, because I want to see technology be able to replace damaged organs rather than parts of other people. I'd rather have one replacement than many replacement attempts using many different peoples parts (Mary Shelley would of had kittens)

As for the subject of people assuming everyones an organ donor...

I assume I'm noted in everyones Will and also assume that note will give me 70% of their estates. Afterall you can't take your worldly possessions with you when you die.

Seems unfair? Well thats what you are asking of people under a forced donor system.

 

[Tiassa]

(Insert Title Here)

How is opting out of an organ donation [to/for] a matter of public policy?

Such a system would require the force of law. Without it, any doctor or facility honoring the opt-out exclusion would be subject to malpractice and civil rights lawsuits. If that lawsuit resulted in no fault on the part of the doctor and hospital, the program would become at that moment a matter of public policy, backed by the force of law.

There are many who would ignore DNRs just as there are many who would see a near fatal accident victim and choose to convince their near and dear to give up organs for transplant.

Those who ignore DNRs—except under genuinely extraordinary circumstances—shouldn't be doctors.

Its usually up to the administrative and legal departments to protect the doctors from their tendencies to want to abide by the Hippocratic oath.

I'm not sure what to make of this statement because, to the one, there is an aspect about it that is absolutely correct, yet to the other there are frightening implications. In the case of ignoring DNRs, some resuscitations will lead to extended existence in pain. Still, the phrase, "protect the doctors from their tendencies to want to abide by the Hippocratic oath", is ... well, I can see how it could be controversial. Throw that one into the abortion debate and see if we can find heads and tails, for instance.

 

[Anti-Flag]

To be honest I have a concern in regards to "Causality" (Cause and Effect), I guess this could be seen similar to a religious concern but if I became an organ donor, it means I would have to have died (or been led down a dark alley way to have my organ stolen). It can be taken further, afterall for someone to have an organ replace means they would of had an organ fail.

There is also the other factor that some people like Alcoholics go out of their way to drink, replacing their organs when they get damaged doesn't give them a second chance at life as for the most part they keep drinking destroying the replacement organ.

I was going to bring up something along those lines, if we don't stop those who willingly destroy their own organs I imagine some people would always remain reluctant to donate. I'm sure there are many minor reasons that add up to a significant proportion of people who don't donate.