Voluntary opt-out scheme for organ donors

[snowychap]

It is a good post Levi BUT it misses a fundamental point in the discussion. The point being that the organs only become property of the state once the person is dead. I also think the idea of conscription and non-voluntary pregnancy is a huge leap to make for a democratic nation and I don't think said party would last very long at all, and I'm not sure those changes are relevant to a discussion about how to dole out the organs of a dead person. Plus the peripheral law changes around your hypothetical conscription scenario DO change the rights of the individual. They REMOVE things we can do from day to day, they force people to do 'a' 'b' or 'c' and again I think that is changing the argument, because it is adding a perceived greater risk to the 'opt out' organ scheme than the one that currently exists.

I don't normally quote US Presidents (unless making fun of the recent ones) but here's something from Lyndon Johnson :

"You should not examine legislation in the light of the benefits it will convey if properly administered, but in the light of the wrongs it would do and the harm it would cause if improperly administered."

[BOF]

That's a good quote snowy but I still don't see where you can make a tangible link between an organ opt out scheme that will only benefit the health system and fundamental changes across the board to human rights that need massive societal changes. It is specious to me, and if I may be so bold, I think it highlights the weak position of the counter-argument to the point of the thread, and perhaps explains the 77% take-up (which is much higher than I expected).

[snowychap]

I don't think there is anything false about the counter-argument.

I am not going so far as to say that the presumption of consent is a massive infringement of liberties but it is a reversal which is wrong in my view.

I have an inherent problem with being 'volunteered' for anything (yes even something with which I agree) whereas I have little problem in volunteering (if it is something with which I agree).

Again, an opt out scheme does not necessarily benefit the health system and is very unlikely to on its own and I maintain the argument that a system change per se does not address inherent problems with a process.

Without massive investment in personnel, training, co-ordination and public education - there is no way that merely flicking over to a soft opt out system will obtain the threefold increase currently required in organ donations.

As far as the 77% take-up, it is very easy to give the feel good answer in response to a survey question.

My reason for the quote is that it represents the scepical way with which I view any legislation and thus I apply it to this proposal as any other.

[Bazdavies79]

I agree, there must be an overhaul and improvement of the logistical system, most countries which do this have an improved donation rate. However it cannot be ignored that the biggest increases have occurred in countries who have also adopted the opt out system, particularly Austria and Belgium, who have a hard opt out system in place. The Spanish soft opt out system although a success, due to additional factors cannot really be used as a solid basis to argue for or against the opt out system.

The bottom line is hard opt out (in all studies I've read) improves donation rates significantly.

In conclusion I'd have to say I'm for a hard opt out system.

Firstly, on principal I'm not against it, presumed consent to save a life with my (useless to me) organs is fine by me, it leaves me in no moral dilemma at all, it's as they say, a no brainer.

In terms of rights, the facts, as I see it are that I nor anyone else are losing any rights at all as the opt out option is available. In fact, far from taking rights away from me I believe the 'hard' system empowers me, as my relatives would not be able to overrule my decision after my death.

In my case I'm sure it would reduce the stress for my close relatives should the unfortunate happen to me as they would not have a difficult decision to make during a period of grief, although this may not be the case for all. I know my family would be happy my wishes were carried out, although that is where one huge problem for the system may exists. Would doctors be happy taking organs against relatives wishes?

[leviramsey]

It is a good post Levi BUT it misses a fundamental point in the discussion. The point being that the organs only become property of the state once the person is dead. I also think the idea of conscription and non-voluntary pregnancy is a huge leap to make for a democratic nation and I don't think said party would last very long at all, and I'm not sure those changes are relevant to a discussion about how to dole out the organs of a dead person. Plus the peripheral law changes around your hypothetical conscription scenario DO change the rights of the individual. They REMOVE things we can do from day to day, they force people to do 'a' 'b' or 'c' and again I think that is changing the argument, because it is adding a perceived greater risk to the 'opt out' organ scheme than the one that currently exists.

I may have leapt a little far on that example.

However, the point that it effectively implies that we are merely temporary inhabitants of our bodies, with the terms of the lease contingent on the benefit for society overall stands. If I may have another try at it, one that is more directly related to the discussion (and perhaps even more shocking, I grant you):

If the State is to be the landlord over the body with the authority to revise the lease at any time, then is it not justified that the State can evict the tenant, that is to say end one's custody of their body, if such would save some arbitrary lives? After all, if murdering or executing one could save a dozen (which when you consider the waiting lists for various important organs isn't outside the realm of possibility), isn't that overall a net good for society?

And here we have an illustration of the primary ill of utilitarian ethics (ethics based on the greatest good for the greatest number of people or some similar construct): there comes a point where utilitarianism says that it is ethical to murder someone, be it the state-sponsored murder on Death Row (death penalty advocates argue that the death penalty, thanks to its deterrent (though that's laughable, when you think about it) and prevention aspects, saves some number of lives with every execution) or for a doctor to see that a patient is on the donor list for several organs that are deeply needed and to kill the patient to distribute the organs. Of course, utilitarianism sometimes creates much better decisions than more Kantian systems, the classic example being a mad gunman asking where your neighbour is and is it acceptable to lie in that situation (a utilitarian decides that it is ethical to lie to save the neighbour, while the strict Kantian would tell the truth, because it's completely unethical to lie).

[El Zen]

Bringing the subject of utilitarianism vs kantianism is an interesting perspective, Levi. I certainly agree with the main objection against utilitarianism, that it ultimately is prepared to sacrifice the individual for the greater good. I can see the appeal in utilitarianism, but in the end I consider myself a liberal Rawls-kantian, if that makes any sense at all. Principles are more important after all, and we should only work towards the greater good within the framwork set by our principles.

But in this case, I don't see how any individual is sacrificed. I just don't see how any rights are breached, or even changed. The rights remain the same, it's just the technicalities that are reversed so to speak. I see the proposal as a change for the greater good without sacrificing the individual. I don't see it as strictly utilitarian at all, but perfectly compatible with my set of liberal Rawls-kantian ethics.

[snowychap]

Firstly, on principal I'm not against it, presumed consent to save a life with my (useless to me) organs is fine by me, it leaves me in no moral dilemma at all, it's as they say, a no brainer.

Please, please, please, don't use this phrase. It does nothing to add to your otherwise well-constructed contribution to the debate.

What are the 'additional factors' which contribute to the success of the Spanish model (which is the model that is being proposed as the one to follow in the UK)?

[Bazdavies79]

Firstly, the term no brainer was simply me expressing the fact that from a purely personal moral standpoint, in my head, I didn't need to think very long about it. I understand that it obviously may not be so straight forward for everybody, I should have made it clear. I have no moral objection to people presuming they can take my organs if I have not exercised my right to tell them otherwise.

With the Spanish soft opt out model relatives can refuse consent. Currently in Spain about 20 to 24 per cent of relatives refuse, compared with currently 40 per cent in the UK. Therefore that particular model may not work so well here. But why is the refusal rate so much higher in the UK? Are our procedures poor, are our staff poorly trained or are there other social factors such as differing attitudes to death between the Brits and Spanish?

It's not so easy to say yes for sure 'soft opt out' will work in the UK. I guess your argument could be that an overhaul and improvement of the logistical system alone could have similar results without going down the opt out road. Although not my preferred option, I would support a soft opt out model with logistical improvements as has been successfully adopted in Spain. But how much that success is due to social or other factors is unknown.

As I said in my previous post, I favour the hard opt out option. I don't think relatives should ever be put in a position to decide. It's unfair and often the grief stricken relatives may have to make a decision they later regret. This way the deceased individual is fully in control of what happens after death.

And why do I prefer the the hard opt out and not an opt in? Well simply because it's proven to increase the number of donors available. Firstly, 90 per cent of the UK population say they'd be willing to donate their organs after death, only about 20 per cent of people have actually put their names on the NHS Organ Donor Register.

God this is a difficult subject, I hope that lot makes sense!

[BOF]

It does make sense Baz. I wasn't aware of the Spanish complication of bringing relatives into it. I agree that it has to make for some terribly difficult decisions. For me personally with any system like this, the relatives would only ever be brought into consideration if they were still a guardian i.e. if the potential donor was a minor. It would still be a horrific decision to have to make but my reasoning is that, ethically, an adult should make their own decisions and a minor should not (in this extreme case).

Levi, I need to do some reading. Although I've heard of utilitarianism I wasn't versed on what it meant. By the sounds of your example and Michelsen's responses, I definitely am not a utilitarian

[Gringo]

But why is the refusal rate so much higher in the UK? Are our procedures poor, are our staff poorly trained or are there other social factors such as differing attitudes to death between the Brits and Spanish?

I guess the alder hey hospital harvesting of babies might help explain some of that

[BOF]

Might be an example where voluntary opt-out would've helped. Where's that 'whistling innocently' smiley

[snowychap]

Firstly, the term no brainer was simply me expressing the fact that from a purely personal moral standpoint, in my head, I didn't need to think very long about it. I understand that it obviously may not be so straight forward for everybody, I should have made it clear. I have no moral objection to people presuming they can take my organs if I have not exercised my right to tell them otherwise.

With the Spanish soft opt out model relatives can refuse consent. Currently in Spain about 20 to 24 per cent of relatives refuse, compared with currently 40 per cent in the UK. Therefore that particular model may not work so well here. But why is the refusal rate so much higher in the UK? Are our procedures poor, are our staff poorly trained or are there other social factors such as differing attitudes to death between the Brits and Spanish?

It's not so easy to say yes for sure 'soft opt out' will work in the UK. I guess your argument could be that an overhaul and improvement of the logistical system alone could have similar results without going down the opt out road. Although not my preferred option, I would support a soft opt out model with logistical improvements as has been successfully adopted in Spain. But how much that success is due to social or other factors is unknown.

As I said in my previous post, I favour the hard opt out option. I don't think relatives should ever be put in a position to decide. It's unfair and often the grief stricken relatives may have to make a decision they later regret. This way the deceased individual is fully in control of what happens after death.

And why do I prefer the the hard opt out and not an opt in? Well simply because it's proven to increase the number of donors available. Firstly, 90 per cent of the UK population say they'd be willing to donate their organs after death, only about 20 per cent of people have actually put their names on the NHS Organ Donor Register.

God this is a difficult subject, I hope that lot makes sense!

Your points do make sense.

I would counter with a few:

The Spanish have had presumed consent for at least 30 years and it is only in the last twenty that their donation rates have increased. One reason is the reduction in relatives' refusal rates from about 27% to about 15%. This has come about because of an overhaul of how they manage their system.

What they didn't do is say that the soft opt out system was not working, that a hard opt out would increase the donor pool and therefore have the desired results. They addressed the reasons why they were not getting large enough donation rates within the boundaries of the system which they had.

That is what improved their donation rates not their system.

Now I am not doubting that a change from our system to a hard opt out system would increase donation rates but I'm not so sure that it would satisfy the demand or be as successful as might be thought logical.

Austria's donation rate is. I believe. less than that in the US.

The US system is one that requires specific consent (though differs slightly from state to state) and yet they manage a rate which is twice that of the UK (25.5% as opposed to 12.8%).

Yes a hard opt out system would increase the pool of donors (though not necessarily the immediate or short term pool of donor organs :winkold: ) but would it do what is need or required of itself?

I think that as soon as you start to mention a hard system that the agreement rate would drop from the 90% achieved by the small 'shopping centre' surveys.

As of march 2007, there were about 14 million on the donor register (I have no figure about how many of these are under 16) and that figure increased by about 1 million in the previous year so we could guess that there are a few more than 14 million now.

The potential adult pool (to whom presumed consent would apply) is at most 48 million (80% of 60 million population over 16).

At 90% this is around 43 million - though again I would maintain that a 'hard' system would bring that down.

However, staying at a best case scenarion of 90% - the increased pool is pretty much exactly 3 times the current pool.

The conclusions that I would draw from these rough figures is that - yes, changing to a hard opt out system could increase the donation rate by what is required. Though it would appear that it would only do so in the most favourable of winds using the most favourable (and questionable) of estimates and that it would be pretty tight.

Whereas if we could reduce the relative refusal that we have in this country (of 40%) by the same scale that the spanish have (i.e. by close to half) then that would double the rate. Then we would only need to increase the pool by 50% - around 7 million: something which, surely, is not that difficult with a bit of investment considering that the pool increased by 1 million between 2006 and 2007 without much investment and/or promotion of the cause?

[Bazdavies79]

I'd agree with you that you could possibly achieve similar results to Spain without implementing the soft opt out by somehow reducing the family refusal rates. The more I think about the soft opt out option the less I like it, it seems pointless if your going to ask the family anyway. What would be it's purpose? to cover the NHS' ass in the event of a cock-up?

My favoured option the hard opt out option has proven beyond doubt to work in Austria and Belgium, so it's pretty hard to argue against such clear results, there are no other systems which come close which I know of. I also think, as I've touched upon before, that the hard option, far from removing rights, empowers the individual and is the way forward if we truly want to get to grips with this problem.

[snowychap]

I'd agree with you that you could possibly achieve similar results to Spain without implementing the soft opt out by somehow reducing the family refusal rates. The more I think about the soft opt out option the less I like it, it seems pointless if your going to ask the family anyway. What would be it's purpose? to cover the NHS' ass in the event of a cock-up?

My favoured option the hard opt out option has proven beyond doubt to work in Austria and Belgium, so it's pretty hard to argue against such clear results, there are no other systems which come close which I know of. I also think, as I've touched upon before, that the hard option, far from removing rights, empowers the individual and is the way forward if we truly want to get to grips with this problem.

I see the consistency in your argument about hard opt out with regard to observing the actual person's wishes rather than relying upon the consent of family members, etc.

And to be honest, I would prefer a 'hardness' applied to the current system, i.e. as I have volunteered to be a donor and registered my wishes then no one else but me has the right to withdraw my volunteered consent.

Baz,

I don't think we'll agree, will we? But I think it has been an interesting discussion. Thanks.

My last comment is a quote from another forum :

They (organ recipients) do not receive organs because we HAVE to donate them, they receive them because we WANT to donate them. As soon as we lose sight of this, we (society) become little more than parasites.

[Bazdavies79]

Yeah, good civil debate.