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Organ Donation, opt in or opt out?


paddy

Should organ donation be opt in or opt out?  

63 members have voted

  1. 1. Should organ donation be opt in or opt out?

    • Opt in (and I do currently)
      17
    • Opt in (and I don't currently)
      11
    • Opt out (which I would)
      4
    • Opt out (which I wouldn't)
      34


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It's no-one elses decision but my own. I have no need to justify further. I'd consider opting in, I probably will in fact, but purely as it's my choice to decide. I don't like the fact that the state would decide I'm in unless I decide I'm out, should be the other way round.

I think that's a bit of a cop out to be honest. We're talking about human beings not I.D. cards.

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Well it isn't DDID, it's true. It is my choice, and no-one elses, what happens to me after death is what I want to happen, not what someone else decides should happen.

It would still be your choice. They're not going to just implement it and not tell us it's in place. If you feel strongly about it, I would imagine it would be just as easy to opt out as it is to opt in under the current system.

I really don't see the issue. They're not grave robbing, the choice is still yours.

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Where I would be in favour of a change in legislation is where a dead person has given consent when he was alive and the relatives change the persons decision once he's dead, that should be stopped. A decision made in good faith and of sound mind when you are alive should be honoured in death. If you opt in, that is a binding contract until such times as you opt out again and no relative can change that

I agree with that. The family are being asked at a time of grief and are only likely to give one answer. It's probably give that answer in that situation, I wouldn't be thinking straight for sure. Even if they are thinking clearly, as you say, they shouldn't go against their loved one's decision.

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It's the principle of the state assuming that is someones wishes, which isn't right at all. Thats the problem.

People say lots of people don't sign up because they can't be bothered. In this scenario you get signed up, possibly against your wishes, and you have to go out of your way to off it. That isn't right, and I'm pretty sure thats contrary to an individuals liberty and the choice to choose ones own destiny.

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I think opt out is better.

I wouldn't opt out.

ditto.

in think this system would produce a lot more donors too, which can only be a good thing.

If people do not make the effort to actively opt-out, then IMO they aren't too bothered about people benefitting from their organs. They are either in favour of organ donation, or simply not bothered, and thus their organs can be used.

I think it's the best way forward.

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It's the principle of the state assuming that is someones wishes, which isn't right at all. Thats the problem.

People say lots of people don't sign up because they can't be bothered. In this scenario you get signed up, possibly against your wishes, and you have to go out of your way to off it. That isn't right, and I'm pretty sure thats contrary to an individuals liberty and the choice to choose ones own destiny.

Should there never be exceptions to that rule?

Basically, if there were enough organ donors out there this wouldn't be a problem that needs addressing. But the truth is people can't be **** arsed to take 10 minutes out of their life to sign up.

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Opt out, and out of principle I'd do it 9opt out). I don't like the idea that the state presumes what I want doing with what is essentially, well, me.

the state only presumes, becuase you haven't told them not to use your organs.

if you know about the scheme, whcih everyone would, then if you don't opt out, surely that is, in itself, permitting use of your organs.

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in think this system would produce a lot more donors too, which can only be a good thing.

If people do not make the effort to actively opt-out, then IMO they aren't too bothered about people benefitting from their organs. They are either in favour of organ donation, or simply not bothered, and thus their organs can be used.

I think it's the best way forward.

I think you need to do some research Jon

We do so few transplants because of a lack of qualified professionals not a shortage of donors. The evidence of Spain suggests that changing from opt in to opt out does not actually affect the amount of suitable donors

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Well it isn't DDID, it's true. It is my choice, and no-one elses, what happens to me after death is what I want to happen, not what someone else decides should happen.

:?

if you don't want your organs to be used, you opt-out.

It's quite simple. :?

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If the rule you mean is the individuals liberty, then no off the top of my head I can't think of any reasons to ever circumvent that principle.

If more donors are needed, campaign more, get GPs to hand out the forms with every consultation, make it easier, make it more known. Don't simply presume everyone wants to donate just they can't be bothered.

In all honesty I think the number of people who wish to donate is overestimated. An awful lot of people don't, through no reason other than they simply don't wish to IMO (I'm not one of them, in case that's thrown at me).

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It's the principle of the state assuming that is someones wishes, which isn't right at all. Thats the problem.

People say lots of people don't sign up because they can't be bothered. In this scenario you get signed up, possibly against your wishes, and you have to go out of your way to off it. That isn't right, and I'm pretty sure thats contrary to an individuals liberty and the choice to choose ones own destiny.

Should there never be exceptions to that rule?

Basically, if there were enough organ donors out there this wouldn't be a problem that needs addressing. But the truth is people can't be **** arsed to take 10 minutes out of their life to sign up.

really ? does it actually mean that? who says there is a lack of donors btw?

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in think this system would produce a lot more donors too, which can only be a good thing.

If people do not make the effort to actively opt-out, then IMO they aren't too bothered about people benefitting from their organs. They are either in favour of organ donation, or simply not bothered, and thus their organs can be used.

I think it's the best way forward.

I think you need to do some research Jon

wwell, i was just going on the wild presumption that the opt-out scheme was designed to increase the potential number of donors, which IMO it undoubtedly would.

If that is not the reason, then i'm at a complete and utter loss as to the reason behind this scheme.

what would the govt have to gain by it, if they don't actaully need any more organs than they currently have? :?

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Well it isn't DDID, it's true. It is my choice, and no-one elses, what happens to me after death is what I want to happen, not what someone else decides should happen.

:?

if you don't want your organs to be used, you opt-out.

It's quite simple. :?

Read what I've said, the principle of the state assuming you want your organs donated isn't right, thats the individuals choice and it should be taken as no until they say otherwise, as it is not anyones place but their own to say what happens to them. It doesn't matter that the choice is still there, it's the fact that is assumed that the state can do what they like to someone's body in the event of their demise from the moment they are born, unless they go out of their way to say no.

If anyone doesn't agree with that principle then I'm afraid we'll have to agree to disagree.

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positive publicity for the slack jawed jokel?

You see the reason this story is in the news today is because The UK Organ Donation Task-force an independent body set up to look at this very issue came out and said that an opt out scheme would not increase donors. Gordo's response was that, it wouldn't be ruled out in the future. The Govt are going to spend £4.5 mil in a new push to get donors onto the register. $4.5mil sounds like an awful lot of money to be spent on this pressing concern doesn't it? Nope its not even a decent lottery win, lets face it it is just a positive spin story, its not even the lose change in the treasury's coffers, its a miniscule amount, compared to say the NHS non functioning super duper computer

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The easy solution is to ask :

If critically ill would you accept an organ transplant INTO your body ?

If you answer yes to that question you automatically agree to donate your organs at death

In other words want the benefits you must be 'on the programme'

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For those interested in reading a bit more about it, I've highlighted the bit most relevant to the discussion we're having:

Too many presumptionsAdvocates of a presumed consent system of organ donation are ignoring the weakness of the evidenceComments (31) Rafael Matesanz and John W Fabre guardian.co.uk, Monday November 17 2008 12.16 GMT Article historyThe government has embarked on a campaign to convince the nation that an opt-out or presumed consent system for organ donation will improve the rate of donation and save many lives.

The British Medical Association and the chief medical officer support this initiative, as does the Observer through its Donor for Life campaign. Earlier this year, Polly Toynbee's Guardian comment, Living people matter. When you're dead, you're dead, referred to the battle for presumed consent as "a fight with the forces of superstition and reaction", and she insulted Patient Concern and the Patients Association for opposing it.

All of this is very curious, given the weakness of the evidence supporting presumed consent as a significant factor in organ donation. In our view, it contributes little or nothing to the improvement of organ donation rates and, on the debit side, diverts precious resources to imaginary rather than effective solutions.

The fact that Spain and France have presumed consent legislation in place, and consistently much higher organ donation rates is fuelling this fire – the donors per million of population rate in Spain is 35.1; in France, it is 22.2; the 2005 figure in the UK was 12.7. Further fuel is supplied by the fact that about 40% of families in the UK refuse consent for organ donation.

However, the presumed consent legislation in Spain was in place for 10 years, from 1979, with little effect on organ donation rates. It was the introduction of the comprehensive transplant coordination system in 1989 that was coincident with the progressive rise in organ donation in Spain to its current enviable levels.

The simplistic appeal of presumed consent legislation is that if consent can be presumed, the refusal rate must fall. However, such legislation is designed solely to make assumptions about the wishes of the potential donor. The decision about actual donation always remains with the potential donor's family.

In France, where presumed consent legislation has been in place since 1976, the refusal rate remains at about 30%. In Spain the refusal rate declined slowly over many years from about 40% during the 1980s to 20% in 2003, and it now stands at 15% with regional variations from 0 to 25%. The principal determinant of the refusal rate is not legislation. The key factors are public confidence in the medical profession, public understanding of the organ donation process, and the professionalism of the approach to the potential donor's family.

Spain's outstanding transplant coordination network, based on intensivist physicians in every hospital, is undoubtedly the major factor contributing to the country's superior organ donation rates. In addition to being responsible for public education and public relations with the Spanish media, this centrally organised system ensures every potential donor has the opportunity to become an actual donor and that the approach to the family is optimal in every case.

Differences in the level of intensive care provision between the UK and Spain might also be important. A British Transplantation Society working party on organ donation reported that the relatively low provision of intensive care facilities in the UK was very likely a factor limiting organ donation.

Within Spain, the region with the highest organ donation rate – La Rioja, 310,000 inhabitants, 74.2 donors per million during 2007 – also has one of the highest provisions of intensive care facilities. It is possible that intensivists with a substantial capacity in their units are more likely to admit patients with a poor prognosis, especially older patients. This might indirectly affect organ donation rates, as these are precisely the patients likely to become organ donors.

Another potentially important difference could be that deaths from road traffic accidents, one of the major causes of death in organ donors, have been consistently twice as high in Spain than the UK at 110 deaths per million versus 54 deaths per million, with France having 87 deaths per million, according to 2004 figures from the United Nations Economic Commission for Europe. However, road traffic accidents as a cause of death represented only 10% of the Spanish donors during 2007, so this is unlikely to be a major factor.

The introduction of Spanish-style transplant coordination in the UK is an obvious and long overdue measure. Improved transplant coordination has been recommended by the Department of Health's organ donation taskforce, is supported by the government, and has been universally welcomed. A cautionary note is that simply appointing more coordinators, while to be welcomed, will not replicate the comprehensive, nationally organised Spanish system.

Before embarking on an always complicated and potentially divisive change of legislation, we probably should take stock.

A key and highly informative statistic is provided by the potential donor audit – the number of patients in intensive care units who could become organ donors. A recent survey gave a figure for the UK of 23 per million of population. If this is correct, it suggests the maximum possible donation rate in the UK would be far lower than the actual donation rate in Spain. Prospective studies with common methodologies are clearly needed to compare potential for donation in the UK, Spain and other countries.

The numbers of potential donors and the causes of death in the different countries would greatly inform the debate and provide solid facts on which to plan further improvements of organ donation in the UK.

The government should also be conscious of its obligation to maintain an ethical framework in society. The idea that the absence of an objection represents informed consent is plainly nonsense and consent that is not informed is valueless. Inevitably, the socially disadvantaged and poorly literate will be less aware of their rights, less likely to care about them in advance and less likely to have confident advocates in the face of medical authority at the time of their deaths.

Advocates of presumed consent legislation frequently state such a law would enable a more positive approach about donation to the bereaved family. However, given that transplantation is now well established, and that it has widespread public support, such a positive approach is possible without legislation and has been well demonstrated by Zink and Wertlieb in the United States.

Rafael Matesanz is clinical director of the Organizacion Nacional de Trasplantes in Madrid, Spain. John W Fabre is professor of clinical sciences at the department of hepatology and transplantation at King's College London School of Medicine.

Source

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You see the reason this story is in the news today is because The UK Organ Donation Task-force an independent body set up to look at this very issue came out and said that an opt out scheme would not increase donors.

That MUST be wrong. I don't see how that is possible.

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