Organ Donation, opt in or opt out?

[bickster]

Is perhaps the only real issue of Opt Out - Consent and the ethical boundaries that surround it?

that seems to be the line that quite a few are taking on here, yes.

I can understand that position, but it's not one i agree with.

for 2 reasons mainly:

1. implied consent. If someone has not opted out, that means that they either agree to the use of their organs, or are not bothered either way, once they are dead. If they were vehemently against it, surely they would opt-out.

2. Once you're gone, you're gone. What does it matter what is done to your living vessel on earth once you have vacated it. Let someone else benefit, as your body is of no use to you any more.

But despite all of that perfect sense Jon, it seems that some would rather take the selfish view, one often pointed towards certain political parties, and refuse this because of which political party was in power at the time of the decision.

I suppose it shows a lot about the person

point out a single person that said that, you can't because no one did

[wiganvillain]

My voting for the "Opt Out" system is purely personal.

I'll happily donate my organs to anyone if they're worth donating but my other half has categorically stated she'll blank any request so the only way I could donate is the Opt Out unless we change the current rules

[snowychap]

My voting for the "Opt Out" system is purely personal.

I'll happily donate my organs to anyone if they're worth donating but my other half has categorically stated she'll blank any request so the only way I could donate is the Opt Out unless we change the current rules

Though in a 'soft' system, the final say would still rest with the next of kin/family.

[ianrobo1]

First it's this, you know, your dead who cares, then Soylent Green, well it's wastful, all that meat, their dead... lets resell, then perhaps Logan's Run, if people live over thirty, the meat gets all stringy and you a bit tough to eat... Government knows best.

dear me, talk about posting for effect ...

so Nick do I presume if you needed a transplant in the future for you and your family, say your biy got unforntalty sick you would refuse it ?

[Nath182]

I have a donor card at the moment and didnt have any second thoughts about becoming a donor, I dont see the use in my organs rotting away after im dead if some other human could live with it. An opt out system in theory would work well but I can just imagine the hassle it would cause in some cases, for example someone hasnt opted out due to god knows what but then unexpectedly dies, the family doesn't agree with this person having their organs donated so it all kicks off. At the end of the day I dont think they are forcing you to become a donor, you still have the choice to opt out of the system and no one is stopping you doing so.

[bickster]

My voting for the "Opt Out" system is purely personal.

I'll happily donate my organs to anyone if they're worth donating but my other half has categorically stated she'll blank any request so the only way I could donate is the Opt Out unless we change the current rules

Though in a 'soft' system, the final say would still rest with the next of kin/family.

Exactly, so as I stated all the way back in the thread, the thing that actually needs changing is the ability of the relatives to change the deceased's prior consent, not any of this state owning the dead body bollocks

[snowychap]

But despite all of that perfect sense Jon, it seems that some would rather take the selfish view, one often pointed towards certain political parties, and refuse this because of which political party was in power at the time of the decision.

I suppose it shows a lot about the person

Who are these 'some'?

It would be helpful if you could point out who has taken this 'selfish view' and who has refused it because of a political party.

[nrogers]

First it's this, you know, your dead who cares, then Soylent Green, well it's wastful, all that meat, their dead... lets resell, then perhaps Logan's Run, if people live over thirty, the meat gets all stringy and you a bit tough to eat... Government knows best.

dear me, talk about posting for effect ...

so Nick do I presume if you needed a transplant in the future for you and your family, say your biy got unforntalty sick you would refuse it ?

Again, totally missed the point, and why should I be surprised.

You must have missed where I said I was a card carrying donor. I think paraphrasing Prescilla White would be logical here.

[drat01]

point out a single person that said that, you can't because no one did

Of course Bicks - The comments of certain posters - see no posting on posters - is fairly clear but of course you wouldn't / couldn't see that. No doubt you will come back with something but hey don't waste your time sir because I wont pay it much attention (thanks for the advice)

Jon has summed it up perfectly but it would seem that message is ignored and you (and Snowy - what a shock!) would rather take issue with the fact on who has posted rather than the subject matter. Keep 'em coming boys

[snowychap]

you (and Snowy - what a shock!) would rather take issue with the fact on who has posted rather than the subject matter.

I took issue with the contents of your post and not who had posted.

[Chindie]

Dear God can we leave the party political bollocks.

[ianrobo1]

chindie, I think it is about poltical philosphy, those disagreeing seem to be saying so because of the so called big brother aspect of this if it ever came into being

it is an argument I and others fundamently disagree with on because for a start is not the blood donor service independent of governement anyway ?

[snowychap]

Would you make blood donation opt out, too?

[ianrobo1]

you know what Snowy I would because I knwo how vital blood supplies are

and for that I would opt in as well

[Chindie]

It's perfectly possible to have a debate about opposing political philosophy's Ian without bringing parties into it. I find it pretty damn easy. But when it becomes left v right in these threads it goes to rack and ruin in seconds, and it's always the same reasons why. It turns into a fight, the same one over and over. Add in the style of some of the posting and it makes for really unsavourary (let alone dull) reading.

I could take my stand on this issue without bringing the parties into it (it's pretty damn easy for me, I don't staunchly support either), it'd probably be better if we all could on some wider reaching moral/ethical issues imo.

[nrogers]

you know what Snowy I would because I knwo how vital blood supplies are

and for that I would opt in as well

What a load of shit... you are demanding that the government can take blood unless you say no... your values are **** up!

[snowychap]

you know what Snowy I would because I knwo how vital blood supplies are

and for that I would opt in as well

As a registered blood donor, were that to be the case then I would stop giving blood, I'm afraid.

[snowychap]

Why we said no to presumed consent

An opt-out system would do nothing to increase the number of transplant organs available

Over the past nine months, members of the organ donation task force have been considering whether Britain should adopt “presumed consent” - whereby all people are potential donors unless they actively opt out. Each of them, myself included, is committed to increasing the number of donors. All started with an open mind, with many - again I include myself - leaning towards the idea. But when we had reviewed everything we had heard, every single member opposed the introduction of presumed consent.

Why? In a word, evidence. This indicated that presumed consent would not increase the number of donors and might do the opposite. And increased numbers are the bottom line, not whether the public are “ready” for presumed consent - the bizarre suggestion of those Sunday clairvoyants who commented on the report before it appeared.

There was no single piece of evidence that tipped the balance. Rather, it was layer upon layer of challenge, concern and practicality that decided the case for us.

One issue ran through every discussion: trust. Trust that our organs will not be taken until we are really dead, or that treatment for the critically ill will not be pursued less vigorously if they are seen as potential donors. These fears are misplaced but they are primeval, akin to those we have about being buried alive. They were frequently expressed at public events. Trust that doctors act at all times in the patient's best interest is essential. Clinicians with the most day-to-day contact with bereaved families were particularly concerned about the erosion of trust presumed consent might bring.

Trust in doctors took a battering after the scandals at Alder Hey and Bristol Children's Hospital. The Human Tissue Act was introduced to put consent at the centre of medical practice. Presumed consent would go against its principles.

If we wanted to opt out would we trust the State to safeguard our personal data or to enact our wishes? From the comments at the public events, the answer is “no”. Lack of trust forced the repeal of presumed consent legislation in Brazil and badly dented confidence in the French system after a single highly publicised case of mistaken organ removal.

There are formidable practical problems. Being a donor is seen as the correct moral choice, so those who opt out might not want others to know. Such sensitive data requires greater security than the Organ Donors Register (ODR) can offer at present. This security is important given that a vocal minority think that those who opt out should get lower priority for transplants. If this view were widely expressed people might not let their true wishes be known.

Letting people know that they had the right to opt out would require an extensive and expensive advertising campaign that concentrated on a negative. Meanwhile, how does one ascertain the wishes of those who lack capacity, the homeless, visitors to Britain or non-British EU citizens who are entitled to NHS transplants?

While some are happy to donate solid organs such as kidneys, they may be iffy about hearts and downright squeamish about eyes. An “opt-out” scheme would have to record preferences: do you publish the whole list of some 70 transplantable tissues? People should have proper information but a list that feels like a butcher's order book would risk prompting many to say “no” to the whole lot.

Ethnic minorities are doubly disadvantaged by higher rates of diseases such as diabetes that may make transplants necessary and by having fewer matching donors. They account for 23 per cent of the donor waiting list, yet only 8 per cent of the population. The need to increase numbers within these communities is particularly pressing. All 17 faiths interviewed support organ donation yet their own members may be unsure of their faith's position. One study in Birmingham found that 60 per cent of Muslims believed organ donation went against their faith.

The families of donors said that it was important for them to take the decision, however hard, themselves. The families of recipients said that knowing that an organ had been freely given was a great comfort.

The public assume that presumed consent will increase donor numbers. But Spain had the system for a decade without increasing donation rates. What made a difference was when, in 1989, it began to develop a transplant co-ordination network.

According to the architect of the Spanish system, Rafael Matesanz, public confidence in the medical profession, understanding of the donation process and a professional approach to bereaved families are the key factors, not the law.

What will increase donation is removing uncertainty. In the UK only 10 per cent of families refuse permission if a relative's name is on the ODR but at least 39 per cent do if it is not. Merely by discussing organ donation in the media, more than a million names have been added to the register in the past year. There are surer ways to increased donation than presumed consent. Let's take them fast.

Vivienne Parry is a science writer and broadcaster and member of the organ donation task force

[Bazdavies79]

I think all humans have it built in to want to help a fellow human, we are altruistic........but also a bit lazy so I have no moral qualms with presumed consent it all seems very natural to me. I have no fears that it would be a slippery slope to the government 'owning' my body, and I don't feel the need to dig my heels in 'on a point of principal', it seems a bit silly when lives could be saved.

[leviramsey]

Slightly off-topic, but didn't want to start a new thread

In early 2006, Matt Thompson of San Jose, California, decided to give a kidney to Sonny Davis, a 65-year-old physicist living in nearby Menlo Park. Thompson was moved to donate after reading an impassioned plea from Davis’s wife, who had sent 140 letters to friends and relatives asking them to consider helping her husband. One of the recipients happened to be a colleague of Thompson’s, who passed it along, thinking Thompson just might heed the call. Sure enough, Thompson, a devout young Christian and former missionary, contacted the transplant program to volunteer.

But the transplant program at Kaiser Permanente of Northern California turned him down. Had Davis been a family member or a good friend, he would have been acceptable to the program. Thompson was frustrated and surprised, but he and Davis were determined to do the transplant. According to the San Jose Mercury News, they “knew they had to forge a bond that would assure Davis’ surgeons that Thompson was donating his kidney for the right reasons.” This meant, among other things, that Thompson would not profit financially. So the two developed a relationship and convinced the transplant program that no money was secretly being exchanged. On November 14, 2006, the transplant finally took place.

Far more than a human interest tale of a stranger opening his heart to a suffering soul, the story of Sonny Davis and Matt Thompson draws back the curtain on the culture of the organ transplant establishment. It shows that transplant professionals would have allowed a 65-year-old man to languish on dialysis for years or die—a strong probability given his age—while waiting for a kidney, out of fear that he might be remunerating someone for an act that would save his life.

There are about 78,000 people in queue for a kidney from a deceased donor. In places like California, the wait can be up to eight years. And unless a friend or relative gives a kidney to a loved one, he will weaken on dialysis. Four thousand people die each year because they cannot survive the wait. This explains Mrs. Davis’s frantic plea to anyone who might volunteer a kidney to her husband.

The woeful inadequacy of our nation’s transplant policy is due to its reliance on “altruism.” According to the guiding narrative of the transplant establishment, organs should be a “gift of life,” an act of selfless generosity. It’s a beautiful sentiment, no question. In fact, I, myself, am a poster girl for altruism. In 2006, I received a kidney from a (formerly) casual friend who heard secondhand about my need for a transplant. In her act, there was everything for me to gain, and, frankly, not much for her. My glorious donor was moved by empathy and altruism as purely as anyone could ever be.

Yet, it is lethally obvious that altruism is not a valid basis for transplant policy. If we keep thinking of organs solely as gifts, there will never be enough of them. We need to encourage more living and posthumous donation through rewards, say, tax credits or lifetime health insurance.

But what about the Matt Thompson–Sonny Davis problem: anxiety surrounding the very notion that an organ donor should receive anything of material value for his sacrifice. It is important to understand the nature of this anxiety because it is a formidable obstacle to devising a rational transplant system.

Arguments against creating incentives to donate fall into two general categories: arguments from corruption and arguments from consequence. These designations were coined by political philosopher Michael Sandel.

Arguments from consequence go like this: there is nothing intrinsically wrong with compensating donors, but it is not possible to design an incentive-based system without exploiting them. The worry is that economic straits could compel reluctant individuals to relinquish a kidney for the sole sake of enrichment.

This is indeed a troubling situation. Fortunately, it can be addressed with good policy. For example, a state government could provide compensation such as tax credits, tuition vouchers, a contribution to a tax-free retirement account, or lifelong health coverage. A non-cash reward won’t appeal to those in desperate need of financial help. What they want is quick cash, not delayed in-kind rewards. A months-long waiting period would dampen impulsivity and give more than ample time for donor education and careful medical and psychological screening. Finally, donors would receive quality follow-up care, something the current system does not ensure.

Arguments from corruption proceed from the belief that donors, and perhaps society at large, will be diminished or corrupted if organs are given in return for something of material value. Giving a kidney “for free” is noble but accepting compensation is illegitimate, a sordid affront to human dignity. Indeed, the debate surrounding incentives for organ donation sometimes resembles a titanic struggle between uplift and greed. “As a rule, the debate is cast as one in which existing relations of selfless, altruistic exchange are threatened with replacement by market-based, for-profit alternatives,” observes Kieran Healy, a sociologist at Duke University.

Dr. Luc Noel of the World Health Organization subscribes to this false choice. “There are two prevailing concepts of transplantation,” he says. “One relies on money and leads to increased inequality, besides putting a price on the integrity of the body and human dignity. The second is based on solidarity and the donor’s sole motivation to save a life.” The National Kidney Foundation warns against “self-interest on behalf of the donor.” The notion also troubles a primary care physician in Columbus, Ohio: “What sort of organ transplant program do we want,” he asks, “one that pressures the financially vulnerable with cash incentives, or one that encourages the show of kindness through a loving, voluntary gift of organ donation?”

Paradoxically, our current transplant system makes every donation seem like a “loving, voluntary gift of organ donation.” Think about it: there is no other legal option. Some altruistic donations come as close to the technical definition: my experience would be one of those. Yet, our current altruism-only system has a dark side: It imposes coercion of its own by putting friends and family members in a bind. They might not want to donate, but they feel obligated, lest their relative die or deteriorate on dialysis. Sociologists have written about familial dynamics that involve guilt, overt pressure, or subtle threats. Consider the “black-sheep donor,” a wayward relative who shows up to offer an organ as an act of redemption, hoping to reposition himself in the family’s good graces. Some donate as a way to elicit praise and social acceptance. For others, donation is a sullen fulfillment of familial duty, a way to avoid the shame and guilt of allowing a relative to suffer needlessly and perhaps even die.

As famed anthropologist Marcel Mauss observed in his classic work, The Gift, gifts are never free; they demand reciprocity. “The [given] objects are never completely separated from the men who exchange them,” he learned from his work with Polynesian natives in the early 1900s.The same applies to organs. The “tyranny of the gift” is an artful term coined by sociologists Renee Fox and Judith Swazey to capture the way in which immense gratitude at receiving a kidney can morph into a sense of constricting obligation. In their 1992 book, Spare Parts: Organ Replacement in American Society, the authors write, “The giver, the receiver, and their families, may find themselves locked in a creditor-debtor vise that binds them one to another in a mutually fettering way.” Indeed, the virtue of market-like exchanges is that they are emotionally liberating.

An unusual take on altruism comes from the National Kidney Foundation, a vocal opponent of incentivizing organ donation. According to Dolph Chianchiano, its senior vice president for health policy and research, the NKF believes that compensating donors will “cheapen the gift.” Such an affront to would-be donors will cause them to hold onto their organs. On one level, this seems absurd. Can you imagine a brother telling his ailing sister, “Gee, sis, I would have given you my kidney but now that I hear that someone across town is accepting a tax credit for his donation, well, forget it.”

But if Chianchiano is correct—that some people will withhold voluntary action if remuneration is available to others—then, paradoxically, a regime of donor compensation would be quite the boon to such “altruists.” They would have bragging rights: They were the ones who acted out of generosity, not for material gain, a distinction that not only allows them to retain the “warm glow” that comes from performing acts of charity but also intensifies it. Given the importance of “social signaling” through gift-giving (“look at me, so generous, so civic-minded!”) the opportunity to accentuate the distinction should be most welcome.

No wonder scholars ranging from philosophers to evolutionary biologists to psychologists and economists are skeptical about whether true human altruism even exists. It is more realistic to envision a broad middle ground between the poles of selflessness and greed. It is the arena in which most organ donation already plays out. And it is where compensated donation would likely reside, too.

Simply look at our daily lives. Financial and humanitarian motives do not reside in discrete realms. Moreover, it is unclear how their comingling is inherently harmful—the goodness of an act is not diminished because someone was paid to perform it. The great teachers who enlighten us and the doctors who heal us inspire no less gratitude because they are paid. A salaried firefighter who risks her life to save a child trapped in a burning building is no less heroic than a volunteer firefighter. Soldiers accept military pay while pursuing a patriotic desire to serve their country. The desire to do well by others while enriching oneself at the same time is as old as humankind. Indeed, the very fact that generosity and remuneration so often intertwine can be leveraged to good ends: to increase the pool of transplantable organs, for instance.

The practice of assigning values to body parts has roots in antiquity. The Code of Hammurabi provides an elaborate schedule of compensation for them; for example, it specifies that if an individual should “knock out the teeth of a freed man, he shall pay one-third of a gold mina.” Today we routinely assign valuation to the body. Human blood plasma is collected primarily though paid donation. Personal injury lawyers seek damages for bodily harm to their clients. The Veterans Administration puts a price on physical disabilities. We pay for justice in the context of personal injury litigation in the form of legal costs, and for our very lives in the form of medical fees. There is little reason to believe—nor tangible evidence to suggest—that these practices depreciate human worth or undermine human dignity in any way.

It is all too easy to romanticize altruism. Sociologist Amitai Etzioni urges the postponement of paying for organs in favor of what he calls a “communitarian” approach “so that members of society will recognize that donating one’s organs . . . is the moral (right) thing to do . . . it entails a moral dialogue, in which the public is engaged, leading to a change in what people expect from one another.” Thomas A. Shannon, a professor of religion and social ethics, writes, “I would think it a tragedy if . . . we tried to solve the problem of the organ shortage by commodification rather than by the kindness of strangers who meet in the community and recognize and meet the needs of others in generosity.”

To be sure, these skeptics have a right to their moral commitments, but their views must not determine binding policy in a morally pluralistic society. A donor compensation system operating in parallel with our established mechanism of altruistic procurement is the only way to accommodate us all. Moreover, it represents a promising middle ground between the status quo—a procurement system based on the partial myth of selfless altruism—and the dark, corrupt netherworld of organ trafficking. The current regime permits no room for individuals who would welcome an opportunity to be rewarded for rescuing their fellow human beings; and for those who wait for organs in vain, the only dignity left is that with which they must face death.

Obligatory note: the author is a resident scholar at AEI, perhaps the most influential think-tank on the Dubya administration.