organ donation - presumed consent

uberwolf

Todays IT has an article prompted by a lecture to be held tomorrow at the Irish Council for Bioethics.

The guest speaker, a Prof John Harris, 'will suggest rules governing organ donation should be changed from requiring consent to a model in which "refusal to participate requires justification" '

He claims "it is far from clear that people are entitled to conscientiously object to practices that will save innocent lives."

Ireland currently has the third highest rate of organ donation in the world.


So what of it, do you have the right to selfishly deny someone else life in a fit of posthumous vanity? Should you even have rights to property after your life ceases - if you fail to make a will decreeing your property the state can claim it in certain circumstances.

Is anyone here a conscientious objector to organ donation?

Capt'n Midnight

a) if you have a driving license - fill in the donor form on the back

b) we should have a continental type "opt-out" system, all citizens are put on the dB and once a positive ID has been made and there is nothing listed in the dB against it you are considered a donor. (if no ID is made then you aren't)

The dB should also register things like illnesses that might prevent you being a suitable donor - this could save valuable time in accessing suitability eg: have you had jaundice (liver) , AIDs , etc. - this is the grey area for me.

Moriarty

I dunno.

I have an organ donor card around here somewhere and have told my family that's what I want to do, but the idea of presumed consent doesn't sit too well with me for some reason.

If we already have the third highest rate of organ donation in the world - which is nice to see - would it really achieve that much more? Isn't there a possibility of having a backlash against organ donation if we change to a policy of presumed consent? Would we not be better served to simply better promote voluntary organ donation and keep what I suspect is a very powerful motivation behind donating - giving the gift of life to somone else when you didn't have to. Hell, give people a tax break for it, that seems to work well for other things.

Capt'n Midnight

Moriarty wrote:

If we already have the third highest rate of organ donation in the world - which is nice to see - would it really achieve that much more?

IIRC (on RTE radio 1 a while back) - we only have 1/3rd of the kidneys needed at present. Your argument could be rephrased as "if even the highest rate of voluntary donation is nowhere close, how is it ever going to be possible to have enough organs without an opt-out system ?"

Other grey areas are those who claim that someone who is a donor may not get as much life support because they need the organs ! Because of tissue matching and rejection and all that it's unlikely to be able to ID someone as having the required organs that soon, but an opt-out scheme means this is even less plausable.

Or we could do like they do in other parts of the world and buy third world organs. eg: poor people in India selling one kidney. The other options of artifical organs and stem cell won't be economic/ethical any time soon.

uberwolf

Capt'n Midnight wrote:

Other grey areas are those who claim that someone who is a donor may not get as much life support because they need the organs ! Because of tissue matching and rejection and all that it's unlikely to be able to ID someone as having the required organs that soon, but an opt-out scheme means this is even less plausable.

conversely someone could be kept alive until such a time as there organs were required... which is just as bad.

You're correct though - it appears regardless of that rate of donation there still exists a massive shortage of organs.

It could be viewed as simply reversing the current situation. No one is forced to donate - if they don't wish to do so they can opt out - perhaps its sheer laziness which has prevented these people not signing up?

Although would there then be scope for debate for just how conscientious their objection has to be. Like military service in germany - you have to prove to a certain parameter that your wish to perform some other form of service is reflected in your life style/life decisions

nesf

Moriarty wrote:

I dunno.

I have an organ donor card around here somewhere and have told my family that's what I want to do, but the idea of presumed consent doesn't sit too well with me for some reason.

Same here. My family are not very comfortable with me carrying a donor card. I view it as my choice, but they seem to have this idea of being buried as an untouched body kind of thing.

They are not opposed to organ donation as a general thing, but they seem to have a "not me" attitude towards it.

Maybe it's a re-education thing? Most people I know in my generation have at least considered being a donor. They might be lazy with actually getting the card, but the idea doesn't seem to bother them.

So maybe a consent given until a person requests to be off the list would be a good thing?

So long as people are given the choice to not participate, I don't see why it would be a bad thing, provided it was properly advertised and people were informed about it.

Capt'n Midnight

uberwolf wrote:

conversely someone could be kept alive until such a time as there organs were required... which is just as bad.

like the film coma..

uberwolf wrote:

perhaps its sheer laziness which has prevented these people not signing up?

how many people have filled in the form on the back of thier driving license - about half the population have to take it with them every day !

uberwolf wrote:

Like military service in germany - you have to prove to a certain parameter that your wish to perform some other form of service is reflected in your life style/life decisions

that and up to three years of Red Cross / community service , depending whether you do it all at once or at weekends

Capt'n Midnight

nesf wrote:

Maybe it's a re-education thing? Most people I know in my generation have at least considered being a donor. They might be lazy with actually getting the card, but the idea doesn't seem to bother them.

I'll say it again - all drivers are required to have their Driving License with them. There is an organ donor form on the back of it - most people ALREADY HAVE the card, the only way of making it any easier is to have an opt-out system.

uberwolf

@ Cap't I'm not sure if you're rebutting me or just making points

also in crazy hypothetical situation no.3072 and guy gets rushed into hospital, dies promptly and they only have X minutes to save the organs, in the presumed consent state they would presume they had permission unless they could find documentation to prove otherwise. Meaning in most cases they could claim not to have found, twas left in mangled glovebox, etc. and organs are harvested despite the wishes of the individual.

What grounds are there for objecting though - to expand the debate somewhat? As teh Prof points out - are the rights of the deceased greater than the rights of the living (and needy)?

DrIndy

Organ donation is very important. There is a great dearth of organs in ireland and indeed in the whole world. There is a shortage not only of kidneys, but also liver, lungs heart and other organs.

Bone marrow is also in short supply - although this is much easier to donate as it grows back so quick.

The issue of presumed consent with an opt out is very workable and life saving.

mike65

I can only belive that opting out is the right way. Purhapes I'm too ideological
about things like this but I dispair of I see/read of organs being denied due to some (religious-based) belif.

In fact I'd go further and make it law that all organs of value have to be submitted to use regardles of the next of kins views. But only a heartless atheist would think like that proberly!

Mike.

nesf

Capt'n Midnight wrote:

I'll say it again - all drivers are required to have their Driving License with them. There is an organ donor form on the back of it - most people ALREADY HAVE the card, the only way of making it any easier is to have an opt-out system.

Eh, quite a lot of people I know, in fact most, don't have driving licences or at least don't have a valid one that they carry around with them. Myself included.

I really should get around to driving again and passing that test.

Fysh

uberwolf wrote:

@ Cap't I'm not sure if you're rebutting me or just making points

also in crazy hypothetical situation no.3072 and guy gets rushed into hospital, dies promptly and they only have X minutes to save the organs, in the presumed consent state they would presume they had permission unless they could find documentation to prove otherwise. Meaning in most cases they could claim not to have found, twas left in mangled glovebox, etc. and organs are harvested despite the wishes of the individual.

What grounds are there for objecting though - to expand the debate somewhat? As teh Prof points out - are the rights of the deceased greater than the rights of the living (and needy)?

If I'm reading your crazy hypothetical situation right, you're suggesting that a combination of unexpected time constraints, dodgy medical ethics and a lack of available information being a possible situation is enough to refute the idea. I'd counter this as follows (though if I've read this wrong these arguments may not apply):

1)I suspect that there aren't going to be a hugely significant number of people dying suddenly whose organs can be verified as suitable for transplant. While any organs available should if possible be used (since we're generally short of organs for donation anyway), I don't suspect there would be that many cases where the possibility of the organ being useful would lead doctors to skip on the necessary checks. Well, outside of an exciting episode of ER or something .

2)It would be unethical for the doctors carrying out the transplant to do so without ensuring that all legal and medical requirements are met. If you don't trust them to do this or adhere to the standards, it's going to cause far wider-reaching problems than just the possibility of a recently-deceased person's rights being ignored.

3)In the case of the proposed system being implemented as an opt-out system, I personally would think that as well as carrying a donor card some form of registry would be a good idea. Not just because it avoids any awkwardness in terms of "do you have the card on you" but also because it means that in the case of family/next-of-kin challenging the verdict there would be an official record somewhere.

Now, the question that popped into my head when I was thinking of the advantages/disadvantages of 3....firstly, would we trust the government to maintain such a database? Secondly, one of its advatages would be that if you die abroad there would be a relatively straigthforward way for medical services abroad to check what your wishes were. However - who would be entitled to your organs in that case? Would it be someone in your home country, or anyone in the vicinity where you died who needs the organ?

Speaking as an atheist, I think that a mandatory-unless-you-opt-out system of organ donation would be a good idea. I think it should be extended in scope, personally, to include the idea of donating bodies to science for research. Death is death, and ritual burial takes up too much space as it is. Might as well let your cooling flesh be used for some good rather than go to waste in a wooden box underground. TBH I'm not convinced of the argument of respecting the dead vehicle in which an individual used to reside - I mean, as long as you're alive, ok. But once you're dead, what conceivable difference is it going to you to make if someone yanks out your gall bladder or whatever? And if it's not your own body, what entitles you to an opinion on what happens to it? Difficult questions...

athena 2000

Fysh wrote:

2)It would be unethical for the doctors carrying out the transplant to do so without ensuring that all legal and medical requirements are met. If you don't trust them to do this or adhere to the standards, it's going to cause far wider-reaching problems than just the possibility of a recently-deceased person's rights being ignored.

Speaking of trust...this point made me think of some doctors in Ireland that were removing organs from dead infants without the knowledge or consent of the parents or next of kin. This had to do with post-mortem practices in hospitals. Some of these organs were kept for years.
Link to an archived news story from May of 2000.
Some additional background information.

Fysh wrote:

Secondly, one of its advatages would be that if you die abroad there would be a relatively straigthforward way for medical services abroad to check what your wishes were. However - who would be entitled to your organs in that case? Would it be someone in your home country, or anyone in the vicinity where you died who needs the organ?

Since organ viablity is limited, it would make sense to donate on-site first. A seven year old boy from California died in Italy while on vacation in 1994 and his parents consented to organ donation. The lives of seven Italians were saved or radically improved. Of course, it was completely voluntary on the part of the parents to give their son's organs.

Fysh wrote:

...TBH I'm not convinced of the argument of respecting the dead vehicle in which an individual used to reside - I mean, as long as you're alive, ok. But once you're dead, what conceivable difference is it going to you to make if someone yanks out your gall bladder or whatever? And if it's not your own body, what entitles you to an opinion on what happens to it? Difficult questions...

Definitely difficult questions. In some cultures, the dead person must be buried within 24 hours - it is both ritual and related to religious practices. Though it theoretically wouldn't make a difference to the dead person, another question related to the decision would probably involve a right to privacy.

The idea of a new organ donation model in which "refusal to participate requires justification" would be an interesting lecture. If organ donation moved to the model proposed, then regulation would probably be involved and the goverment wouldn't just be in your external environment, but also in your viscera.

The Irish Council for Bioethics

uberwolf

Fysh wrote:

1)I suspect that there aren't going to be a hugely significant number of people dying suddenly whose organs can be verified as suitable for transplant. While any organs available should if possible be used (since we're generally short of organs for donation anyway), I don't suspect there would be that many cases where the possibility of the organ being useful would lead doctors to skip on the necessary checks. Well, outside of an exciting episode of ER or something .

well as you say it was a flippant hypothetical situation - posed simply to develop a few problem areas. My talk of time issues was based on athena2000 brought up - organ viability. Even if they can last 24, 48hrs iced or whatever there is presumably an even more limited time frame in which to remove them, in order to preserve them.

And iirc a very significant number of donors come from accidents rather than timely deaths - it's the only way their organs are any use. So you would be looking at traumatic sudden deaths. (having worked for DFB briefly, there is a reason motorcycles are known as donorcycles).

All of which leads to a situation where people aren't entering hospitals in full control of their senses, aware of their impending deaths and signing forms consenting to harvesting. This then transfers responsibility to the harvesting to someone else. It's a bit late to object to harvesting when all the organs have been neatly removed!! So there will be a time pressure!

Conveniently I'm removed from this debate because my organs aren't fit for public consumption (British resident in 80's!!). But is there anybody here who'd object to their organs being removed - and on what basis?

skywalker

uberwolf wrote:

So what of it, do you have the right to selfishly deny someone else life in a fit of posthumous vanity?

Conversly why should someone else have a right to say what happens to your body against your wishes, should that be the case. Its pretty much the only thing that cant be taken away from you in this life.

Personally I certainly wouldnt favour an opt out system.

uberwolf

skywalker wrote:

Conversly why should someone else have a right to say what happens to your body against your wishes, should that be the case. Its pretty much the only thing that cant be taken away from you in this life.

Personally I certainly wouldnt favour an opt out system.

the argument is that your rights as a dead person should be outweighed by the rights of the living.

Why wouldn't you favour the opt out system?

skywalker

uberwolf wrote:

the argument is that your rights as a dead person should be outweighed by the rights of the living.

Why wouldn't you favour the opt out system?

True, but its your body your talking about, not your car. I dont see that anyone else has a right to overrule your wishes in what happens to it, or gives another person an innate right to something which (in the belief of some) god gave you.

Whats the religion where people wont have any invasive surgery, even if its life saving. seeks (sp?) i think. It goes against their entire belief system, Whats the point in them going through their life living according to their beliefs, only for their organs to be harvested when they die.

Some of the reasons.

Moriarty

uberwolf wrote:

the argument is that your rights as a dead person should be outweighed by the rights of the living.

Why wouldn't you favour the opt out system?

I guess it all comes down to how you view yourself and society. An opt-out system leaves the implication that your body is under the ownership of society and you're just borrowing the use of it for the extent of your lifetime. I suspect a lot of people would find that thought unsettling.

Fysh

skywalker wrote:

True, but its your body your talking about, not your car. I dont see that anyone else has a right to overrule your wishes in what happens to it, or gives another person an innate right to something which (in the belief of some) god gave you.

But if you're dead you aren't using it any more. And no matter what the religiously inclined might prefer to think, I can assure you that religious internment provides no defence against decay and eventually becoming wormfood. The argument is that, if it's going to waste by being buried after you die anyway, useful organs which might save someone else's life could be harvested, and it could be considered that withholding those organs is selfish. The issue is whether the government (which should not make policy decisions based on religion if it is to be truly democratic) has the right to overrulle the personal aspect of religious choices regarding what happens to you after you expire.

skywalker wrote:

Whats the religion where people wont have any invasive surgery, even if its life saving. seeks (sp?) i think. It goes against their entire belief system, Whats the point in them going through their life living according to their beliefs, only for their organs to be harvested when they die.

Some of the reasons.

I'm pretty sure that kind of attitude is present in Jehovah's witnesses. Where it gets interesting is that the right to refuse surgery or blood transfusions (something they're big on, apparently) is pretty much the same as the right to die argument. However, if we are accepting that one has the right to choose not to be healed, or to die, then it is very difficult for the state to reclaim the right to the organs once someone is dead. I'll be very interested in the suggested legal phrasing for this, because it's an awkward issue.

simu

Once a person is dead, their corpse isn't any different from any other piece of matter imo so I don't see why the government shouldn't use it to help other living people. People seem to have an emotional attachment to corpses that I don't share though - hence the resourses spent on recovering corpses from disaster scenes etc - and I suspect many people would be uneasy at the idea of compulsary harvesting of organs after death. A government could probably convince the public of the benefits of assuming a person accepts having their organs used unless they have stated otherwise, though.

skywalker

Moriarty wrote:

I guess it all comes down to how you view yourself and society. An opt-out system leaves the implication that your body is under the ownership of society and you're just borrowing the use of it for the extent of your lifetime. I suspect a lot of people would find that thought unsettling.

Thats what I was trying to get at with my comment about it being your body not your car.

Fysh wrote:

But if you're dead you aren't using it any more.

Right but just because im not using it any more, doesnt make it any less my property. If my not using my old car anymore, am I selfish for not giving it away? Should society have a right to take it and give it to someone who needs a car?

Fysh wrote:

I'm pretty sure that kind of attitude is present in Jehovah's witnesses. Where it gets interesting is that the right to refuse surgery or blood transfusions (something they're big on, apparently) is pretty much the same as the right to die argument. However, if we are accepting that one has the right to choose not to be healed, or to die, then it is very difficult for the state to reclaim the right to the organs once someone is dead. I'll be very interested in the suggested legal phrasing for this, because it's an awkward issue.

Can someone clarify how are those situations dealt with at present, do people have the right to refuse invasive surgery/blood transfusions for themselves and their children on religious or other grounds.

seamus

Moriarty wrote:

I guess it all comes down to how you view yourself and society. An opt-out system leaves the implication that your body is under the ownership of society and you're just borrowing the use of it for the extent of your lifetime. I suspect a lot of people would find that thought unsettling.

Not necessairily, it all depends on how it's phrased. It could be phrased in a such a way that says that your body becomes State property only upon on your death unless stated otherwise. This also closes the door for mandatory "donations" of organs by the terminally ill while they're still alive.

Fysh

skywalker wrote:

Right but just because im not using it any more, doesnt make it any less my property. If my not using my old car anymore, am I selfish for not giving it away? Should society have a right to take it and give it to someone who needs a car?

This is different. You are not using it because you are not their. You have no physical world interests. You are defunct. Expired. You have ceased to be. Your body is a lump of flesh that will rot uselessly, and might as well be used to benefit others as feed worms underground. This is the point. You are not around to have any say in what happens to it any more.

pickarooney

Two randomish points on conscientious objection.
A guy in the local paper wrote in saying he had requested that his organs only be donated to persons who were also on the list of donors (excludig chidren). His request was refused as the health service refused to discriminate between possible recipients on this criteria. In protest, he withdrew himself from the list of donors. I could see his point (-ish) but found it quite a petty, spiteful reaction.

A colleague of mine was in a near-fatal tram accident some years back. She was actually pronounced clinically dead by the police at the scene. When she was brought to the hospital she was re-checked and it was decided that although there was minimal brain activity it was only a matter of hours before she inevitably died and so her organs could be harvested for transplant purposes. She had no donor card, purely because she never got round to getting one, so her parents were asked, and refused on the grounds that they believed their daughter was salvageable. She survived somehow and made a complete recovery over time. Had she been on the donor list, she would have had her heart, lungs and kidneys removed. She won't ever get a donor card.

Obviously this is a one in a million case, but she has an undeniably good reason for not carrying the card.

skywalker

Fysh wrote:

This is different. You are not using it because you are not their. You have no physical world interests. You are defunct. Expired. You have ceased to be. Your body is a lump of flesh that will rot uselessly, and might as well be used to benefit others as feed worms underground. This is the point. You are not around to have any say in what happens to it any more.

True, but the point im trying to make remains. What right has society as a whole got to tell me what to do with my body? you wouldnt accept them telling you what to do in the example with the car.

Your body is the one thing your guaranteed to have from the moment your born to the moment you die, you only get one, and its more personal to each of us than anything else you will have in this world. In my mind noone has a right to tell me what to do with it(as long as im not harming anyone), or take it or any part of it away from me.

Fysh

skywalker wrote:

True, but the point im trying to make remains. What right has society as a whole got to tell me what to do with my body? you wouldnt accept them telling you what to do in the example with the car.

Your body is the one thing your guaranteed to have from the moment your born to the moment you die, you only get one, and its more personal to each of us than anything else you will have in this world. In my mind noone has a right to tell me what to do with it(as long as im not harming anyone), or take it or any part of it away from me.

You aren't getting me at all.

The fundamental difference is that property only makes sense in the context of a conscious living owner. So while a car that you don't use should remain yours because you may choose at a later stage to use it again, a body that you have permanently vacated may as well be donated to the public good because there is no scientific evidence anywhere suggesting that you're ever going to need that body again. Religious beliefs notwithstanding, there's no actual proof. End of story, as far as I'm concerned.

Your point about people taking your body away is flawed - it only works if someone was trying to steal your organs while you were alive. When you're dead, you're not going to care. So what difference does it make? The only possible objection is one founded on irrational religious beliefs, which frankly doesn't cut the mustard considering we're talking about a situation where you are no longer alive to hold those beliefs.

Moriarty

Fysh wrote:

You aren't getting me at all.

The fundamental difference is that property only makes sense in the context of a conscious living owner. So while a car that you don't use should remain yours because you may choose at a later stage to use it again, a body that you have permanently vacated may as well be donated to the public good because there is no scientific evidence anywhere suggesting that you're ever going to need that body again. Religious beliefs notwithstanding, there's no actual proof. End of story, as far as I'm concerned.

It's funny, you seem just as willing to impose the implications of your belief system on everyone else as, for example, hardline christians - who you no doubt lambast at every opportunity. Go figure.

Sleepy

Since I'm agnostic and don't follow (or if I'm honest, respect) any religion, I can't see any good argument against making organ-donation an opt-out thing.

Manach

Throwing this idea out for discussion – why not allow the sale of the deceased’s body parts, to benifit the immediate family. As some previous posters have inferred, these organs are nothing but rapidly cooling pieces of meat, so allow the market to have a stake.

Fysh

Moriarty wrote:

It's funny, you seem just as willing to impose the implications of your belief system on everyone else as, for example, hardline christians - who you no doubt lambast at every opportunity. Go figure.

I think you've missed the bit about me being in favour of the opt-out system. The above is me trying to explain the argument behind the notion of changing the system from opt-in to opt-out. If people really want to opt out, then while I don't personally see why they'd bother, I think they should have that right, and have said so. I just don't think we should assume everyone would object to their organs being used, in the event of their death, to give someone else a better chance of living. Especially not if the dead person concerned didn't object enough to fill out an opt-out form, which if you have serious ethical or religious beliefs concerning the matter wouldn't be much effort at all.

As for your attempt to compare me to hard-line Christians, well done. I almost cared. Better luck next time, but bonus points for effort.