Organ Donation becomes Opt Out from June

Sorry, but this is is everything that is wrong with Ireland. Like it or not, the state controls the medical system for the entire population. The vast majority of people want this free service provided by the government. The idea that this is suddenly some over reach by the same government that people demand a health service from is bonkers.

If people fear the government this much, opt out and go fully private and if they ever need a transplant, then decline organs on noble the basis that they may have been harvested.

The notion that there will be a wholesale organ harvesting and storage industry is a little bit hysterical TBF.

Organs have a short shelf life outside of the body, From 6/7 hours for a heart to maybe 36hrs for a kidney. Outside of corneas, heart valves and cadaver tissue, organs as they are conventionally thought of, cannot be stored.

We should dispel the notion that folks are going to be harvested as a matter of course. Indeed even where an end of life patient in an ICU has viable organs and a matched patient? That's a matter of luck as much as it is foresight. The likelihood of a donor being matched outside of a living donor is low, and whilst it improves with assumed consent, in the UK, which has adopted the assumed consent system, the wait is still up to 3 years.

There is also, as I touched on in my 1st post on this thread (as have others) the simple calculus of the capacity of the Irish system to harvest and transplant organs. The logistics around such procedures are complex, the number of surgeons skilled in the procedure is low, both in harvesting and transplanting them.

The ODTI also have a limited number of liaison nurses to manage and address donor family support during the process. I mentioned in an earlier post that the limit for harvest in Ireland is currently 300 per year (+/-25). That is based on both the Surgeons available, operating theatre time and the logistics surrounding the process.

The viability of the current organ donor system is also very much dependant upon ICU capacity. COVID highlighted just how tight Ireland is on capacity in that regard. Ideally I'd love to see our ICU capacity grow, along with that of ODTI to better manage the process.

Issues such as incomplete medical histories, unknown drug use and necessity for post mortem already mean a chunk of otherwise viable donors are excluded from consideration. Opening up the pool of potential donor's is IMHO vital. The assumed consent option has been discussed for over a decade and it's roll out must come with an educational and information component.

The family of the presumed donor will still be at the centre of the choice to donate. I've seen nothing to show that precept has changed.

Reading the law, family objections absolutely will act as an effective opt out. Also @Ezeoul , no family member would mean you wouldn't end up donating as well.

Thanks. Glad to hear that, at least.

Though I would like some clarity on what "designated" family member means.

I expect that once this comes into place, GPs and other healthcare providers will be checking whether paitents are already on the new register (either as confirmed as a donor or opted out) and anybody who has not made an active decision will be advised of the new opt-out system and encouraged to make a decision.

I disagree.

Within a family, who decides who is the "designated" person? What if the family members cannot agree?

These are the issues that come with an opt-out system and assuming consent for someone who cannot state their preferences. Unlike the current opt-in system, where at least the deceased has stated their preferences while still alive.

You can argue until you're blue in the face, but I feel an opt-out system is wrong. There will be organs harvested from people who would not want that, but didn't know they had to opt-out, mark my words.

Wouldn't be the first time we had a scandal around human organs in this country.

Andrew I’m reluctant to draw the analogy as I know you’re going to outright reject it on the basis that it’s completely different, but the above reasoning you’re using is the same reasoning that was used to justify treating women as mere vessels whose bodies weren’t their own.

It was ethically unjustifiable then too.

I would imagine your designated person is your next of kin which should be listed in your medical files as standard or at least a note made of it. If you don't have it stated, it is your spouse (has to be spouse not just partner) or if you are not married, it is your child if you have one. I would imagine if the child is under 18, it would then revert to your parents, if they are living. If no living parents, it would be your next closest living relative (brother or sister). Almost like what they do when someone dies without a will. It's not complicated at all. And again this is why it is incredibly important to have this conversation with your family at any point in time & not just assume they know your wishes. A bit like having a will. It is also like the opt-out system in the sense of family members, if you hadn't recorded your wishes, could opt you in if they didn't know that you had objections to it.

Oh my god it is very different things. The "State" isn't growing people to be organ donors like we're on a farm. And people have a choice. The difference now is that those who don't want to donate organs actually have to do something about it. What is the massive issue with that. And next-of-kin (designated family member) will still have a say so again, if you've discussed the topic with them, where is the issue? It's not like they're going to grab people off the streets to steal a kidney for a transplant. Women weren't being given a choice in your analogy. Here everyone is getting a choice, you just actually have to do something about it.

If family retain the ultimate veto post enactment, I can't see how this law will be effective at increasing donation rates since family already can opt in or out for the deceased.

I'm not being disingenuous at all, that's your own interpretation.

I'm also not making any assumptions about you either. You've already stated that you're not disclosing your own stance and that it's irrelevant what way you think (I disagree, but deliberately didn't press you on it).

When I say "I'm uncomfortable with you receiving an organ…..", I'm not talking about you specifically. I'm talking about someone, anyone, everyone who, hypothetically, doesn't donate and is trying to understand why they're being 'discriminated' against. I'm using you as a stand-in for anyone who a person who refuses to donate their organs but would happily accept donated organs if the shoe was on the other foot. If everyone thought like that there'd be no such thing as transplants.

https://www.sciencedirect.com/science/article/pii/S003335062400355X

"Our longitudinal analysis suggests that changing to an opt-out default does not increase organ donation rates. Unless flanked by investments in healthcare, public awareness campaigns, and efforts to address the concerns of the deceased's relatives, a shift to an opt-out default is unlikely to increase organ donations."

Because if someone has discussed it properly, the new legislation states that the designated family member must give weight to what the individual wanted. Therefore if the person had not chosen to opt out, that must be considered and there may even be an argument that if they didn't discuss it with family, they just were happy to go along with it.

And this is exactly the assumption I'm uncomfortable with. Just because someone may not have "gotten around" to opting out or having that discussion with their family, it should not mean they should be considered as "happy to go along with it".

Let's be honest how many people between the ages of 18 and 35 have seriously thought about organ donation? It's not a coincidence that this is also the age group they want to target as donors the most.

I know if I ever found myself in the circumstances were a relative had not formally opted out, and I did not know their wishes that I would default to an automatic refusal.