Organ Donation from Cadavers

[FA Xerrik]

So in the US today, organs may be taken from a cadaver only if the person had, while alive, indicated that they wished to donate their organs. Alternatively, if the surviving family allows it, the organs may also be taken. My question is this: given the chronic shortage of healthy donor organs, why not simply take organs without regard to the former wishes of the dead person, or their family? Can non-voluntary retrieval be morally justified?

[General Zod]

So in the US today, organs may be taken from a cadaver only if the person had, while alive, indicated that they wished to donate their organs. Alternatively, if the surviving family allows it, the organs may also be taken. My question is this: given the chronic shortage of healthy donor organs, why not simply take organs without regard to the former wishes of the dead person, or their family? Can non-voluntary retrieval be morally justified?

Nevermind the morality, anyone going against the family's wishes for something like this is looking to leave themselves open to get the shit sued out of them for everything they own.

[Mayabird]

I know some countries are going towards opt-out systems instead of opt-in (basically, unless you specifically say that your organs are off limits, any useful ones will be harvested). It takes out the opportunity for lawsuits as well.

It's really stupid for people to just let their organs go to waste; they're not going to need them anymore and other people could use them. It keeps a black market for human parts from forming if there's an ample supply, too (there isn't an ample supply, and there is a black market for parts). I'd say it'd be morally justified but until there's an opt-out system it'd involve way too much secrecy (I'm sure there's a lot of paperwork that goes into each transplant and the paper trail would get too questionable).

[FA Xerrik]

So in the US today, organs may be taken from a cadaver only if the person had, while alive, indicated that they wished to donate their organs. Alternatively, if the surviving family allows it, the organs may also be taken. My question is this: given the chronic shortage of healthy donor organs, why not simply take organs without regard to the former wishes of the dead person, or their family? Can non-voluntary retrieval be morally justified?

Nevermind the morality, anyone going against the family's wishes for something like this is looking to leave themselves open to get the shit sued out of them for everything they own.

Of course. Perhaps I should clarify the question: if non-voluntary retrieval was legal, what if any moral issues would arise? As Mayabird said, it seems stupid to let organs go to waste, and yet throughout history there has been a traditional reverence for the treatment of the dead. Should we respect surviving family members wishes to not have their beloved pillaged for organs within moments of death? Bear in mind any harvesting has to be done quickly if the organs are to remain viable. Is there any justifiable reason to respect the wishes of the deceased, or their family, at the expense of losing valuable and needed organs?

[SCRawl]

Of course. Perhaps I should clarify the question: if non-voluntary retrieval was legal, what if any moral issues would arise? As Mayabird said, it seems stupid to let organs go to waste, and yet throughout history there has been a traditional reverence for the treatment of the dead. Should we respect surviving family members wishes to not have their beloved pillaged for organs within moments of death? Bear in mind any harvesting has to be done quickly if the organs are to remain viable. Is there any justifiable reason to respect the wishes of the deceased, or their family, at the expense of losing valuable and needed organs?

It depends on what you mean by "justifiable". As an atheist, I believe that my defunct corpse will be just another piece of meat, so why the hell should I care what happens to it? If someone believes that their body should remain (relatively) whole post-mortem to retain their ability to get to heaven (or some other such nonsense) then they can justify their position that they don't want to donate. My mother, who was not a religious person nor particularly crazy in other ways, mentioned to me once that she didn't want to donate her organs. Her justification: you hear all the time about babies born without various parts, and maybe there's a connection. I didn't get into great depth in that conversation, and this is a roughly 20-year-old memory, but the gist of it remains pretty clear.

Anyways, as someone (Broomstick, I think) has pointed out in the past, even if we were to harvest every useful organ the demand would still outstrip the supply. The circumstances of death required for the deceased person's organs to be useful are fairly rare.

[General Zod]

Of course. Perhaps I should clarify the question: if non-voluntary retrieval was legal, what if any moral issues would arise? As Mayabird said, it seems stupid to let organs go to waste, and yet throughout history there has been a traditional reverence for the treatment of the dead. Should we respect surviving family members wishes to not have their beloved pillaged for organs within moments of death? Bear in mind any harvesting has to be done quickly if the organs are to remain viable. Is there any justifiable reason to respect the wishes of the deceased, or their family, at the expense of losing valuable and needed organs?

If it's legal then there's less to worry about. Once someone's dead it doesn't really matter what happens to the body insomuch as what the family wants done with it; since it's not really possible to hurt a dead person, morality is somewhat of a non-issue aside from the family's wishes. So the only problem left is to make sure there's sufficient guidelines to harvest only healthy organs that have been thoroughly screened for disease or anything else that would make them poor transplants. As far as going against the family's wishes, a corpse is pretty much like any other piece of property. So it would still be enough to consider it theft if they bothered opting out.

[FA Xerrik]

It depends on what you mean by "justifiable". As an atheist, I believe that my defunct corpse will be just another piece of meat, so why the hell should I care what happens to it? If someone believes that their body should remain (relatively) whole post-mortem to retain their ability to get to heaven (or some other such nonsense) then they can justify their position that they don't want to donate.

As you say, the religious angle seems somewhat nonsensical. The only real angle I could see being pushed here is a sort of Kantian, human value argument where it's imperative to respect peoples wishes, even if it means not harvesting organs. Are there any other more tangible arguments in favor of respecting the sovereignty of a cadaver or the wishes of a family?

[Singular Intellect]

Is there any justifiable reason to respect the wishes of the deceased, or their family, at the expense of losing valuable and needed organs?

Logically? No.

Practically? Definitely.

Quite frankly, until you properly education the majority population, you have to dance on egg shells to avoid upsetting the herd with a known history of stampeding over the stupidest things.

[Melchior]

Her justification: you hear all the time about babies born without various parts, and maybe there's a connection.

She was Lamarckian? Maybe I should get some sleep, but right now I'm not able to draw any even remotely sane connection between removing organs from cadavers and malformed babies.

[Magus]

Her justification: you hear all the time about babies born without various parts, and maybe there's a connection.

She was Lamarckian? Maybe I should get some sleep, but right now I'm not able to draw any even remotely sane connection between removing organs from cadavers and malformed babies.

Lamarckian? What does Lamarckism have to do with it? You can't reproduce when you're dead. I think she was toying around with the possibility of some sort of reincarnation - lose your spleen after you're dead, and your next body will be spleen-less.

At any rate, regarding the OP - why wouldn't the body be considered part of the person's estate, to be done with what they wish? Or are you suggesting that a person's money, possessions, and other property be appropriated upon death?

[SCRawl]

Her justification: you hear all the time about babies born without various parts, and maybe there's a connection.

She was Lamarckian? Maybe I should get some sleep, but right now I'm not able to draw any even remotely sane connection between removing organs from cadavers and malformed babies.

Well, I'm not saying that it was a well-formed theory, I'm just saying that that's what she said to me at the time. Obviously, it isn't the sort of thing I can ask her to elucidate -- she died in 2001. I suppose that in the back of her mind she considered the possibility that reincarnation was possible, and that through that mechanism the post-mortem disposition of one's corpse could have an effect. Such an idea does not stand up to much scrutiny, but I never claimed that it did.

(As a (sort of) aside, my mother wasn't a stupid person -- she was a nurse, after all, and as I said, not in the least religious. She might have been a little too superstitious for her own good.)

[Broomstick]

Anyways, as someone (Broomstick, I think) has pointed out in the past, even if we were to harvest every useful organ the demand would still outstrip the supply. The circumstances of death required for the deceased person's organs to be useful are fairly rare.

Yeah, that was probably me - mandatory donation, so to speak, will not solve the organ shortage problem and may well result in some negative feedback. I doubt it would stop a black market in organs, either, as there would still be shortages.

[FA Xerrik]

At any rate, regarding the OP - why wouldn't the body be considered part of the person's estate, to be done with what they wish? Or are you suggesting that a person's money, possessions, and other property be appropriated upon death?

A good point. The only reply I can think of would be that organs can be removed to save lives. Of course, you can make the argument that all of the deceased's belongings could be sold off or given to charity or what not and also save lives. However, there's no reliable system currently in place to ensure such a beneficent result. With organs, however, you can be assured that the existing infrastructure, so to speak, will result in saving a life (barring of course the organ being rejected or any other complications arising).

[Broomstick]

At any rate, regarding the OP - why wouldn't the body be considered part of the person's estate, to be done with what they wish? Or are you suggesting that a person's money, possessions, and other property be appropriated upon death?

A good point. The only reply I can think of would be that organs can be removed to save lives. Of course, you can make the argument that all of the deceased's belongings could be sold off or given to charity or what not and also save lives. However, there's no reliable system currently in place to ensure such a beneficent result. With organs, however, you can be assured that the existing infrastructure, so to speak, will result in saving a life (barring of course the organ being rejected or any other complications arising).

Incorrect.

The VAST majority of people who die are not suitable, or even possible, organ donors. They are eliminated as donors well before the problems of recipient complications arising.

PRO:
1) You will get a few more viable organs. If they actually match donors (and a subset of them will) you will even save a few lives.


CON:
1) Vast new bureaucratic and medical infrastructure to investigate every death that could possibly yield organs or tissues which will cost money and will only yield viable organs/tissues in a minority of instances.

2) Possible intense social fallout ("death tax", "stealing the dead", etc.) and animosity.


WHAT WE REALLY NEED:
1) A better way to head off medical problems so fewer people will need transplants

2) A means to create/grow/manufacture substitute organs so we will no longer need to rely on organ donations.

[salm]

1) Vast new bureaucratic and medical infrastructure to investigate every death that could possibly yield organs or tissues which will cost money and will only yield viable organs/tissues in a minority of instances.

Are you saying that we should abolish all transplantations?

We allready have to investigate every death for organs that has a donor pass so the current bureaucratic and medical infrastructure needed now compared to the current results is proportional to the infrastructure needed compared to the results if everybody had a donor pass.
If anything, then more bodies being checked would mean assembly line checking, probably resulting in more efficient procedures.

[Broomstick]

I don't think we should abolish organ transplants right now, certainly not, but long-term we need a better source of replacement organs than cadavers because, for the foreseeable future, there will never be enough. Thus - reduce the need for new organs with better prevention/treatments, and come up with an alternative to cadavers, probably through bio-engineering.

That said - only certain types of deaths require asking the family if donation is an option. Generally, head-injuries and young people. If you die from infection or cancer or a variety of other ways you will simply not be suitable and the question won't even come up (unless the family mentions it). Of the subset that die in a manner making them potential donors, at least in the US, the family is asked to give consent (even if the person has a donor card the family can overrule them). If consent is not given it ends there. If consent is given then medical history must be checked, certain things ruled out (although the limited time involved means many things can't be checked) and that's the bureaucracy I mean. If we had presumptive donation EVERY death that could result in a potential donor will need to have this done, and perhaps without the family around or uncooperative, which will add difficulty and expense. It will never be an "assembly line" because most people die in a manner which rules them out as a donor.

Will presumptive donation result in more donors? Yes - but probably not as many as people think there will be. It might still be worthwhile, but you will not as much return on investment as most people think you will. There may be negative social costs as well. At least in the US, there is already a perception that doctors give up early on donors to recycle them and if there is presumptive donation this perception will only intesify - other countries may or may not have that problem either - but it will impose a significant social cost by creating mistrust between doctors and patients.

[salm]

I don't think we should abolish organ transplants right now, certainly not, but long-term we need a better source of replacement organs than cadavers because, for the foreseeable future, there will never be enough. Thus - reduce the need for new organs with better prevention/treatments, and come up with an alternative to cadavers, probably through bio-engineering.

Ah, yeah, no argument here.

Will presumptive donation result in more donors? Yes - but probably not as many as people think there will be. It might still be worthwhile, but you will not as much return on investment as most people think you will. There may be negative social costs as well. At least in the US, there is already a perception that doctors give up early on donors to recycle them and if there is presumptive donation this perception will only intesify - other countries may or may not have that problem either - but it will impose a significant social cost by creating mistrust between doctors and patients.

Germany has a huge problem with the impression of doctors giving up early on them. However, this could probably be reduced by a good PR campaign.
At the moment 52% of Germans would donate their organs (as opposed to 81% of Swedes just to clearify the problem we have here). Only 16% of Germans have a donors pass, though. I have the impression that this is simply because people are too lazy or just forget to get one.
Now, we´re talking about ~13 million potential donors vs ~40 million potential donors. There would be about three times as many organs available than now if all these people had a donors pass.
At the moment every third person waiting for an organ donaition in Germany dies. This problem could be solved simply by introducing that you´re a donor by default and have to opt out of it just like they did in Austria.

Here´s an article about this problem but unfortunately only in German.
article


Source for amount of donor pass owners

[Broomstick]

Germany has a huge problem with the impression of doctors giving up early on them. However, this could probably be reduced by a good PR campaign.

I question if a mere PR campaign would work, especially somewhere like the US where we have a legacy of such things as the Tuskegee experiment where doctors failed to act in the best interests of patients. This is a particular sore spot among ethnic minorities. It may, however, work in other countries where this is not such an issue.

At the moment 52% of Germans would donate their organs (as opposed to 81% of Swedes just to clearify the problem we have here). Only 16% of Germans have a donors pass, though. I have the impression that this is simply because people are too lazy or just forget to get one.

In the US a certain number of people (very difficult to quantify) are willing to donate but refuse to get donor cards (here, that usually means an indication on the driver's license) because of the fear doctors will give up too soon if they are known to be donors - so they rely on their families to speak up AFTER the docs have given up. Whether this is really necessary or not is questionable, but you can hardly fault someone for trying to protect their own life, even if they are willing to donate after death is certain.

[salm]

Germany has a huge problem with the impression of doctors giving up early on them. However, this could probably be reduced by a good PR campaign.

I question if a mere PR campaign would work, especially somewhere like the US where we have a legacy of such things as the Tuskegee experiment where doctors failed to act in the best interests of patients. This is a particular sore spot among ethnic minorities. It may, however, work in other countries where this is not such an issue.

Eh, people are sheep. If you hammer it into them for long enough they can be conditioned into allmost anything.

In the US a certain number of people (very difficult to quantify) are willing to donate but refuse to get donor cards (here, that usually means an indication on the driver's license) because of the fear doctors will give up too soon if they are known to be donors - so they rely on their families to speak up AFTER the docs have given up. Whether this is really necessary or not is questionable, but you can hardly fault someone for trying to protect their own life, even if they are willing to donate after death is certain.

So in the US you can basically check a box on your drivers license if i understand this correctly which means that everybody allready has a donor card. In this case it can´t be the laziness of people. Seems like this needs to be a rather expensive and long lasting PR campaign then.

[Broomstick]

In the US a certain number of people (very difficult to quantify) are willing to donate but refuse to get donor cards (here, that usually means an indication on the driver's license) because of the fear doctors will give up too soon if they are known to be donors - so they rely on their families to speak up AFTER the docs have given up. Whether this is really necessary or not is questionable, but you can hardly fault someone for trying to protect their own life, even if they are willing to donate after death is certain.

So in the US you can basically check a box on your drivers license if i understand this correctly which means that everybody allready has a donor card. In this case it can´t be the laziness of people. Seems like this needs to be a rather expensive and long lasting PR campaign then.

Yes.

In fact, when you go to renew your driver's license you are specifically asked about being a donor, do you want that indicated, etc. For those who don't drive, the State ID cards (which function as ID in lieu of said license) are obtained at the same locations and the same question(s) are asked.

Rates of donation are rising, thanks both to PR/education and people getting accustomed to the idea over time. Also, with long-term survivors out in the community it also increases the perception that this is something that is truly worthwhile, you're not just making medical cripples. (One of the local business owners in town went from being bedridden to a 20 year post-transplant survivor who is still quite active and athletic - that's some of the best PR you can get)

There is still, however, enormous distrust among the African-descended community towards doctors and transplants. The fact that many ethnic blacks are actually mixed race here also means they are MUCH harder to match to a donor organ that those of less well blended ancestry. (That does, in fact, also apply to many white folks whose families have been here for awhile and have non-European ancestry back a few generations, as well as our Eurasian and other combination folks. The upside for them is fewer recessive genetic disorders. The downside is much greater difficulty getting donor organs if they ever need them.) Add into that some of the well-documented maltreatment of minorities at the hands of doctors in the US and it's quite a problem. ANYTHING seen as coercive is going to cause people to dig in their heels and resist. Minorities have already noticed that the overwhelming majority of recipients are white - and it's true. But the only way that will change is if more ethnic minorities are willing to donate. It's extraordinarily rare you can cross racial lines in organ transplants. When it's possible and the organ is available it certainly can and has been done but it's like winning the lottery twice.

Right now, the US is trying to increase minority donors as the need for them is the most pressing. This includes even such things as a price break - for example, if I wanted to get on the bone marrow donors list (which doesn't even require my death to donate) I would probably have to pay for testing for compatibility factors ($75 last I checked) but there are funds so that potential ethnic minority donors don't have to pay out of pocket, in order to encourage more people to sign up and to remove price barriers. Also, living organ donors, whether they are insured or not themselves, have all associated donation costs paid for by the recipient, including for any complications. Families of deceased donors likewise pay nothing for donation costs. Given how profit and price driven US health care is, that's a pretty big concession (though it seems an obvious one to me).

A proposal to pay for the funeral costs of deceased donors, however, caused immense outrage - even the perception of buying and selling human body parts causes outrage, particularly among those whose ancestors were slaves and bought and sold while still alive. This is probably not as much an issue in Europe as the US. It is, however, something serious enough here that organ donation proponents have to be cautious about it.