The Opt-Out Organ Donor System

[Admiral Valdemar]

Recent murmurings in Whitehall have led to the possible implementation of an opt-out system with respect to the way organs are allocated post mortem.

I don't normally get riled up and genuinely disgusted at people for expressing their opinion, however retarded, but I think an exception is in order here. On another forum, there was a thread on this very topic. I've made my thoughts known and considered, given the nature of the board, it was to be expected.

At work today, however, I heard the same sort of arguments about the sanctity of the body after you have ceased respiration, as if this rather useless principle needs to be upheld instead of acquiescing to the need for more organs to supply an always overstretched organ network.

Am I being obtuse here, or does this un-stoical behaviour deserve a second look? Is this the view of people elsewhere as well? I know everyone hates Gordon Brown, and I'm not too fond of the man either, though I can't see even the most vengeful Tory being this rabid for an attack on Brown, whatever the benefits of the proposal objectively.

Mind you, that means one of two things: Either people genuinely believe Gordon is so evil, they can leap on anything he says and put a negative spin on it, or they stand firm by their reasoning that, as a cadaver, they should be free to rot without doing good for the medical world.

I don't particularly like either.

[NoXion]

I don't understand how people can get so worked up about an "opt-out" organ donation system. If it really bothers them that much, they can opt out. If people don't opt out, then obviously they don't feel strongly or care enough about the issue to do so. Isn't that the whole point of an opt-out system?

An opt-out system just makes a whole lot more sense.

[Androsphinx]

People are just hugely and deep-rootedly irrational about this subject. You should not expect coherent argumentation on this subject. Also, thanks to years of scare stories, people are profoundly distrustful of the idea of giving your body to the government and not having half your organs taken for 1st-year medics to cut up.

Fortunately the Lib Dems seem to be onboard, so there shouldn't be any problem getting this through.

[Rye]

Getting a "worm's eye view" of the same subject on SB is pretty saddening and funny. The impression I get is that they are morbidly fearful of doctors and think that they will turn off your life support machine to give your kidneys to someone else, even someone they've never met. They also think that having more organs in circulation and more lives saved is actually less preferable than organs rotting in bodies because people can't be bothered getting donor cards, though they probably would donate.

[Melchior]

your body to the government and not having half your organs taken for 1st-year medics to cut up.

Frankly, I fail to see the problem with that: if the organs are not fit for transplant, the body can still be used to save lives through better teaching.
I'm a first year med student, and we have a critical shortage of body parts.

[SCRawl]

your body to the government and not having half your organs taken for 1st-year medics to cut up.

Frankly, I fail to see the problem with that: if the organs are not fit for transplant, the body can still be used to save lives through better teaching.
I'm a first year med student, and we have a critical shortage of body parts.

In the old days, didn't they just start digging corpses up in the middle of the night when their supplies started running dry? Or is that just some Robert Louis Stevenson echoing in my head?

More seriously, I can't imagine what an intelligent argument against an opt-out system would sound like. Maybe a bit like the sound of one hand clapping.

[Admiral Valdemar]

In the old days, didn't they just start digging corpses up in the middle of the night when their supplies started running dry? Or is that just some Robert Louis Stevenson echoing in my head?

More seriously, I can't imagine what an intelligent argument against an opt-out system would sound like. Maybe a bit like the sound of one hand clapping.

They didn't legally do that. The grave robbers of the 19th century were supplying the market in the same way a crack dealer does.

[SCRawl]

In the old days, didn't they just start digging corpses up in the middle of the night when their supplies started running dry? Or is that just some Robert Louis Stevenson echoing in my head?

More seriously, I can't imagine what an intelligent argument against an opt-out system would sound like. Maybe a bit like the sound of one hand clapping.

They didn't legally do that. The grave robbers of the 19th century were supplying the market in the same way a crack dealer does.

Yeah, I was making a wisecrack, without being terribly obvious about it. I'll try not to do it again.

[Androsphinx]

your body to the government and not having half your organs taken for 1st-year medics to cut up.

Frankly, I fail to see the problem with that: if the organs are not fit for transplant, the body can still be used to save lives through better teaching.
I'm a first year med student, and we have a critical shortage of body parts.

From a purely rational perspective you are probably correct. But as I said above, death and dead bodies are some of the most powerful, oldest and deeply-ingrained taboos we have. In order to persuade people to consent to this sort of thing, the arguments which have to be made are those which involve the life and death (or at least considerable quality of life) of other people. But compared with ten thousand years of cultural, religious and emotional exoerience, the convenience of students doesn't really cut it.

[Adrian Laguna]

ten thousand years of cultural, religious and emotional exoerience, the convenience of students doesn't really cut it.

Actually, it's probably biological. Being near corpses is not conductive to one's health, for numerous reasons.

[Androsphinx]

The jury, AFAIK, is still out on whether there's a direct biological element, as opposed to health-taboos and everything else mentioned above. It's certainly ingrained into our psyche, but I'm not sure about our genes. I seem to remember being told by a friend (sociology PhD) that there are a few cultures with no major death taboos.

[Broomstick]

Am I being obtuse here, or does this un-stoical behaviour deserve a second look? Is this the view of people elsewhere as well? I know everyone hates Gordon Brown, and I'm not too fond of the man either, though I can't see even the most vengeful Tory being this rabid for an attack on Brown, whatever the benefits of the proposal objectively.

Gordon Who? (Just kidding)

I see this topic come up periodically on a US board I frequent and see same/similar arguments, minus the political ones.

Without getting into what I personally believe, this is my off-the-cuff summary of objections:

- Some religions forbid cutting up the body after death and we need to respect religion.

- Rightly or wrongly, people are very emotional about dead bodies, particularly of loved ones. This sort of of "opt-out" system can cause great emotional distress and/or mental trauma to relatives and is thus damaging. The fact that organ donors don't look very dead because they are maintained artificially on machines and medications to keep their heart beating, lungs moving, and so forth makes this start to look more like vivesection than recycling.

- Arguably, your body is the only thing you really own. Because you own it, you have a right to dictate what occurs to it after your death just as you can dictate what is done to any other possession after your death, such as in a will. Yes, there are limitations - you couldn't, for example, insist on having your corpse left to rot on a table in a local restaurant - but the government's ability to interfere with what happens to your body after death is limited and should continue to be limited.

- Whether we want to admit it or not, viable human organs have a very real value. Under this argument, viable organs are assets. If you're a nice person you can choose to give these away, but forcing people to give them up (which the "opt-out" system is perceived by some people to be, even if it isn't in reality) you are seizing assets. There are people who argue that the relatives of donors should receive some sort of compensation for the donation in recognition that such organs have real value, and that that would increase donations significantly.

- Even if all potential organs were harvested, it still would not be nearly enough to save everyone waiting for an organ. We should be concentrating on prevention and other routes to repair/restore damaged organs.

- There is a belief out there that doctors already tend to "give up" early on people with donor cards so they can harvest their organs. An opt out system would only give further incentive for doctors to give up on patients who could be saved, particularly poor and minority patients, so others, presumably non-minority and rich, could be save from various diseases.

To reiterate - I am NOT saying I believe in any of the above, it is merely listing of arguments I have seen made against opt-out organ donation.

[Junghalli]

I'm totally in favor of an opt-out system. Like NoXion said, if you don't want to donate your organs, you can just opt out. What's the big deal?

It's just an unthinking emotional knee-jerk reaction to the idea of people cutting you open after you're dead, never mind if you have a problem with it you can avoid it. They need to get over it.

[Rye]

The dissenting arguments are peculiar, because most of them can be answered with "so opt out, then." "I don't want to go to the trouble of opting out" seems to be their main de facto position, and the fact that it would do a lot of good by supplying extra organs and tissues just sails straight by. It is not something that for the life of me I can fathom.

[CaptainChewbacca]

I totally support the opt-out system. I have been unable to get the sticker on my card, but my family knows that if I die I want to donate everything but my eyes (which are terrible and nobody wants) and my skin (for purely irrational reasons). I have no problem being buried full of sawdust.

Personally, I'm hoping I wake up in the body of a government-engineered super-soldier, but that's just me.

[Wyrm]

Anyone who feels that strongly about the sanctity of a body after death will write their local Organ Bank Office and ask for an opt-out. If you didn't and you then die with harvestable organs... well, you obviously didn't care enough about the matter to speak up. Onto the chopping block with you.

[Adrian Laguna]

There is a belief out there that doctors already tend to "give up" early on people with donor cards so they can harvest their organs. An opt out system would only give further incentive for doctors to give up on patients who could be saved, particularly poor and minority patients, so others, presumably non-minority and rich, could be save from various diseases.

I can understand the appeal of that argument. I'm registered as an organ donor, and every time that argument is mentioned I start getting real queasy. It's a horrible feeling, my extremities feel cold, I get shifty and uneasy, and my insides are all weird. There's something in the back of my head screaming at me to listen to it, just in case. I don't, because I trust that doctors will behave ethically, but it's still undeniably there.

[brianeyci]

The practical reason is doctors always acquiesce to the wishes of the family. Even the opt-in system we have now doesn't override the wishes of the family for disposal of the body after death. Signing a donor card does not guarantee your body would be donated. Chewbacca's parents could be dicks if they wanted and cremate his body after death, and the doctors would not fight the family. I'm sure the person could hire a lawyer and give him Power of Attorney or a Will that says do this with body regardless of family's wishes.

But in an opt-out system this is necessary anyway. You still must inform your family of what you want to do, and be on relatively good terms with them. Because doctors don't want to get into an endless stream of legal battles over dead bodies. The only time it isn't necessary is if the family of the deceased doesn't give a shit about the body at all, and you die.

Unless the opt-in system is radical in the way that doctors and the government cannot be sued by families who want to alter their relative's burial plans, opt-out is not guaranteed to be effective at all. Doctors will err on the side of caution and ask the family. Then the family will say, er, I don't know what he wanted because he never talked about it, and the doctor will cover his own ass and forget it, just like they do now.

[Zac Naloen]

There is a belief out there that doctors already tend to "give up" early on people with donor cards so they can harvest their organs. An opt out system would only give further incentive for doctors to give up on patients who could be saved, particularly poor and minority patients, so others, presumably non-minority and rich, could be save from various diseases.

I can understand the appeal of that argument. I'm registered as an organ donor, and every time that argument is mentioned I start getting real queasy. It's a horrible feeling, my extremities feel cold, I get shifty and uneasy, and my insides are all weird. There's something in the back of my head screaming at me to listen to it, just in case. I don't, because I trust that doctors will behave ethically, but it's still undeniably there.

The one problem with this argument is that now there will be a lot more organs in the system. There won't be the same sort of shortage we have now.

[Broomstick]

Actually, there probably WILL still be a severe shortage of organs. Even if every single organ suitable for donation was made available there would STILL be a shortage because you have be of a certain level of health and die in a certain manner in order to be an organ donor. Specifically, you need your brain destroyed and your body (largely) intact. That usually means death by accident. Although accidents are the leading cause of death in some demographic groups they are not the leading cause overall. Death by cancer or heart disease leaves your organs useless for donation. Even many accidents will leave you unsuitable to be a donor.

Which is not to say organ donation is useless, it certainly isn't, but it also won't sure everything either.

[Broomstick]

Anyone who feels that strongly about the sanctity of a body after death will write their local Organ Bank Office and ask for an opt-out. If you didn't and you then die with harvestable organs... well, you obviously didn't care enough about the matter to speak up. Onto the chopping block with you.

I think the concern with that point is also people who have no families - if you have no family and you opt out, what if your opt-out card is lost? What if the medical authorities "lose" the information or simply do not exert themselves to find it, justifying their actions as for the greater good? There is a concern with the person's wishes to opt out being ignored.

Obviously, the manner in which the system is set up will have an impact on whether or not that ever actually happens.

[Boyish-Tigerlilly]

I had this discussion on another forum once, and the general "consensus" on the forum is that everyone hates the idea. They either thought:

1. It's a violation of their sacred right to something (event though they still have a choice)

2. It's "unconstitutional." This simply ends the debate. There's seriously no discussion to be had once they trot this one out. It ends.

[Broomstick]

Well, since the specifics of this discussion are that it is in the UK the issues of "constitutional or not" do not apply.

[Boyish-Tigerlilly]

You are lucky, but you always come across people online on forums who assume everyone's American or really everyone follows the "Constitution" like it's holy writ.

They seem to have a bit more leeway and aren't boggled down in debate-ending statements.

There were a few UK people on the forum. The only ones I talked to dismissed the idea as bad because it violates their "choice." It made no sense, since they still have choice, technically.

[Molyneux]

I had this discussion on another forum once, and the general "consensus" on the forum is that everyone hates the idea. They either thought:

1. It's a violation of their sacred right to something (event though they still have a choice)

2. It's "unconstitutional." This simply ends the debate. There's seriously no discussion to be had once they trot this one out. It ends.

...the heck? Do they say what's unconstitutional about it?