Organ Donation After Execution

[Molyneux]

the death penalty simply isn't humane in the first place, that's why humane methods of execution are uncalled for.
It is only consistent that those people in favor of it resort to methods which are as cruel as they can get away with.

Strange, I'm in favour of the death penalty and strongly advocate the most humane way of execution possible.

I'm starting a death penalty for/against thread, if you two would like to hash it out there (since I didn't want to hijack the thread myself by getting into an argument).

[Alphawolf55]

For information :

In Soviet Gallia In France, you are automatically considered as an organ donor, unless you are registered on the "Registre National des Refus" (register of the peoples who don't want to give their organs after their death). That or unless your family / husband refuse, if you don't have your "Carte Nationale de Donneur d'Organe" (a card that specifically say : "I give my organs") to attest your will to give them.

That's pretty much the system i would like to see in Germany and other nations or enforced by UNIT
If you really object to organ donation, it should be your responsibility to declare it.

The question I would ask then, should people who decide to go on a "registre national des Refus" be put automatically on the back of the list for organ transplants unless given specifically to them by a relative or friend? I would say they should but I wonder how others feel.

[Broomstick]

Nope, I don't agree with it - punishing people for not donating their organs (which is, essentially, what you're getting at) starts to smack of coercion.

[Rabid]

It would go against the values of the French Republic (Liberty, Equality, Fratenity), not even speaking of basic human considerations. Plus, in France the National Commission on Bioethic would never permit it anyway (as they don't even allow assisted suicide, they won't condone state-sponsored murder). So... no, or at least not in my country.

[Alphawolf55]

Nope, I don't agree with it - punishing people for not donating their organs (which is, essentially, what you're getting at) starts to smack of coercion.

In a world without an organ shortage your point would be good but organs are an extremely limited resource and sadly someone has to get excluded for the time being. We already make hard choices on who gets to receive them and who doesn't thus having an existing rationing system. How is it fair that people who choose not to donate after they die and no longer need them, receive a limited resource from a system that they willingly choose to not add to?

Also do you believe in punishing people for not paying taxes, dodging jury duty or for draft dodging? Because if refusing society services unless the receiver gives something up in return (Even a token effort) is coercion then society is itself coercion since to be part of it, you are required to give up something, to receive things in return a lot of them necessary for survival.

[Broomstick]

Nope, I don't agree with it - punishing people for not donating their organs (which is, essentially, what you're getting at) starts to smack of coercion.

In a world without an organ shortage your point would be good but organs are an extremely limited resource and sadly someone has to get excluded for the time being. We already make hard choices on who gets to receive them and who doesn't thus having an existing rationing system. How is it fair that people who choose not to donate after they die and no longer need them, receive a limited resource from a system that they willingly choose to not add to?

First of all, as with every time this subject comes up, I get the impression that people somehow think that making such donation mandatory will solve the shortage problem. It won't. It won't, because the need is so great, and only a very, very few people die in such a manner that their organs are usable. MOST deaths do not allow for usable organs, and that's not going to change. There are countries now with opt-out programs, they still have organ shortages. Will this save a few more lives? Probably. But it won't solve the underlying problem.

Second, I know people here don't put much stock in belief systems different than theirs, but it does matter. There are people who object on religious grounds. There are people who are squicked out, who liken organ donation to cannibalism. And there are people who truly fear that if this was the case doctors would not save their life but rather butcher them while still alive for the benefit of others. You can poo-poo all you want, but these beliefs are real, as are the people who hold them. They aren't going to meekly comply, and eventually they'll ramp up to things that disrupt society. In other words, such a policy won't be without cost. There was recently an incident in Singapore where the family of someone brain dead staged a sit-in to attempt to prevent the organ harvest of their loved one. That was in Singapore, where people are pretty compliant with government, imagine what would happen in the US between the tinfoil-hat conspiracy nuts, the anti-government types, and American propensity to get violent.

In other words, there will be a societal cost to such a policy and I'm not convinced the benefits would outweigh the liability. That's on top of the administrative machinery you'd have to put in place to truly recover every possible organ in a nation that can't be arsed to even make sure children have easy access to vaccination. What other programs would be cut to pay for this, in the current atmosphere of the US? Nor will it solve the problem that if you're in need of an organ and don't have insurance here you'll still be shit out of luck, because in the US if you haven't a means to pay for such an operation AND the follow up care, which is life long, you don't get an organ transplant even if a matching organ is available. Under such circumstances, simply marginally increasing the organ supply isn't going to solve the problem(s).

Also do you believe in punishing people for not paying taxes, dodging jury duty or for draft dodging?

All very poor analogies. Failure to pay taxes or serve jury duty are not life-or-death matters, as organ donation is. The draft is an even poorer analogy, as, at least in the US (when we have had the draft) we DO have an opt-out policy called “conscientious objector”, nor have the draft ever required service of every person, such as your policy would require.

Because if refusing society services unless the receiver gives something up in return (Even a token effort) is coercion then society is itself coercion since to be part of it, you are required to give up something, to receive things in return a lot of them necessary for survival.

In the case of a US you're talking about a society that, hypothetically, will demand your very flesh and blood with NO guarantee that YOU will benefit even if you need it stay alive. Why should people be required to give up their organs under a system where only a minority will benefit? Why should people be required to surrender the bodies of the dead to save the lives of others when they themselves will be judged not worthy to live due to having less money and have no chance at available organs themselves?

It's not a matter of “Oh, go along with this and if you need a kidney you'll get one, when your turn comes up”. You're saying people should participate even though they will NEVER have a chance at a organ. You're harvesting their dead and they and their heirs will get nothing. In some cases, it might even cause mental distress with no benefit to the survivors left behind, who know that they themselves will never have chance at a needed organ due to poverty but have to let their loved one's body be (from their viewpoint) butchered just like a cow or pig.

Here in the US, your proposed system only benefits the well-off. The poor will simply be recycled to keep the rich alive. I mean, goddamn, at least with jury duty and the draft you get paid. If you pay taxes you gain benefits from government operations, be that a police force or working sewers or food stamps if you're really poor. What you propose would, in this country, be taking from the poor to serve the rich with zero benefit give to the poor.

Under such circumstances, no, I don't think compliance should be coerced. An opt-out system, sure, because despite the uneven distribution of organs many people are willing to do this to save someone else's life, but given that so many in the US will never get an organ, even if they need one, not for medical reasons but for social reasons, I think people should be able to opt out.

[Alphawolf55]

First of all, as with every time this subject comes up, I get the impression that people somehow think that making such donation mandatory will solve the shortage problem. It won't. It won't, because the need is so great, and only a very, very few people die in such a manner that their organs are usable. MOST deaths do not allow for usable organs, and that's not going to change. There are countries now with opt-out programs, they still have organ shortages. Will this save a few more lives? Probably. But it won't solve the underlying problem.

Never said this will solve the organ problem indefinitely, in fact I took great care not to. But this system wouldn't add just "a few more organs" but a great deal of them. I've seen estimation that 6-12,000 people a year aren't collected due to not being organ donors, when one considers that a single human body can help around up to 50 people each, it becomes not a small number

Second, I know people here don't put much stock in belief systems different than theirs, but it does matter. There are people who object on religious grounds. There are people who are squicked out, who liken organ donation to cannibalism. And there are people who truly fear that if this was the case doctors would not save their life but rather butcher them while still alive for the benefit of others. You can poo-poo all you want, but these beliefs are real, as are the people who hold them. They aren't going to meekly comply, and eventually they'll ramp up to things that disrupt society. In other words, such a policy won't be without cost. There was recently an incident in Singapore where the family of someone brain dead staged a sit-in to attempt to prevent the organ harvest of their loved one. That was in Singapore, where people are pretty compliant with government, imagine what would happen in the US between the tinfoil-hat conspiracy nuts, the anti-government types, and American propensity to get violent.

So because people are stupid we're suppose to let them off the hook? Additionally, I can see religious objection but most religions that don't allow to give organs also forbid receiving them. To be considered a conscious objector, one has to truly believe in the religious material of your text. If you're willing to follow the part that says "I can't give my organs out" but refuse to follow the part that says "I shouldn't receive them", then IMO you fail that litmus test. If you're willing to potentially take someone else's chance at living away from them due to your religion, you should be willing to give up your chance as well.

In other words, there will be a societal cost to such a policy and I'm not convinced the benefits would outweigh the liability. That's on top of the administrative machinery you'd have to put in place to truly recover every possible organ in a nation that can't be arsed to even make sure children have easy access to vaccination. What other programs would be cut to pay for this, in the current atmosphere of the US? Nor will it solve the problem that if you're in need of an organ and don't have insurance here you'll still be shit out of luck, because in the US if you haven't a means to pay for such an operation AND the follow up care, which is life long, you don't get an organ transplant even if a matching organ is available. Under such circumstances, simply marginally increasing the organ supply isn't going to solve the problem(s).

This is a completely different issue then you started out with and a complete red herring, since all you're arguing is why the idea is bad for one country, not the idea itself.

All very poor analogies. Failure to pay taxes or serve jury duty are not life-or-death matters, as organ donation is. The draft is an even poorer analogy, as, at least in the US (when we have had the draft) we DO have an opt-out policy called “conscientious objector”, nor have the draft ever required service of every person, such as your policy would require

You're right, you just go to jail where your freedoms are taken away and you receive inadequete care IF you refuse to pay taxes, to me that isn't much. It also doesn't change the fact that under your system it's a form coercion and like I pointed out, society itself is coercion, since to receive it's services you are required to participate and pay your dues in some way some of those services vital to survival.

In the case of a US you're talking about a society that, hypothetically, will demand your very flesh and blood with NO guarantee that YOU will benefit even if you need it stay alive. Why should people be required to give up their organs under a system where only a minority will benefit? Why should people be required to surrender the bodies of the dead to save the lives of others when they themselves will be judged not worthy to live due to having less money and have no chance at available organs themselves?

Oh come on you're making it sound way more dramatic then it actually is. One, they're organs that aren't used anymore, we're not talking about things that are actually used, it's not I'm proposing taking people's still beating heart or making blood donation required. Also you spend a lot of time focused on the US, this critique only works for the US, and if we had a single payer system like so many other countries it becomes null and void.

Edit: Wait a minute in fact even in the US, your objection doesn't even work and it seems your arguing a point that wasn't made. You originally argued that we shouldn't make it so people who refuse to donate are put at the end of the transplant list because it's coercion, but then you argue that they shouldn't be forced to donate because they lack health care. No one said they had to donate and if being part of the system offers no benefit cause they're poor, then how is not being part of the system going to hurt them? They were never going to receive help in the first place according to you.

[Broomstick]

First of all, as with every time this subject comes up, I get the impression that people somehow think that making such donation mandatory will solve the shortage problem. It won't. It won't, because the need is so great, and only a very, very few people die in such a manner that their organs are usable. MOST deaths do not allow for usable organs, and that's not going to change. There are countries now with opt-out programs, they still have organ shortages. Will this save a few more lives? Probably. But it won't solve the underlying problem.

Never said this will solve the organ problem indefinitely, in fact I took great care not to. But this system wouldn't add just "a few more organs" but a great deal of them. I've seen estimation that 6-12,000 people a year aren't collected due to not being organ donors, when one considers that a single human body can help around up to 50 people each, it becomes not a small number

I used to work down the hall from the transplant coordinators at Blue Cross. I think the greatest number of multiple used organs to come from one person was eight. EIGHT. Not fifty. That 50 might be theoretical but it's wildly inflated compared to actual reality. That's because we can't save most organs for any length of time. If you can't use a liver within X number of hours it's useless biological waste. The odds of 50 people who are a match needing bits of a body AND being within reasonable transport distance is so close to zero you might as well say it's impossible.

Sure, you can collect bits, but can you use them? There is no point going to the trouble and expense of harvesting an organ unless you can definitely use it. Now, for corneas and skin and bone we can preserve and store the tissues, but what those are used for aren't necessarily life-or-death circumstances. Unquestionably, a cornea transplant that restores sight is worthwhile, but going without won't kill you. You'll just have to wait a bit longer. Average wait these days is two weeks, so clearly if there's a shortage in that category it's not that big of one.

So because people are stupid we're suppose to let them off the hook?

The majority of human beings ARE stupid. You will have to deal with that rather than handwave it away if you're seriously discussing this rather than keeping it as idle speculation.

Additionally, I can see religious objection but most religions that don't allow to give organs also forbid receiving them.

You are assuming religion is rationale. It's not.

To be considered a conscious objector, one has to truly believe in the religious material of your text.

One does not have to be religious to be a conscientious objector, although it's easier to establish that status if you're a member of a group like the Quakers or the Amish. It is possible to be an atheist conscientious objector, though proving it might be difficult.

This is a completely different issue then you started out with and a complete red herring, since all you're arguing is why the idea is bad for one country, not the idea itself.

Nope, not a red herring. It's one reason I am opposed to such a system, as I am obliged to live in just such a country. Are you saying a nation of 300 million is irrelevant? Nor is the US the only nation that shafts the poor in this regard - both India and China have health "systems" closer to what the US has than what Europe has. That's... what? Around 2 billion people living in nations that don't have universal coverage and don't help the poor obtain organ transplants. If you're poor, you die. If you're rich, you can get new organs. I object to money being the primary determinant of who is worth saving and who isn't.

All very poor analogies. Failure to pay taxes or serve jury duty are not life-or-death matters, as organ donation is. The draft is an even poorer analogy, as, at least in the US (when we have had the draft) we DO have an opt-out policy called “conscientious objector”, nor have the draft ever required service of every person, such as your policy would require

You're right, you just go to jail where your freedoms are taken away and you receive inadequete care IF you refuse to pay taxes, to me that isn't much.

You are incorrect. The US Supreme Court has stated that it is required that prison systems provide any medically needed health care to prisoners and that includes organ transplants. So, currently, if I needed, say, a new liver I'd be far more likely to get one if I committed a crime and was sentenced to many years in prison than if I remained a law-abiding citizen. If I'm in prison the government has to give me whatever health care I need. If I'm not, then the health "systems" are free to deny me a needed organ and leave me to die.

I really don't think this is a good system.

Also you spend a lot of time focused on the US, this critique only works for the US, and if we had a single payer system like so many other countries it becomes null and void.

As I said - this would also apply to India and China.

Wait a minute in fact even in the US, your objection doesn't even work and it seems your arguing a point that wasn't made. You originally argued that we shouldn't make it so people who refuse to donate are put at the end of the transplant list because it's coercion, but then you argue that they shouldn't be forced to donate because they lack health care. No one said they had to donate and if being part of the system offers no benefit cause they're poor, then how is not being part of the system going to hurt them? They were never going to receive help in the first place according to you.

Why should anyone participate at all, since, even if you agree to donate, if you're poor you will NEVER have a chance at an organ, ever. You just won't be on the list at all, period. Even IF they had an organ to match your need, even IF you were first on the list medically in the US if you don't have the money you will NOT get the organ. Period. So why contribute at all to a system that will only take and never give back? Why should I let you butcher the body of a loved one, to distribute the parts to other people who, frankly, don't give enough of a fuck about me and mine to vote in health care for all? For many people, autopsies and organ donations ARE distressing, so why would the agree to that distress when there is no chance of any benefit to them whatsoever? It's not a matter of trading some distress now for the possibility of help later, for all too many there will never be the chance to benefit.

So... no chance of benefit, but definite mental distress. I don't see where hurting other people - even emotionally or mentally as opposed to physically - to benefit others is ethical. Let them opt out without penalty if they want, without putting their name "last on the list" or whatever punitive mark or scarlet letter you want on their record because the intent there is not to distribute organs to those who need them most but to pass moral judgment on others. Sure, lots of people do feel better knowing that from the death of their loved one came something that did save someone else's life, but that's not a universal sentiment, especially if they realize there's not a chance in hell they'd ever benefit from the so-called system.

Nope, can't go for it, not unless there are a LOT of other changes first. I like to think that if enough people opted out the rulers would get a clue, but I'm too cynical to believe that. A lot of the resistance to organ donation does boil down to actual, real concerns - concerns that doctors won't work hard enough to save a life if organs could be harvested, concerns that the rich will plunder the bodies of the poor, concerns that even if you give into the system you will never be able to benefit. If more work was done to deal with those fears there would be far less resistance and less need for coercion.

[Alphawolf55]

I used to work down the hall from the transplant coordinators at Blue Cross. I think the greatest number of multiple used organs to come from one person was eight. EIGHT. Not fifty. That 50 might be theoretical but it's wildly inflated compared to actual reality. That's because we can't save most organs for any length of time. If you can't use a liver within X number of hours it's useless biological waste. The odds of 50 people who are a match needing bits of a body AND being within reasonable transport distance is so close to zero you might as well say it's impossible.

Can you provide some kind of citation for this? I'm not saying you're lying and not denying 50 is theoretical, but I'd rather go with what the organ donation sites consistently say then he-said, she said.

The majority of human beings ARE stupid. You will have to deal with that rather than handwave it away if you're seriously discussing this rather than keeping it as idle speculation.

Doesn't mean we bend over backwards for them.

You are assuming religion is rationale. It's not.

So that invalidates my entire point? "Oh religion is irrational thus members can use it to benefit themselves if they want but not have to live by the restrictions". Additionally even the religious objection is minor, there are very few actual religions which point blank don't allow organ donations even Islamic leaders are changing their minds about it.

Nope, not a red herring. It's one reason I am opposed to such a system, as I am obliged to live in just such a country. Are you saying a nation of 300 million is irrelevant? Nor is the US the only nation that shafts the poor in this regard - both India and China have health "systems" closer to what the US has than what Europe has. That's... what? Around 2 billion people living in nations that don't have universal coverage and don't help the poor obtain organ transplants. If you're poor, you die. If you're rich, you can get new organs. I object to money being the primary determinant of who is worth saving and who isn't.

And yet none of that negates the idea itself, it just means the system would have to go along with a single payer healthcare system.

"Why should anyone participate at all, since, even if you agree to donate, if you're poor you will NEVER have a chance at an organ, ever. You just won't be on the list at all, period. Even IF they had an organ to match your need, even IF you were first on the list medically in the US if you don't have the money you will NOT get the organ. Period. So why contribute at all to a system that will only take and never give back? Why should I let you butcher the body of a loved one, to distribute the parts to other people who, frankly, don't give enough of a fuck about me and mine to vote in health care for all? For many people, autopsies and organ donations ARE distressing, so why would the agree to that distress when there is no chance of any benefit to them whatsoever? It's not a matter of trading some distress now for the possibility of help later, for all too many there will never be the chance to benefit."

Because you can help someone? Also your argument still doesn't make sense. If you feel that you shouldn't donate because your organs will go to fat cats who don't care about you, take yourself off the list. Sure you bar yourself from receiving organs in the future, but you weren't going to get them either way so you're no worse for wear. Your objection only works if we're talking about forced donation.

So... no chance of benefit, but definite mental distress. I don't see where hurting other people - even emotionally or mentally as opposed to physically - to benefit others is ethical. Let them opt out without penalty if they want, without putting their name "last on the list" or whatever punitive mark or scarlet letter you want on their record because the intent there is not to distribute organs to those who need them most but to pass moral judgment on others. Sure, lots of people do feel better knowing that from the death of their loved one came something that did save someone else's life, but that's not a universal sentiment, especially if they realize there's not a chance in hell they'd ever benefit from the so-called system.

So if there's no chance of benefit, whats the harm in disallowing them if they opt out? Also you act like people will cut up the organs in front of their family and taunt them to their face.

Also "the intent to pass moral judgment not to distribute organs" wtf, no one has even implied that. If someone says "I propose that organ donations become an opt out system rather then opt in and those who opt out should go to the back of the list for random donations due to reasons of fairness and to encourage people not to opt out" you can't just pretend there's some insidious REAL reason to propose the system.

Nope, can't go for it, not unless there are a LOT of other changes first. I like to think that if enough people opted out the rulers would get a clue, but I'm too cynical to believe that. A lot of the resistance to organ donation does boil down to actual, real concerns - concerns that doctors won't work hard enough to save a life if organs could be harvested, concerns that the rich will plunder the bodies of the poor, concerns that even if you give into the system you will never be able to benefit. If more work was done to deal with those fears there would be far less resistance and less need for coercion

Most of those concerns aren't reasonable. "Doctors won't work hard enough to save a life"? Completely different doctors handle that shit in the US. "The rich will plunder the bodies of the poor", not how organ donation works (you make it sound like grave robbing).

Hell it sounds like all your concern is just that not everyone benefits in the current system which is easily changable. So how would your objections work for say Canada or France?

[Broomstick]

I used to work down the hall from the transplant coordinators at Blue Cross. I think the greatest number of multiple used organs to come from one person was eight. EIGHT. Not fifty. That 50 might be theoretical but it's wildly inflated compared to actual reality. That's because we can't save most organs for any length of time. If you can't use a liver within X number of hours it's useless biological waste. The odds of 50 people who are a match needing bits of a body AND being within reasonable transport distance is so close to zero you might as well say it's impossible.

Can you provide some kind of citation for this? I'm not saying you're lying and not denying 50 is theoretical, but I'd rather go with what the organ donation sites consistently say then he-said, she said.

No, I can't, because I am bound by confidentiality agreements. I will not break the law to win an internet argument. I have tried to find publicly available sources but without much success, more's the pity, because I think the average person doesn't know as much about organ transplants as they should, both the good and the bad.

The organ donation sites will always state it as "could" help "up to" 50 people because, to the best of my knowledge, there has NEVER been an instance where an actual donation actually helped half that number. The problems involved with tissue typing and the logistics involved in getting organs/tissues to recipients interferes with perfect usage and, until we achieve teleportation, the transportation problem will always be there.

That 50 number is, I am assuming, also including "exotic" transplants like thymus (which would require a pre-pubescent donor, as past puberty it pretty much atrophies to nothing) and intestinal transplants (seldom done due to the complexity of the operation and limited number of people likely to benefit). So if, hypothetically, I became available for harvesting tomorrow there wouldn't be a thymus gland to speak of, and it would be very unlikely anyone within reasonable transport distance would even be waiting for a small intestine. Pretty unlikely anyone who's a match would be waiting on a face or hands, either, as those are still quite rare. Generally, they only harvest what is actually needed in the area, so if, say, your lungs aren't a match for anyone they won't bother to take them, they'll just be buried or cremated or whatever with the rest of you. It's not that the organs aren't suitable, it's that there's no one who can use them.

Really, some breakthroughs in preserving organs and tissues would likely do much more to relieve the shortages than pressuring yet more people to bring out their dead. If we could actually harvest everything from a donated carcass and then put what we don't immediately need on ice for even a few months (a few years would be even better!) we could utilize much more than we do now, and transportation will become much less of an issue. Of course, right now that's a pipe dream for major organs though some things like blood and bone can be preserved for awhile.

The majority of human beings ARE stupid. You will have to deal with that rather than handwave it away if you're seriously discussing this rather than keeping it as idle speculation.

Doesn't mean we bend over backwards for them.

Doesn't mean we ignore them and/or treat them as cattle, either.

You are assuming religion is rationale. It's not.

So that invalidates my entire point? "Oh religion is irrational thus members can use it to benefit themselves if they want but not have to live by the restrictions". Additionally even the religious objection is minor, there are very few actual religions which point blank don't allow organ donations even Islamic leaders are changing their minds about it.

I actually think it's Buddhism that's the current biggest problem - there's no bar to accepting organs, as far as I know, but it doesn't recognize brain death so under Buddhist rules you have to wait until the heart stops beating - at which point the heart is useless, and so are most of the other major organs. I think they can salvage kidneys from that, but even then, it results in an inferior organ for transplant. Better than nothing, but with less chance of success.

And it's fine to say religion is superstitious and nonsense and all that, but the majority of the human race still takes it very seriously indeed, to the point quite a few people are willing to kill or die over it. Unleashing that sort of irrationality is not going to yield good results.

Nope, not a red herring. It's one reason I am opposed to such a system, as I am obliged to live in just such a country. Are you saying a nation of 300 million is irrelevant? Nor is the US the only nation that shafts the poor in this regard - both India and China have health "systems" closer to what the US has than what Europe has. That's... what? Around 2 billion people living in nations that don't have universal coverage and don't help the poor obtain organ transplants. If you're poor, you die. If you're rich, you can get new organs. I object to money being the primary determinant of who is worth saving and who isn't.

And yet none of that negates the idea itself, it just means the system would have to go along with a single payer healthcare system.

That's just one of the minimum conditions required.

"Why should anyone participate at all, since, even if you agree to donate, if you're poor you will NEVER have a chance at an organ, ever. You just won't be on the list at all, period. Even IF they had an organ to match your need, even IF you were first on the list medically in the US if you don't have the money you will NOT get the organ. Period. So why contribute at all to a system that will only take and never give back? Why should I let you butcher the body of a loved one, to distribute the parts to other people who, frankly, don't give enough of a fuck about me and mine to vote in health care for all? For many people, autopsies and organ donations ARE distressing, so why would the agree to that distress when there is no chance of any benefit to them whatsoever? It's not a matter of trading some distress now for the possibility of help later, for all too many there will never be the chance to benefit."

Because you can help someone?

So?

Yes, I'm being difficult here, but really, while you or I might help someone out of the goodness of our hearts there are plenty of other people who don't give a fuck about other people and absolutely have no motive to participate if there isn't something in it for them. And why shouldn't the estate of the deceased be compensated for the organs and tissues, which unquestionably have real value?

Oddly enough, I'm participating in a similar thread on another message board right now, and one of the suggestions was that the compulsory donation not be limited to mere organ donation. After all, even someone unsuitable for organ donation could be very useful for gross anatomy classes for doctors in training. Surgeons occasionally use cadavers to develop new techniques. The auto industry uses cadavers in some sorts of crash testing (not something extensively advertised, needless to say). People with various conditions and diseases might have parts of interest to researchers. All of those uses could have a "saving lives" payoff, even if not as directly.

So... how about this idea (assuming a perfect society with single-payer health, rational decision making in the medical sector, and other ideal conditions):
1) At death - regardless of manner of death and condition of the body - the deceased is a presumed available corpse (I'm not going to say "donor" since that implies volunteering, and what we're looking at here is more compulsory) unless there is an opt-out document on record. If there is, the heirs have the option to over-rule and donate (that would be a donation in that case), but if the individual hasn't opted out they can't refuse to hand over the body. "Opt-out" would also include being able to opt out of certain uses, so if someone was willing to be an organ donor but not a crash test dummy they could state that - but they would have to make the preference known in advance, in a legal document of some sort.
2) Some sort of medically trained person (doesn't have to be a doctor in many instances, but they'll need to know when to call in a doctor, obviously) or committee assesses the deceased and determines possible uses. This would be after a doctor has declared the person dead, of course.
3a) If the body is not usable at all there would still be base sum (a token amount, but still there) given to the estate of the deceased which can be used for "final expenses" like funeral, cremation, whatever. This would serve to discourage opt-outs, and act as an incentive for heirs to consider over-ruling opt outs.
3b) If the body is usable, a greater sum would go to the estate which, again, could be used for "final expenses" (but not body disposal - see below) or memorial service or distributed among heirs or whatever. It could be either a flat fee, or it could scale according to use so, for example, if you could use 5 organs from someone their estate might get more than someone who was useful chiefly for instructing medical students in anatomy.
4) After the body has been used for whatever purpose, either those doing research, or the health system or the state (whatever is appropriate) will pay for the body's disposal, be that cremation or burial (in the US, most research agencies will cremate the remains and either return them to the family or will have some sort of arrangement for a final resting place, so this isn't really that different)

Now, as for what the bodies are used for - in the case of organs they decision as to who gets them should be based entirely on medical criteria. That's it. Even those who are not contributing organs ARE presumably helping to support the system via things like tax money. Yes, it's a little selfish, but after a few generations such selfishness will be held in contempt if this system becomes the norm. Refusniks, honestly, are going to be outliers and if society is harvesting as much as it can otherwise they will not be a significant issue.

Also your argument still doesn't make sense. If you feel that you shouldn't donate because your organs will go to fat cats who don't care about you, take yourself off the list. Sure you bar yourself from receiving organs in the future, but you weren't going to get them either way so you're no worse for wear. Your objection only works if we're talking about forced donation.

A system of presumed consent IS a form of forced donation. It's not comparable to gathering organs at gunpoint, but it can no longer be described as entirely voluntary, either.

Nope, can't go for it, not unless there are a LOT of other changes first. I like to think that if enough people opted out the rulers would get a clue, but I'm too cynical to believe that. A lot of the resistance to organ donation does boil down to actual, real concerns - concerns that doctors won't work hard enough to save a life if organs could be harvested, concerns that the rich will plunder the bodies of the poor, concerns that even if you give into the system you will never be able to benefit. If more work was done to deal with those fears there would be far less resistance and less need for coercion

Most of those concerns aren't reasonable. "Doctors won't work hard enough to save a life"? Completely different doctors handle that shit in the US.

Nonetheless this is a very real and very present fear among the poor and minorities in the US right now. It's a little baseless in fact, as race DOES, in fact, matter in organ transplants to some degree. While some organs from black people have gone to white people, the odds are that another black person is far, far more likely to be a match than another white person. And vice versa. Regardless, it's still a very real fear. It still makes some families reluctant to consent to donation. Given the history of medical experimentation and exploitation in the US it can't even be called a baseless fear as shit very much like that HAS happened in the past.

Unfortunately I can't provide you with particular cites as my sister's medical ethics books are in Buffalo, New York and I'm here in Indiana, but every single one of them brings up this issue. There are many groups in the US who simply do not trust doctors to have their best interests in mind, who do not trust doctors to treat them equally, who do not trust doctors to avoid exploiting them. The Tuskegee Syphilis experiment is probably the most well known example of doctors treating minorities and the poor as expendable, but there are others.

"The rich will plunder the bodies of the poor", not how organ donation works (you make it sound like grave robbing).

Worse than that, actually - there are a lot of poor people in India who sold a kidney and did not receive all the money they were promised, who suffered complications and yet had no access to follow up care... quite ugly business, really. Absolutely, there are some people with money who will buy the organs they need and not ask too many questions. This happens today, if not necessarily in the US.

Hell it sounds like all your concern is just that not everyone benefits in the current system which is easily changable. So how would your objections work for say Canada or France?

I think opt-out systems are more ethically sound in places with single-payer like, as you suggest, Canada or France. Or Germany or the UK.