Organ donation - presumed consent alternative

[Matty1973]

The UK is looking at ways to increase organ donation with presumed consent one option http://news.bbc.co.uk/1/hi/health/7729009.stm . ie opt out rather than opt in.

I have an alternative idea which is still based around the opt in system but it would give priority to people who need organs if they have opted in. Currently 8,000 are waiting for organs and only 3,000 are carried out each year. According to the article most people are in favour of donating organs but only 25% are registered. This would encourage those who don't have objections to register. This would also protect those who do have objections (Jehovah's Witnesses etc) from both giving and receiving them.

Exemptions could be made for under 18's and exceptional cases.

Should people who haven't opted in expect to get an organ in front of someone else who has? It seams fairer to me but are there any moral reasons against it?

 

[Ivor the Engineer]

<snip>

Should people who haven't opted in expect to get an organ in front of someone else who has?

Should homeless people who have given to homeless charities be prioritised over those that have not?

It seams fairer to me but are there any moral reasons against it?

See above. Once you start down the road of tit-for-tat, where does it stop?

According to people who know about such things, the number of donors in the UK can be increased by providing extra resources so that potential donors are not missed. Apparently it was not until this happened in Spain that the number of donors increased significantly, even though it had had presumed consent for about 10 years.

 

[Acleron]

Should people who haven't opted in expect to get an organ in front of someone else who has? It seams fairer to me but are there any moral reasons against it?

If there are any moral/cultural objections to donating organs then a simple opt-out system is available. The mainly religious groups who oppose this are trying to impose their will on those who actively want to donate or those who don't particularly care.

Ivor's point about tit-for-tat bartering is a good one. It could be extended to those who support medical charities. Do they get priority?

 

[Ivor the Engineer]

Here's the link for anyone in the UK reading who has not signed up yet:

http://www.uktransplant.org.uk/ukt/how_to_become_a_donor/how_to_become_a_donor.jsp

It's quick and simple.

 

[Ivor the Engineer]

If there are any moral/cultural objections to donating organs then a simple opt-out system is available. The mainly religious groups who oppose this are trying to impose their will on those who actively want to donate or those who don't particularly care.

<snip>

One of the interesting arguments I've heard against an opt-out system is many recipients may feel uneasy about receiving a donor organ if they are not certain it was given willingly.

My objection to opt-out is that the only difference in practice between it and an opt-in system is the extra coercion (via social norms) applied to relatives when being asked about donation.

IMO, the optimal solution is a sufficiently resourced opt-in system.

 

[Acleron]

One of the interesting arguments I've heard against an opt-out system is many recipients may feel uneasy about receiving a donor organ if they are not certain it was given willingly.

My objection to opt-out is that the only difference in practice between it and an opt-in system is the extra coercion (via social norms) applied to relatives when being asked about donation.

IMO, the optimal solution is a sufficiently resourced opt-in system.

It may depend on how easy it is to opt-out. If it's just carrying an easily obtainable signed card then there can be no real objection. Where there is a worry is that our overlords, the civil service, may want to tie this in with an ID card and all the baggage that carries. Then anyone who may feel the donation is coerced may be correct.

I'm interested in what extra resources are required for our present opt-in system.

 

[Soapy Sam]

I'm not in favour of an opt out scheme.
Call me a stick in the mud.
The desire to do potential good in this way to total strangers is laudable.
As soon as the heavy hand of Big Brother gets involved, the whole concept takes on an authoritarian flavour I personally find distasteful.
This may be irrational, but there it is.

 

[Ocelot]

There would ahve to be some sort of "length of service" factor or people might wait til they find out they need a kidney before signing up.

One fear people have is that by signing up for the register, the doctors may be eyeing up thier organs and not make the full effort to save your life they might have done otherwise. Of course that's nonsense, there's a great deal of separation between the trauma team and the team in need of donor organs however if mroe could be done to alleviate that fear we might get a more full register. Perhaps we could ensure that organ donor infomration should not be released unless death has already been declared.

 

[fls]

There would ahve to be some sort of "length of service" factor or people might wait til they find out they need a kidney before signing up.

One fear people have is that by signing up for the register, the doctors may be eyeing up thier organs and not make the full effort to save your life they might have done otherwise. Of course that's nonsense, there's a great deal of separation between the trauma team and the team in need of donor organs however if mroe could be done to alleviate that fear we might get a more full register. Perhaps we could ensure that organ donor infomration should not be released unless death has already been declared.

Or perhaps it could be pointed out that nobody is interested in your organs once your body is dead, serving as a strong incentive to keep you alive?

I've always wondered why any doctor should care whose body a particular set of organs is in? If those organs can save your life, why bother taking them out to save someone else's life?

Linda

 

[Ivor the Engineer]

It may depend on how easy it is to opt-out. If it's just carrying an easily obtainable signed card then there can be no real objection. Where there is a worry is that our overlords, the civil service, may want to tie this in with an ID card and all the baggage that carries. Then anyone who may feel the donation is coerced may be correct.

I'm interested in what extra resources are required for our present opt-in system.

Are you thinking of system similar to that in operation in Austria where the family has no say in the matter? If so, I don't think that type of system was ever under serious consideration for the UK. The relatives will always have the final say, so changing the default from opt-in to opt-out is unlikely to have much effect, as was discovered in Spain.

What is needed is more public awareness, more transplant coordinators and more doctors to be trained how to ask relatives about donation.

IMO the body belongs to those people who (most likely) cared about the person while they were living and it is their decision as to what happens to it (within reason).

 

[Professor Yaffle]

Or perhaps it could be pointed out that nobody is interested in your organs once your body is dead, serving as a strong incentive to keep you alive?

They might be after your corneas!

 

[Ivor the Engineer]

<snip>

I've always wondered why any doctor should care whose body a particular set of organs is in? If those organs can save your life, why bother taking them out to save someone else's life?

Linda

The fear (however irrational) is that "death" may be called (or even induced)earlier if you have a donor card, because the doctors have made a judgment on your likely chances of survival or quality of life, and decided more good can be done by putting those perfectly good kidneys in a couple of other people.

 

[fls]

They might be after your corneas!

Poo. They can take those at any time. Ever awoken in the bathtub in a strange hotel room with your clothes on inside-out and an inexplicable craving for pickled herring?

Linda

 

[fls]

The fear (however irrational) is that "death" may be called (or even induced)earlier if you have a donor card, because the doctors have made a judgment on your likely chances of survival or quality of life, and decided more good can be done by putting those perfectly good kidneys in a couple of other people.

But why would I care about some unknown stranger's quality of life if I don't care about the person in front of me? Alternatively, if I care about the person in front of me, why would that be superseded by consideration for some unknown stranger?

On the one hand, my sense of concern is so deep that I would risk revocation of my license to practice medicine in order to help a stranger, while at the same time my sense of concern is so shallow that I can't be bothered to make an effort to save the life of someone under my care when given the opportunity to do so?

Linda

 

[Ocelot]

There's always that old chesnut of a hypothetical dilema. Imagine a doctor treating a family of 6 brothers. Two have kidney disease and will die without a donor. One has liver disease and will die without a donor, one needs a heart lung transplant. Another is in deperate need of bone marrow. The sixth is perfectly healthy and has compatible tissue type to donate to his brothers. What would you think of this doctor if he killed the 6th brother to save the lives of the other 5?

 

[fls]

There's always that old chesnut of a hypothetical dilema. Imagine a doctor treating a family of 6 brothers. Two have kidney disease and will die without a donor. One has liver disease and will die without a donor, one needs a heart lung transplant. Another is in deperate need of bone marrow. The sixth is perfectly healthy and has compatible tissue type to donate to his brothers. What would you think of this doctor if he killed the 6th brother to save the lives of the other 5?

How would that be a dilemma? Are you suggesting that anyone would consider the possibility? Really?

ETA: Or maybe that's your point.

Linda

 

[Ivor the Engineer]

But why would I care about some unknown stranger's quality of life if I don't care about the person in front of me?

You walked through the dialysis ward on your way into work?

Alternatively, if I care about the person in front of me, why would that be superseded by consideration for some unknown stranger?

You may care so much that you couldn't possibly let the person in front of you suffer by keeping them alive.

On the one hand, my sense of concern is so deep that I would risk revocation of my license to practice medicine in order to help a stranger, while at the same time my sense of concern is so shallow that I can't be bothered to make an effort to save the life of someone under my care when given the opportunity to do so?

Linda

You may be operating under a utilitarian belief system. You estimate the standard of life the patient you are treating could expect if they survived and about the quality of life improvement his/her organs could provide to other people.

The fear is that the sum of the parts is greater than the whole.

 

[Ocelot]

How would that be a dilemma? Are you suggesting that anyone would consider the possibility? Really?

ETA: Or maybe that's your point.

Linda

Yeah it kinda is my point. With most of these ethical dillemas there's a presumed right choice and a presumed wrong choice. The fact that there's two uncomfortable choices is what makes it a dilema even if one is clearly far worse than another. The fact that the situation would never be considered si what makes it hypothetical.

The interesting part comes in trying to justify it. Take for example a simlar dilllema where someone is standing by the railway points and they see a runaway train hurling towards the points. The way the points are set the train is going to head down one track where it will kill five workmen. If he throws the switch the train will go down another path where it will kill a different workman. In this case most people will think that if the person is quick witted enough to trow the switch and sacrifice the one life thus saving the five then he made the right decision. But what's different with the latter scenario?

I'm not suggesting that we should sacrifice a person when their organs can save more than one life. The idea repells me but the point is I don't know why it repels me. perhaps because the harm such action would do to the perceived integrity of the medical proffession would end up causeing mroe harm in the long run. Perhaps because the runaway train is clealry urgent whereas we hold out hope that another donor might come along for the brothers.

 

[Matty1973]

Should homeless people who have given to homeless charities be prioritised over those that have not?

See above. Once you start down the road of tit-for-tat, where does it stop?

I agree with the logic there but I think the difference is that we are not all equal with ability to donate spare cash but we are equal with ability to donate organs.

 

[fls]

The UK is looking at ways to increase organ donation with presumed consent one option http://news.bbc.co.uk/1/hi/health/7729009.stm . ie opt out rather than opt in.

I have an alternative idea which is still based around the opt in system but it would give priority to people who need organs if they have opted in. Currently 8,000 are waiting for organs and only 3,000 are carried out each year. According to the article most people are in favour of donating organs but only 25% are registered. This would encourage those who don't have objections to register. This would also protect those who do have objections (Jehovah's Witnesses etc) from both giving and receiving them.

Exemptions could be made for under 18's and exceptional cases.

Should people who haven't opted in expect to get an organ in front of someone else who has? It seams fairer to me but are there any moral reasons against it?

This is a bad idea. It would be unethical to withhold lifesaving treatment from anyone, and I don't think you would find transplant physicians willing to go along with this. You are essentially saying that it is okay to allow someone to die if they are an ******* or lazy or irrational (oops, there goes the neighbourhood ). Also, from a practical point-of-view, it seems that outcomes are maximized if organs are allocated on the basis of need, and this process would interfere with that.

However, there is merit to the idea of raising awareness for the tit-for-tat nature of the process. Perhaps an incentive for those who are willing to donate would be in order. For example, under my health plan, if one member of our family signs up to donate blood (even if for some reason they cannot donate or their blood is not suitable to be given to another person), then we will not be charged for blood products if any of us requires a blood transfusion.

Linda