Organ donation - presumed consent alternative

[Ivor the Engineer]

I have a couple of technical questions.

What does brain death mean?

What order are the organs removed?

ETA: Some interesting changes in the UK with respect to when organ donation can start:

http://www.timesonline.co.uk/tol/life_and_style/health/article4232319.ece

The government is to allow organs to be taken from people before they are officially brain dead in an effort to tackle the shortage of transplant donors.

Guidelines being published in September will allow transplant surgeons to begin removing organs five minutes after a donor’s heart has stopped.

The move has raised concerns about the drive to harvest more organs from dying patients to meet a government target to increase transplant rates by 50% in the next five years.

The new code of practice for diagnosis and confirmation of death, produced on behalf of the health department, is the first set of rules in Britain to provide clinicians with such instructions.

It will give doctors permission to forgo a complex set of tests to establish brain stem death, which can take 20 minutes. The delay means that unless a donor is on life-support, their organs tend to be too badly damaged by oxygen starvation to be used.

...

David Evans, a retired consultant anaesthetist who has long expressed doubts about the methods of defining death for organ donation purposes, said: “No one of scientific mind really believes you can diagnose death in these simplistic ways. By rushing to retrieve organs we are depriving ourselves of the simplest tool to diagnose death, which is the passage of time.”

Doctors in Paris recently reported that a 45-year-old heart attack victim had begun breathing again as surgeons prepared to retrieve his organs.

Last year in Frederick, Oklahoma, Zack Dunlap, 21, was declared dead after a quad-biking accident. Two cousins who were nurses had arrived as a transplant team was landing by helicopter and found he reacted to having his feet and hands touched. He has since made a full recovery.

Peter Simpson, former president of the Royal College of Anaesthetists who led the working party behind the new code, said he was confident such disasters would not occur in the UK.

Yes, they will occur.

 

[Cainkane1]

I may donate my kidney. The one with the stones in it.

 

[Soapy Sam]

Linda
you make sense as usual. I'm a bit baffled by this line though-

If it was made that easy to marry someone of the same sex, we'd all be dancing in the streets.

I guess that wasn't fair, since you did admit that it was irrational and petty.

No problem , but I have no idea what that line about same sex marriage means. (Actually, I think it should be made rather harder to marry anyone of any sex, to stop people doing it till they are actually ready.)

 

[fls]

No problem , but I have no idea what that line about same sex marriage means. (Actually, I think it should be made rather harder to marry anyone of any sex, to stop people doing it till they are actually ready.)

I'm sorry. It's an example of the government interfering in my life in a way that does prevent me from exercising my choice. Right now, the government will not extend the usual protection to my choice of life partner if that person is the same sex as me. If all it took to obtain that protection (in addition to the usual barriers to marriage) was for me to register my intent or for me to tell my closest family member of my intent, I think it would be considered a satisfactory solution to all those people who are fighting against this particular discrimination.

Linda

 

[Cuddles]

government intervention in my life

See, this is the part that I really don't understand, for several reasons. Firstly, I don't understand why some people are so rabidly against government involvement in pretty much anything. However, that's really a debate for a different thread. Secondly, the whole point of organ donation is that you're dead. No matter how much you object to governement intervention in your life, that is nothing to do with organ donation which, by definition, doesn't involve your life.

Finally, as already explained by Linda, there is no government intervention involved here anyway. The only difference between opt-in and opt-out is the assumption that is made if you don't tell anyone your preference. At no point does anyone tell you what you can or can't do, it's simply a change in the default practice if you haven't told anyone what you want and there is no-one around to ask. I really can't understand how anyone could have a problem with that at all, and the idea that you'd have such a big problem with it that you'd deliberately change your choice just to spite them seems utterly bizzare.

 

[Professor Yaffle]

And you wouldn't be spiting anyone except perhaps a person who dies because they couldn't get an organ in time and yours was suitable.

 

[Soapy Sam]

See, this is the part that I really don't understand, for several reasons. Firstly, I don't understand why some people are so rabidly against government involvement in pretty much anything. However, that's really a debate for a different thread. Secondly, the whole point of organ donation is that you're dead. No matter how much you object to governement intervention in your life, that is nothing to do with organ donation which, by definition, doesn't involve your life.

Finally, as already explained by Linda, there is no government intervention involved here anyway. The only difference between opt-in and opt-out is the assumption that is made if you don't tell anyone your preference. At no point does anyone tell you what you can or can't do, it's simply a change in the default practice if you haven't told anyone what you want and there is no-one around to ask. I really can't understand how anyone could have a problem with that at all, and the idea that you'd have such a big problem with it that you'd deliberately change your choice just to spite them seems utterly bizzare.

First, I have already accepted that my response is irrational. I disagree that it's utterly bizarre- indeed it seems to be shared to a considerable degree by at least 2 other posters in this thread, so it can't be that unusual.

I'm not ( I think) rabidly opposed to gummint involvement in anything.
I object to it in areas I consider inappropriate- of which I feel this is one. I don't think they should have any part at all in my decision regarding what happens to my corpse. That (IMHO) is a personal decision.
I'm aware of the difference between "In by default" and " compulsory" and find the distinction irrelevant to the discussion. My opinion is that government simply has no right at all to be involved in such decisions.
As happens, I don't much care what happens to my corpse and have no objection whatever to anyone helping themselves to bits they deem useful. (My liver & kidneys may be fine- personally I wouldn't will most of the rest to my worst enemy)
Point is, I'm not dead yet. If a doctor sees my corpse and decides he has a use for it, fine. No skin off my nose. (Sorry). If , on the other hand Gordon Brown thinks he can consider me as a potential organ bank NOW, then he can damn well pay for the priviledge. 5% off my income tax would be acceptable. The sign up rate would be near 100%.

And you wouldn't be spiting anyone except perhaps a person who dies because they couldn't get an organ in time and yours was suitable.

I don't buy that. There are people out there right this minute who are broke. My money would do them nicely. Am I "spiting" them by keeping it?
Let me repeat, my objection is not to organ donation, but to the government's assumption of a right to decide something which is simply outwith their competence.

 

[EHocking]

See, this is the part that I really don't understand, for several reasons. Firstly, I don't understand why some people are so rabidly against government involvement in pretty much anything.

For me it is a personal thing so perhaps less than objective - having the gov interfere directly with how I wish to live my life, of a similar nature to fls' example.

However, that's really a debate for a different thread.

No it isn't, and this is what has been annoying me since I started participating on this thread.

The debate is not, as is being derailed at the moment, about the worth of organ donation, the OP is about presumed consent.

That is, government proposing to change legislation that already protects an individual's interest wrt organ donation.
My objection is firstly that I have yet to see a valid argument for increasing a government's rights over decision on my private life, the second is that I'm deeply suspicious of the current government's agenda on building databases of personal information, and lastly, I'm peeved that Gordon Brown used the "think of the children" appeal to emotions.

The two scenarios I can see for using such a tactics is a cynical attempt to portray the PM in a caring light, or a cynical attempt to divert attention from the actual matter at hand - which is changing a legislation that currently protects an individuals preference on what they'd like or not like to be done to their body after death.

Finally, as already explained by Linda, there is no government intervention involved here anyway. The only difference between opt-in and opt-out is the assumption that is made if you don't tell anyone your preference. At no point does anyone tell you what you can or can't do, it's simply a change in the default practice if you haven't told anyone what you want and there is no-one around to ask. I really can't understand how anyone could have a problem with that at all, and the idea that you'd have such a big problem with it that you'd deliberately change your choice just to spite them seems utterly bizzare.

Again - Gordon Brown's "think of the children" argument is again clouding the real issue here.

The only way to bring in the opt-out system is to change the current legislation that protects an individuals rights and that of their family after death.

The Taskforce that was put in place to review organ donation schemes for the UK stated as much, so it's not just me being paranoid, e.g.
"Furthermore, any move away from a system relying on expressed consent

must be shown to be a justifiable exception to the current ethical norms." (my emphasis).​

THe subect of this thread is not about whether organ donation is good, but about the changes to the legislation and the potential creeping totalitarianism that the current government seems to be steering towards.​

It does seem to me that there are other agenda and that this particular emotional appeal by Brown makes me more suspicious that there are hidden agenda to changing such legislation, especially in light of the fact that Brown himself, when debating reviews of the Human Tissue Act in 2004 shares the same stance as myself and (at least) two other posters here. Reportedly Brown, during that debate, argued presumed consent on organ donation, "...on the basis that there was no public support, adding what happens to people's bodies after death should not be determined by the state.".​

​

​

 

[Cuddles]

Point is, I'm not dead yet. If a doctor sees my corpse and decides he has a use for it, fine. No skin off my nose. (Sorry).

See, this is the bit I don't get. That's exactly what an opt-in system would do - if you are a corpse and a doctor can use it, then they will be allowed to unless you, or your family, has told them not to. No-one wants to do anything with your body while you are using it, the question of opt-in or opt-out only applies once you've stopped using it. As far as I can tell, you're perfectly happy with an opt-in system as long as they don't actually tell you that there is an opt-in system.

I don't buy that. There are people out there right this minute who are broke. My money would do them nicely. Am I "spiting" them by keeping it?

Which is exactly the same point as above. In fact, this is a brilliant anaolgy since we already have an opt-out system for money. No-one is trying to take your money while you are using it. However, if you die, you have not left instructions on what to do with it and there are no relatives or other designated person for it to go to, then it does go to the government, or whoever the appropriate authority is. The only real difference between money and a corpse is that only close relatives tend to want corpses, while pretty much anyone is happy to be given money.

The debate is not, as is being derailed at the moment, about the worth of organ donation, the OP is about presumed consent.

And as has already been explained several times, this has exactly nothing to do with government interference in daily life or "creeping totalitarianism" as you put it. I'll say this once more - the government is already involved intimately, but they do not force you to do anything and are not planning on changing that. The only thing being discussed here is what would happen if you don't make a choice and there is no-one else to ask. That's it. The government isn't trying to get involved in an area it wasn't previously, and it isn't trying to tell anyone what to do. I do find it very amusing that you accuse others of clouding the issue, when it is you who keeps trying to being irrelevant nonsense into it.

I'll put this as simply as I can. Firstly, organ donation cannot be government interference in your life because, by definition, it doesn't involve anyone's life. Secondly, the government is already involved with what can and can't be done with corpses, so opposing change on the grounds of government involvement is just plain ridiculous. If you're so opposed to government involvement with corpses, you should be demanding the government stop being involved, not just whinging that they want to make a small change to one assumption in their involvement.

 

[Stitch]

Point is, I'm not dead yet. If a doctor sees my corpse and decides he has a use for it, fine. No skin off my nose. (Sorry).

See, this is the bit I don't get. That's exactly what an opt-in system would do - if you are a corpse and a doctor can use it, then they will be allowed to unless you, or your family, has told them not to. No-one wants to do anything with your body while you are using it, the question of opt-in or opt-out only applies once you've stopped using it. As far as I can tell, you're perfectly happy with an opt-in system as long as they don't actually tell you that there is an opt-in system.

At the moment I am opted in, by my own choice as I believe Soapy Sam is or at least was. The point is we don't want the government making assumptions about things we don't believe they should be interfering in. If they make the assumption I am in, then I'll take myself out.

 

[Ocelot]

Lets be provocative for a moment...

Isn't it funny how when people bang on about rights it's so often their own rights.

Isn't it strange how people who call a change of rules "government interference," don't tend notice that if there's a rule to be changed the government is already involved.

I'm opted in. Have been for a long time. My family know my wishes. I needed to do this because the government already involves itself in the so called private life of it's citizens. It acts against the rights of doctors to make good use of dead meat that has no other purpose. It interferes with the rights of the sick and infirm to receive the benefit of organs that no-one else is using. If there was no government interference then who could stop a doctor or the family of a sick person from taking what they need to save lives?

The only opportunity you'd have to opt out would be to pay for a security force to protect your body in the event that it's ever left on life support.

No government interference means no option. Everyone takes what they need and if you don't like it then there's a fight.

You know what, I don't support opt in or opt out. I'd be happier if there was no option. If your god or your family or your tradition or your custom want to deny the rights of healers to heal, deny the rights of the sick to live then tough luck! When you're dead you don't exist any more. You corpse isn't yours because you don't exist to own it. It doesn't belong to your family, your religion, your custom or your tradition. It doesn't belong to anybody. Whoever can put it to best use should. If a doctor can use part of it to save a life then anybody who stands in their way is a murderer. Murderers can spout off about their rights all day but I'll always place the rights of the innocent above theirs. I've got nothing against government interference. Government interference keeps me alive, I'd have no problem with it keeping as many people alive as it could by enforcing no-option donations.

But hey pressure from religious groups has stopped the report from even go so far as to change the form of government interference from presuming you want to stupidly preserve an intact corpse, to the slightly less stupid policy of only taking this pointlessly harmful course of action when it's specifically demanded.

A victory for the morbid corpse worshiping religious types! So much for compassion.

 

[EHocking]

...And as has already been explained several times, this has exactly nothing to do with government interference in daily life or "creeping totalitarianism" as you put it. I'll say this once more - the government is already involved intimately, but they do not force you to do anything and are not planning on changing that.

You are demonstrably incorrect.

You seem to have ignored all the quotes that I have supplied from the government AND the government taskforce formed to address increasing organ donation numers in the UK, therefore, I'm obliged to repeat myself.

From the DoH Supplement, to Organs for Transplants A report from the Organ Donation Taskforce
"The remit of the Taskforce was to consider actions to increase organ donation within the existing legislative framework. This excluded the questions as to whether there should be a change in the law to move towards presumed consent (ie opt-out)."
(emphasis, mine)

Subsequently, the government added that agenda to the taskforce's remit and the Taskforce responded with this concern.​

"Modern medical ethics places a high premium on individual consent, and
the importance of consent in the context of organ donation should not be underestimated. Any process by which people register their willingness to donate must be judged in terms of whether that process allows individuals to make a valid and ethically defensible statement of consent. Furthermore, any move away from a system relying on expressed consent must be shown to be a justifiable exception to the current ethical norms."​

It is clear that a. the government IS planning changes to this legislation and b. I am not the only one concerned about what these changes may encompass.​

The above directly addresses the OP's question on the morality of alternatives to the current opt-in system which "allows individuals to make a valid and ethically defensible statement of consent".

The only thing being discussed here is what would happen if you don't make a choice and there is no-one else to ask. That's it.

Again, incorrect.
This, from the OP, "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. ...It seams fairer to me but are there any moral reasons against it? ".
The question was not about what happens to you if you don't make a choice, but whether there are moral reasons with the government's proposed opt-out system (and the OP's suggested alternative).

The government isn't trying to get involved in an area it wasn't previously, and it isn't trying to tell anyone what to do. I do find it very amusing that you accuse others of clouding the issue, when it is you who keeps trying to being irrelevant nonsense into it.

Please reread the OP. I have only wished to discuss exactly the issue at hand and that is the morality of changes required in law to implement alternatives to the current opt-in system. Ad hom attacks and inaccurate statements about clouding the issue when I've ONLY wished to discuss the OP and the topic of this thread are not adding to the debate.

I'll put this as simply as I can. Firstly, organ donation cannot be government interference in your life because, by definition, it doesn't involve anyone's life.

It certainly affects the lives of next of kin. So I disagree that "it doesn't involve anyone's life".

Secondly, the government is already involved with what can and can't be done with corpses,

Under a current legislation that takes into account both my wishes and that of my NoK.

so opposing change on the grounds of government involvement is just plain ridiculous.

Ad hom attack again?

If you're so opposed to government involvement with corpses, you should be demanding the government stop being involved,

Why? My objection is not with the current level of government involvement, but to government's proposal to change the current legislation (or level of "involvement" if you wish), a legislation that was changed in 2004 to effectively address the ethical and moral concerns regarding tissue use by taking into account both my and my NoK's directions on consent.

not just whinging .

Ah, more ad hom attacks. So now, objecting to and debating government changes to legislation is whingeing. Brown uses similar tactics (in this case "think of the children" to shame people into not discussing the proposed changes to the legislation regarding organ donor by tarring those who question the proposal as uncaring swine that would rather see a child die than allow organ donation. Patently untrue, but an effective ploy. This government used similar tactics on the debate of the illegal Iraq War by accussing anyone opposing them as supporting terrorists. They also used a similar tactic to those opposing ID cards, by implying that if you opposed the card, you obviously have something to hide.

...that they want to make a small change to one assumption in their involvement

That is why I used the word creeping in my Totalitarianism description. It is just these sorts of small changes that are used to build a precedent to push through other agenda.

This is not the only issue that concerns me, but it IS the topic of disussion in this thread.

I think it's pretty rich to use an ad hom attack of "whingeing" about the government's proposal to "make a small change to one assumption in their involvement" when that is, in fact, the actual topic of discussion.

Here's a short list of other concerns about "small changes" of legislation by the government, ID cards, DNA sampling of school children, retaining DNA samples by police when no charges are laid, police retaining Oystercard records when they declared they would not, opponents to an illegal war being labelled supporters of terrorism, 42 day detention without charge, use of the Terrorism Act to monitor rubbish bins etc etc.

To accuse me of being ridiculous by remaining ON-topic is a pretty shallow argument.

The government's "think of the children" appeal on organ donation is a cynical tactic to cloud the issue of the morality of their required legislation change to make an opt-out system work in the UK, as is accusations of "whingeing" when someone objects to their agenda.

 

[EHocking]

Lets be provocative for a moment...

Isn't it funny how when people bang on about rights it's so often their own rights.

So when I "bang on" about equality for women, it must be because I'm a woman.
When I "bang on" about freedom of religion, it must be because I'm religious.
When I "bang on" about equality for minorities, it must be because I'm a from a minority.
When I "bang on" about the right to good health care, it must be because I'm on welfare.

The list goes on. The fact that I'm a white, male, atheist who pays for his own health insurance as well as contributing to welfare through paying taxes relates to which of my personal rights that I'm implicitly so selfishly protecting?

Isn't it strange how people who call a change of rules "government interference," don't tend notice that if there's a rule to be changed the government is already involved.

Ah, back to the topic.
But it is not "government interference" it is UNWARRANTED government interference at issue.

The rest is not so much controversial, as an example of exactly the type of "think of the children" emotional blackmail that is being attempted by Gordon Brown so that genuine debate on the required legislation changes cannot be had without those opposing the legislation change being branded callous swine that would rather let a child die for lack of a donor over a "petty" change in a law.

I'm opted in. Have been for a long time. My family know my wishes. I needed to do this because the government already involves itself in the so called private life of it's citizens. It acts against the rights of doctors to make good use of dead meat that has no other purpose. It interferes with the rights of the sick and infirm to receive the benefit of organs that no-one else is using. If there was no government interference then who could stop a doctor or the family of a sick person from taking what they need to save lives?

The only opportunity you'd have to opt out would be to pay for a security force to protect your body in the event that it's ever left on life support.

No government interference means no option. Everyone takes what they need and if you don't like it then there's a fight.

You know what, I don't support opt in or opt out. I'd be happier if there was no option. If your god or your family or your tradition or your custom want to deny the rights of healers to heal, deny the rights of the sick to live then tough luck! When you're dead you don't exist any more. You corpse isn't yours because you don't exist to own it. It doesn't belong to your family, your religion, your custom or your tradition. It doesn't belong to anybody. Whoever can put it to best use should. If a doctor can use part of it to save a life then anybody who stands in their way is a murderer. Murderers can spout off about their rights all day but I'll always place the rights of the innocent above theirs. I've got nothing against government interference. Government interference keeps me alive, I'd have no problem with it keeping as many people alive as it could by enforcing no-option donations.

But hey pressure from religious groups has stopped the report from even go so far as to change the form of government interference from presuming you want to stupidly preserve an intact corpse, to the slightly less stupid policy of only taking this pointlessly harmful course of action when it's specifically demanded.

You obviously have not read one word of the report, otherwise you would not have so grossly misrepresented the purpose of the Taskforce nor it's conclusions.
It is exactly the opposite of what you portray it to be.

But I guess you were just setting up that strawman for the following (again, misdirected) diatribe.

A victory for the morbid corpse worshiping religious types! So much for compassion.

Wow. "Morbid corpse worshiping [sic] religious types, eh? Nothing emotional in that appeal at all.....

Where, in the report "Organs for Transplants, A report from the Organ Donation Taskforce" is there any referenc to religion?

Where, in the pertinent statement (for the third time, I think), is there a reference to religious pressure? If anything, their stance has been a resistance to government pressure.

"Modern medical ethics places a high premium on individual consent, and
the importance of consent in the context of organ donation should not be underestimated. Any process by which people register their willingness to donate must be judged in terms of whether that process allows individuals to make a valid and ethically defensible statement of consent. Furthermore, any move away from a system relying on expressed consent must be shown to be a justifiable exception to the current ethical norms"

ETA: Read what the Taskforce ACTUALLY had to say with regard to religion and organ donation in the Report Supplement at the DoH page. It is not at all what was reported in a number of media and on the web and quite the opposite to your accusation.

 

[Matty1973]

It seems Israel are planning to introduce a organ priority scheme along very similar lines as suggested in the OP. As an extra incentive the priority is extended to partners and close family members. Howewer the UK seems keener to introduce presumed consent:

"The BMA and BHF both support the introduction of presumed consent, where instead of opting into donation by signing a register - as happens in the UK - people would be required to state if they did not want their organs to be used for transplantation."

http://news.bbc.co.uk/2/hi/health/8416443.stm