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Organ Donation: Opt In or Opt Out?

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#1
Vesper

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We haven't had a debate in a while....


Context:

In the UK it is assumed at death that a patient has not given their consent for their organs to be used in transplants. Individuals can 'opt-in' by signing up to the NHS organ donation scheme and thereby receive a card donating that they are okay with their organs being use after death.

In France, Belgium, Norway, Spain and Denmark (to name a few), there is an 'opt-out' system where patients are presumed to have consented to the use of their organs for transplant unless they specifically state otherwise.

Which one do you think is right?


Pros

- There is a serious shortage of organs available for donation. 70% of people, when surveyed say they would be okay with their organs being used after death, yet only 15% actually sign up to the 'opt-in' scheme. Moving to a system of presumed consent would enable those who object to the use of their organs to have their views respected, while ensuring the maximum possible donation rate from the rest of the population.

- Under the current system, the final decision over whether an organ is donated is made by the potential donor’s family. In many cases, family members may not know their relative’s wishes, and may offer an objection which the donor would not support - for example, they may hold beliefs about the importance of bodily integrity before burial which their relative rejected. Consulting the family is a denial of the donor’s autonomy.

- The death of a relative is always extremely traumatic. At this difficult time, families are not best placed to make the right decision on their relative’s behalf. It is wrong to place such a heavy extra burden on them, and better to leave it to the donor herself.

- The number of donors in the USA has declined following an initial increase on the introduction of the "required request" rule. The key point about Spain is that, despite the fact that it routinely consults relatives, it operates an opt-out system and the wishes of the donor are key - it is an example on the proposition side. The only way of ensuring the maximisation of donated organs is to operate a strict opt-out system so that every suitable organ can be used for donation unless the donor specifically objects

Cons

- Withholding of consent is not the most significant factor in the current UK organ shortage. Seven out of every ten families approached do give their consent to the use of their relative’s organs for donation; refusal of consent where the donor has previously indicated a willingness to donate, such as with a donor card, is extremely rare. The biggest single factor in national organ donation rates is road safety: most donors are accident victims, as people who die of old age or disease tend not to have suitable organs for donation.

- Presuming consent and ignoring the wishes of the potential donor’s family could cause major distress to relatives and partners. This could lead to adverse publicity for the cause of organ donation. Offending the family’s feelings could also adversely affect their trust and respect for the medical profession. At death, the wishes of the victim’s family should be more important than those of the victim - they are, after all, still alive, and have to live with the consequences of any decision taken.

- There could be medical risks with removing organs for donation without discussion with relatives. Relatives are an important source of information about the potential donor’s previous health, and are currently routinely questioned as part of the screening process.

- There is no need to adopt this policy in order to achieve an increase in donated organs. In the USA the "required request" rule makes it mandatory to make enquiries into the possibility of organ donation before a life-support machine is switched off. This makes it less likely that opportunities for donation will be overlooked, but ensures that families continue to be involved in the process.



What are your thoughts? Should it be opt-in or opt-out? Do you agree with organ donation at all? Would you be happy donating your organs? Are you a member of a donor register? Who should be a priority on the transplant list? Is fair to treat everyone equally (i.e cancer patients along with alcoholics)?


Mod: Please pin.

#2
uhleckseee

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In California (not sure about other states), we register at the DMV if we want to be an organ donor, and we get a little pink "DONOR" circle on our drivers' licenses/ID's to where if something happens to us, it's in the system. I didn't register when I was 18 because I was kind of spooked out on it. I've recently changed my stance on it because I'm O- (a universal blood donor, I assume that it helps with organ donations) and because it would be a good way to help someone continue living when I no longer can. Unfortunately, I haven't been to the DMV in quite some time, and have been putting off trying to find out how to do it online, so I'm not registered as of yet.

I don't think that it should be universal to re-use organs for transplants. People have their beliefs and I don't want anybody to fuck with something like that. It's their bodies, they can do whatever they like to them.

#3
Vesper

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In California (not sure about other states), we register at the DMV if we want to be an organ donor, and we get a little pink "DONOR" circle on our drivers' licenses/ID's to where if something happens to us, it's in the system. I didn't register when I was 18 because I was kind of spooked out on it. I've recently changed my stance on it because I'm O- (a universal blood donor, I assume that it helps with organ donations) and because it would be a good way to help someone continue living when I no longer can. Unfortunately, I haven't been to the DMV in quite some time, and have been putting off trying to find out how to do it online, so I'm not registered as of yet.

I don't think that it should be universal to re-use organs for transplants. People have their beliefs and I don't want anybody to fuck with something like that. It's their bodies, they can do whatever they like to them.


Glad to hear you did it! I'm a register donor... fuck it, I'm not gonna need 'em once I'm gone, so why not give someone else chance? I have no intention of being cryogenically frozen or anything like that so, I don't think it's going to worry me too much.

I don't know though; sure it's their bodies, but once life is extinguished; it's just a shell. With bits that can be used be the other people. Waste not, want not.

#4
Sofouska

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I'd be glad to donate my organs. In my city, some time ago, a man died and his last wish was his organs to be donated and he saved the life of a child and a young man. So when I die, I want my organs to be donated, my death will help some others live and will therefore have a meaning :)

#5
Artificial Idiot

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I would want to donate my organs as well cause when you die you don't need them. Hopefully they're used for someone who actually needs them and not like a smoker or alcholic that wants a new lung or liver.

#6
Vesper

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I would want to donate my organs as well cause when you die you don't need them. Hopefully they're used for someone who actually needs them and not like a smoker or alcholic that wants a new lung or liver.


Don't you think everyone deserves a second chance though?
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#7
Hermione

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I think it should be opt out, even if it only saved a few more lives it would be worth it. Anyone who doesn't want to donate their organs could easily opt out if that's want they want so it wouldn't take away their right to not donate. One way one group of people has to bother spending 5 minutes filling in a form to opt in, the other way another group of people has to bother spending 5 minutes filling in a form to opt out. The difference is the second way would save lives so it's a no-brainer for me.

The thing that really bothers me is at the moment in this country if someone who's signed up to the organ donation register dies, they still ask their family for permission to take their organs and if they say no they don't do it! I think this is totally wrong, everyone should have the right to donate their own organs whether their family agrees or not.

I would want to donate my organs as well cause when you die you don't need them. Hopefully they're used for someone who actually needs them and not like a smoker or alcholic that wants a new lung or liver.

Whether they've caused it themselves or not they still need a new lung or liver to live. I do think ideally people who need organs for non-self inflicted reasons should be given priority, but that doesn't mean smokers and alcoholics don't also need or deserve them if there's enough available. Not sure how that could be implemented fairly though when there's so many different factors to consider to decide who "deserves" it most.

#8
Black Dynamite

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It should be opt out, it's not like you'll need any of your organs after you die. I don't see the point of letting another person suffer and die if they can be saved by an organ I won't be needing. People come around to the idea of organ donation really quickly when you ask them what if it was a family member that needed one of your organs to live?

As for who you should prioritize, it doesn't really matter, it's always the people who are rich that get the organs the quickest.

#9
Trotsky

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^ On the subject of priority, I take a more utilitarian perspective. For example, say one person has a condition from drinking or smoking which is curable, and could live 30 more years, and another person has an incurable condition through no fault of their own, and they will die in a few years even with an organ transplant. It should be given to the person who will live longer, regardless of fault.

Organ donation should be morally blind. It should consider 'which subjects will get the most usage out of these organs', considering their age, physiology, genetics, and other factors, including whether someone is likely to continue heavy smoking or drinking which will lower their new organ's life span. The issue of children in need, thankfully, doesn't have to be considered in competition with adults, since adult organs don't fit children anyway.

In terms of how you decide between a 35 year old mother of 4, or an 18 year old student, if you're judging them based on their life situation you're going to get subjective perspectives. If the person deciding is a parent of young children, they might see the mother as more important, if the person is a parent of older children, they might see the 18 year old as more important because they're imagining their own child in the same situation. You really can't objectively determine whose life is worth more. So instead, simply decide whose body is most likely to accept the organ without complication and for whom the organ will last longer.

As for donation, once again, I advocate the utilitarian position. Organ donation should be opt out, not opt in, and it should be something inconvenient, like mailing in a form (not a checked box on something one would mail in anyway) That way, the right to opt out is preserved but people don't frivolously choose it.

And as for harvesting from people permanently on life support, yes I think it should be strongly encouraged. Although I do believe in universal health care, I am 100% against spending state money or using public resources on preserving the biological functions of the permanently brain dead. I am not talking about people in comas, that's different, they may potentially wake up. But if the brain itself is gone, and this is actually quite easy to determine, because brain cells don't really regenerate, and the person will never experience consciousness again, they should not be kept alive by the cost or resource of anyone but their families (who are obviously incapable of doing so, but that's the point)

I don't think someone's rights extend into the right to preserving the circulation of what is, for all intents and purposes, a corpse.
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#10
Emilie.

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I'm not going to bother with a long post, because John said pretty much everything I was thinking.

I'm definitely registering as a donor once I turn 16.

#11
Hermione

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^ On the subject of priority, I take a more utilitarian perspective. For example, say one person has a condition from drinking or smoking which is curable, and could live 30 more years, and another person has an incurable condition through no fault of their own, and they will die in a few years even with an organ transplant. It should be given to the person who will live longer, regardless of fault.

Organ donation should be morally blind. It should consider 'which subjects will get the most usage out of these organs', considering their age, physiology, genetics, and other factors, including whether someone is likely to continue heavy smoking or drinking which will lower their new organ's life span. The issue of children in need, thankfully, doesn't have to be considered in competition with adults, since adult organs don't fit children anyway.

In terms of how you decide between a 35 year old mother of 4, or an 18 year old student, if you're judging them based on their life situation you're going to get subjective perspectives. If the person deciding is a parent of young children, they might see the mother as more important, if the person is a parent of older children, they might see the 18 year old as more important because they're imagining their own child in the same situation. You really can't objectively determine whose life is worth more. So instead, simply decide whose body is most likely to accept the organ without complication and for whom the organ will last longer.

This makes a lot of sense, I agree with everything you've written here. Really would be the fairest and most sensible way to do it since deciding who's life is worth more is so subjective, and it would get the maximum possible extension/improvement of lives out of donated organs too. Can't see how any other way would be fairer.

#12
Daughter.of.Rage.and.Love

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I just read Never Let Me Go. Quite some interesting things to think about. I think that's something worthy of discussion in this thread too. As a theoretical dicussion, that is. (for those who haven't read the book but still want to: don't look it up because it'll spoil half the book).

Anyway, I'm for opt out, may elaborate later, although John pretty much did the job already. With opt in you are inevitably going to lose donors, as in peple who do want to donate after their death but don't get to because they didn't fill out a form. Hell, I'm one of those right now, I want to be a donor but haven't filled out the form even though it's just a matter of printing it and sending it (unless it's now possible to do it entirely online, not sure).

#13
Hermione

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Anyway, I'm for opt out, may elaborate later, although John pretty much did the job already. With opt in you are inevitably going to lose donors, as in peple who do want to donate after their death but don't get to because they didn't fill out a form. Hell, I'm one of those right now, I want to be a donor but haven't filled out the form even though it's just a matter of printing it and sending it (unless it's now possible to do it entirely online, not sure).

Here you can just fill in a really quick form online (took me a couple of minutes), call a phone number or send a text to do it. Any time you register at a doctor's surgery or get a drivers license or even just sign up for a rewards card at a popular highstreet chemists/shop called Boots there's a section included on the form where you can sign up to be a donor too. Maybe check the site for it and see if there's anything similar there.

#14
ChuckTaylors

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I would be happy to donate my organs. I mean I'm not going to use them when I'm dead.

#15
Lindsay

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John pretty much said everything I wanted to say. I haven't registered yet but I'd be happy to donate my organs after I've passed... why not help someone out and possibly save a life when you don't need them anymore anyways?

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#16
Brigister

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I haven't registered, but I'm going to, I'd be happy to give my organs to people who really need them, as, when I'll be dead, I clearly can't give a shit about having organs.

#17
It's Splash Time

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I am registered as an organ donor. I got the card a couple of weeks ago and was so happy.

I can see pros and cons of an opt-out system. There are often people who would donate, but never get around to filling in the form etc. That way the lazier people would just donate their organs. There are also people who would think that donating certain organs wouldn't be right. We were discussing this in Biology and the teacher said that if her son died, she would donate his organs, but wouldn't feel right giving his eyes to someone else. Just the thought of someone else going around with her son's eyes would be weird. I would like to have part of me at least buried.

#18
Boston

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I think it should be opt-out. Its just, why would you not donate your organs to someone in need?

#19
Tre's Busted Drumkit

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I think it needs to be opt-in, out of respect for the deceased. That said, a family member giving the ok should count as opting in. Like you said, not many people actually sign up to be an organ donor, despite most people being ok with the idea of their organs going elsewhere.

Personally, I've opted in to be an organ donor. I mean, let's face it, they're not going to do me any good if I croak. I'd rather help a fellow human being than have useful material burned and shot into space with the rest of me.

#20
Daughter.of.Rage.and.Love

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Here you can just fill in a really quick form online (took me a couple of minutes), call a phone number or send a text to do it. Any time you register at a doctor's surgery or get a drivers license or even just sign up for a rewards card at a popular highstreet chemists/shop called Boots there's a section included on the form where you can sign up to be a donor too. Maybe check the site for it and see if there's anything similar there.

Yeah, I just looked at the Dutch site, you can also do an online form now (although you need a sort of government account for that, which no one has until they're almost 18).

So I am about to register. The only thing that's bugging me (and the only thing that would bother me about an opt-out system) is my family. I think family's wishes are also important, because the family still has to live with it while the deceased is, obviously, dead. For example, I am kind of iffy about donating skin after death, because that pretty much removes any chance of an open casket funeral/cremation. I don't mean that skin donation is bad, but it's hard to make a decision about.

#21
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I am registered :lol:
so if I die under the right circumstances, i can make some people very happy..
i see no cons for giving away your organs, because for real: where do you need them for after your death?
even your skiin, if you wrap me in a nice towel, i would still win the Dead 'n Burried beauty show :lol:

#22
Kayfabe

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Opt out. "Can I not save someone's life" is easily the one you have to sign up for.

Also consider the circumstances when people who have viable organs die. You're walking along the street, you get hit by a car, you die. This could happen today. Through death comes life and all that, but think about the fact that someone's life could have been saved through yours, but it's not because you're a bit busy or a bit forgetful and forgot to go to the government and ask that this happen.

Life or death situation, literally. Opt out.

#23
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Opt out. "Can I not save someone's life" is easily the one you have to sign up for.

Also consider the circumstances when people who have viable organs die. You're walking along the street, you get hit by a car, you die. This could happen today. Through death comes life and all that, but think about the fact that someone's life could have been saved through yours, but it's not because you're a bit busy or a bit forgetful and forgot to go to the government and ask that this happen.

Life or death situation, literally. Opt out.

when you're hit by a car, your organs are smashed and probably scattered with glass/metal/stone, there is no way any patient wants your organs anymore... the only way your organs have a chance to be transplanted, is when your brain is dead, but your body still shows the last signs of life...

#24
Hermione

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Yeah, I just looked at the Dutch site, you can also do an online form now (although you need a sort of government account for that, which no one has until they're almost 18).

So I am about to register. The only thing that's bugging me (and the only thing that would bother me about an opt-out system) is my family. I think family's wishes are also important, because the family still has to live with it while the deceased is, obviously, dead. For example, I am kind of iffy about donating skin after death, because that pretty much removes any chance of an open casket funeral/cremation. I don't mean that skin donation is bad, but it's hard to make a decision about.

When I registered, on the form I filled in there was the option to choose exactly which body parts you'd like to donate and which you wouldn't. There was a list of all the parts that can be used and you could just tick the ones you're happy to donate. So it might be worth having a look to see if you can do that.

#25
Kayfabe

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when you're hit by a car, your organs are smashed and probably scattered with glass/metal/stone, there is no way any patient wants your organs anymore... the only way your organs have a chance to be transplanted, is when your brain is dead, but your body still shows the last signs of life...

Well it definitely depends on the case but you know what I mean. Organs aren't taken from people that have died from terminal illness or old age. They're always from someone whose life has been suddenely, tragically cut short. Whatever way it happens, what I said still applies.

#26
Daughter.of.Rage.and.Love

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When I registered, on the form I filled in there was the option to choose exactly which body parts you'd like to donate and which you wouldn't. There was a list of all the parts that can be used and you could just tick the ones you're happy to donate. So it might be worth having a look to see if you can do that.

Oh yeah the system is exactly like that and I started thinking about the skin thing because I saw it on the list. I'd donate any other body part, but skin was the one I doubted about. (haven't registered right now, will think about it later, but now I've seen how easy it is I'll definitely register some time soon).

#27
Johnny.

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I'm an organ donor, and I think it's selfish and pointless not to be.
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#28
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I agree with the "opt-out" system =D (That's the one we have here too.)
Honestly I can't see many people wanting to sign a paper to say they want to be organ donators after they die. (and I'm sure it's not just signing a paper, but losing a day or two, at least that's how stuff goes here)
And since I assume the majority of people wouldn't mind to be donators, it's easier to have a way out for the ones who don't want to be donators.
For a country like mine, it's the best way to do it, I'm sure if it wasn't like that, even more people would be dying waiting for a transplant.

#29
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I think it needs to be opt-in, out of respect for the deceased. That said, a family member giving the ok should count as opting in. Like you said, not many people actually sign up to be an organ donor, despite most people being ok with the idea of their organs going elsewhere.

Personally, I've opted in to be an organ donor. I mean, let's face it, they're not going to do me any good if I croak. I'd rather help a fellow human being than have useful material burned and shot into space with the rest of me.

How is it disrespecting the deceased to ask them to opt-out of organ donation if they don't want to donate for religious reasons? Isn't it disrespecting the living to have them potentially die based on the laziness of a vast majority of the population who might have donated but just never bothered? I personally care more about people than dead people. Dead people are dead, and that's it. Living people have a chance to keep living, and if we can help them live, I say we do it.

What is your reasoning for wanting an opt-in system?

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What is your reasoning for wanting an opt-in system?

I've already said that I personally am an organ donor. That said, and to put it bluntly, my body is my body. When dealing with something like the handling of a body after death, the assumption should be on the side of the person wanting their body left intact. Think of it this way--it's a lot easier to take organs out of someone's body because you had explicit consent in the first place than it is to reattach them because you took them out without consent.

Most things that can help people, I'm all for having them as the default. When dealing with something so sensitive as the handling of a person's body after death, the assumption has to be that that person wants their body left intact for burial unless they (or a family member) tell you otherwise.



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