Opt out organ donation system

[Pammy]

I still don't think it's a good idea...There are some groups in the population who probably would still not be properly informed or understand what is required. Many people don't have internet, don't shop in Western-style supermarkets, are scared to see GPs. How about injecting drug users, for example, or people with undetected mental illnesses...Such a system would ultimately take advantage of already vulnerable people.
And what about children? Would parents opt out for them?
I would start with research as to why not more people opt in and start campaigns addressing those issues. Or, like I said before, just require everyone who you can possibly reach to make a choice (e.g. when they renew their passport).
Pammy

[heed]

i have done quite alot of work on the french donor system actually, and i feel much the same way as Polldoll - if people feel strongly about not wanting to donate organs then the ball is firmly in their court - opt out. In France, the legislation originally (in 1994) included a clause whereby next of kin had a legal right of veto - something which has since been removed due to the large number of cases where families objected, even though the wishes of the donor were well documented. The physician must ask the opinion of the next of kin,and if there is doubt as to the donors wishes during their lifetime then in practise many physicians choose not to harvest organs - in this regard i can see the merits of the system proposed by Pammy.

The approach taken by the Netherlands, Portugal and Belgium during the establishment of their dissent programme included a huge multi-lingual multi-media campaign, including a letter (in your native language) sent by the ministry of health to every person registered as a permanent resident. If you want to opt out, just send back this freepost slip. There you go. Obviously every net has holes - but that can be said of any system.

As far as I am aware, to date the following european conutries operate a dissent system:

France, Belgium, Switzerland, Portugal, The Netherlands, Sweden, and Austria.

[Pammy]

Think Spain too...but there, relatives are allow to disagree.

[Dr Noodle]

I wrote a long answer for this yesterday but it didn't post.

Anyway, if my brother had just died and a surgeon/transplant co-ordinator/whoever came up to me asking me for his organs I think I would seriously consider bopping them one. This is one of the reasons why I would be inclined to agree with opt-out donation apart from the fact that there will be more organs available.

That being said I can understand why people feel uncomfortable with the idea of the NHS deciding what to do with their bodies after they die. As people who work in the healthcare system we know what the situation is with organ shortage. But what are the public awareness campaigns like there? How many people know what it's like (apart from those who watch medical dramas)?

If they go ahead with this they damn well better make sure that people are very aware of what the situation is and the opt-out form should be simple and readily available. And like Pammy says, make sure they're able to reach out to everyone in the community so they don't wind up distressing relatives when their loved one dies and they're not able to take the entire body to the graveyard/crematorium.

[The Fantastic Dr. Fox]

I like pammy's idea about forcing everyone to make a descision about whether to donate as this whole issue is based around what to do wiht the people who don't get round to making their wills known. Could be incorporated any type of form that everyone has to fill out and would then eliminate a lot of confusion and potentially 'lost' organs.

On the subject of the subject of 'opt in' or 'opt out' I personally wouldnt like to see anyone have organs taken against their will ( even though on a utilitarian basis you might put an extra 5/10 years of life above a bit of apprehension over something they wont use) so i think any opt out system would have to be well publicised and easily avaliable. Therefore people who really do care that much could have their wishes respected (although i do agree people are morally wrong to expect an organ if they refuse to donate one ). The real thing that draws me to the opt out system is that i heard 70% of people would like to donate but only 20% are on the register so there are huge numbers of lives that could so easily be saved/improved. when you see that you realise something has to change. Whether you 'gain' those organs by publicising or by opt out is a different matter but opt out would bring very quick results for a lot less money and with safeguards like easy opt outs and perhaps 'soft' opt outs with family vetos (perhaps tricky in time pressured situations though) very few organs would be wasted or taken against someones wishes.

probs contradicted myself a lot but i try to listen to both sides (good for interviews) . opt out with safeguards if pushed for an answer

[chris5656]

Does anyone know how this will be publicised?? I believe that the opt-out form should be available online.. A quick form to click you do not want to be a donar. But it also should be available, perhaps in supermarkets, in the post office, given out with pensions and in GP surgerys.

A campaign also is needed of course reminding people that they do have a choice to make and that it is THEIR responsibility to actually act on their decison. If they feel so strongly about not being a donar, it is not that difficult to opt-out, and if they never actually get round to it, well then who's fault is that??

I agree with this. As long as it is a simple and easy process to opt out should people wish to.(i.e. not like cancelling a mobile phone contract, or quiting AOL)

[levantine]

I am 130% opposed to this idea.

The reason people don't give consent is either because they didn't get round to it/didn't know enough to start caring, or because they didn't want to. Presumed consent assumes the former and entirely dismisses the latter. Already that's a biased position. Some people have called dissent 'selfish'. You are entitled to this view, but there are people who very strongly believe that their corpse is far more than a mere physical entity that's useless unless recycled. To dismiss such beliefs because of your own is contrary to the entire working ethical system of the clinician...

The sudden availability of a resource does not entitle someone else to its use without prior actively given permission. And there is no room for presumptions in 'actively given'. In terms of the law, we wouldn't even assume this over junk property. Someone needing an organ is not ENTITLED, per se, to another human being's organ. It is mostly out of love, kindness and mercy (this is a body organ we're talking about, not time or money) that people donate their organs, not obligation. Presumed consent just leaves too much risk of not, for multifarious reasons, announcing your dissent.

I'd hate to see the law suit filed by the family of a person whose organs were used on the basis of presumed consent purely because the paperwork to register their withdrawal wasn't complete at time of death. Too late, we're going to punish your tardiness/lack of foresight by using your organs anyway? And let's be realistic here, look at the level of bureaucracy in the NHS and the DoH - is it really going to be a quick and easy freepost option? I highly doubt it. What happens if you drop dead in the middle of the formal withdrawal process? Some idiot with a J.D. and in the right position could use all the tricks in the book to rob you of that kidney, despite all the evidence of your dissent.

In this age of digitalising everything, imagine if you will a scenario where the government manages to (once again) lose masses of patient data including withdrawals, and bodies are used in the aftermath against the permission of the deceased? There is just far too much room for error. We can't get far simpler and less high-stake systems running as well as they should right now - no way are we ready for this.

Besides, pioneers in Spain who instigated their impressive donation rates specifically suggested that it is not the presumed consent that increases their organ donation rates so impressively, but their very pro-active coordinator system where families of recently deceased (etc) are approached (very sensitively) about organ donations. (And even then I have mild concerns that the grief, and hence reactionary sympathy for others, that such families may be experiencing could be manipulated to the medical professional's advantage).

As that Spanish surgeon said, of the 45 British people who died in Spain last year, 45 agreed to donate organs of the deceased when approached by such a coordinator (paraquoted... think that's right). I recall reading elsewhere that very few people reacted angrily or negatively on being approached so soon after a bereavement. If this is true (not seen any statistics myself, going entirely on the interview), then it is clearly a system worth trying out. There's no need to rush into such polarised measures when there are potentially far better ones we can try out. And it's hardly as though we have a strong message about organ donation in this country anyway - we need to try all the alternatives first.

We need to put clinicians, not politicians, in charge of this (and many other things), like Spain did - those families are allowed to refuse, yet more often than not they don't. I am sick of the government and its petty, wasteful politics meddling so much with medicine as it is. I sincerely hope we won't be eventually watching them mixing laws with our physical containers as well.


/end rant >_>

[Singh.Simran]

I think we need to look at this more philosophically; it's not the government taking our organs, it is the nation, the people. The government is merely proxy for them.

The only entity that can overrule individual will is the democratic majority; otherwise prison, compulsory education, rule of law, the doctrine of seperation, they would all be pointless.

The opinion and best interests of the people is for as many organs as possible to be donated; the government acts on this opinion with input from expert eg in finance, science, who could well tell them there is no loss to the person concerned, hence the executive executives.

However, to balance this, they take into account the minority opinion and form a compromise; you will acquiesce to the people, just as you do when you vote and you go to court and school and hospital, but if you really feel that strongly, you can pull out.

It's like tax, on personal monetary property, levied by the executive for and with the assent of the people, but it's an inheritance tax onpersonal bodily property, levied by the executive, according to the wishes and needs of people.

And of course the humanitarian-legal arguement: Real human lives > the dead's long enunciated wishes. In the same way as hman suffering trumps breaking the law in the courts (to an extent) and so forth...

[levantine]

The only entity that can overrule individual will is the democratic majority

This is true with regards to the systems you speak of, such as education. However, we as a 'democratic society' have persevered long and hard to fight for the beliefs of the minorities. Beliefs are an entirely different matter from more general things such as education and rule of law in that they do not need to make sense to all in order to be valid, to that person. That's why we can't vote out the (e.g.) religious or sexual orientation preferences of the minority based on the religions or sexual orientations of the majority.

The opinion and best interests of the people is for as many organs as possible to be donated

Generally speaking, people who strongly believe in not donating organs are not likely to accept them either. (I stress 'strongly' here, I'm not talking about lazy/cowardly/selfish free-loaders. I don't have a study to back this up - I am just considering some of the more particular beliefs of some of those who choose not to take part in organ donation). On that basis (of neither wanting to give nor receive organs), they are indeed acting based on their opinion and in their best interests.

The problem with the 'pulling out' option is, as previously noted, that it's likely to be passed by, and not just out of sheer laziness - though I imagine this would be a big factor, as with voting. My other half is an attorney currently working in wills & estates. The situations that people go through/leave behind because someone forgot to make a will, or - which is more applicable to this case - CHANGE a will, are at times terrifying. I'd hate to see that in medicine. EVEN if people don't opt out primarily due to laziness, it is unethical to punish their laziness by going against their wishes based on later external assumptions.

And of course the humanitarian-legal arguement: Real human lives > the dead's long enunciated wishes.

Some people believe that their body is not their property, but a vessel they have been entrusted with the care of during their lifetime. I cannot presume to call such a wish a 'long enunciated wish'. Clearly their intent is that their wish endures beyond death. And if we're going to be really philosophical: given that beliefs outlast people and their decaying matter, the beliefs they leave behind ought to be respected above all other things they may leave behind.

The entire proposal is little more than taking away something of ours by default. That we have the 'option' to refuse is a compensatory detail that distracts from the core issue: that a neutral situation would become intrinsically biased, that a balance would become imbalanced. Is a positive outcome for someone else justified by adding yet more bars to the prisons currently growing up around our personal spheres of existence? We employ such measures in politics and law all the time, but human rights and properties are another matter entirely.

Finally, we speak of 'majorities'. In reality, the people requiring organs are hardly a 'majority' in terms of the entire population. So, even if you're going to justify this using basic democratic philosophy, you would be acting for the benefit of a minority - and in a way that could contradict the beliefs and preferences of a non-consenting sub-population larger than the one benefiting (because I bet that the number of non-consenting people who neglect opting out would outweigh the number of those needing organs). That is a paradox in itself.

I find it interesting that patient groups raised concerns about this. You'd think, based on assumed reactionary sympathy, they of all people would be prone to approve.

[Dr Caz]

I am all for this opt-out system. You do not need your organs when you die, so why not do something useful with them and help save someones live.