SciTech

Should Presumed Consent Be The Law Of The Land?

MayorBob.

Posted to SciTech on Thu Jul 31, 2008 at 02:17:42 PM EST (promoted by port1080). RSS.

Organ donation is in a state of crisis today. Put plainly, there are not enough organs available to satisfy the people who need replacements. Thus, the weak link in the chain of organ donation is that donation is a voluntary act. There is a method proponents say would absolutely solve the dilemma of too many failing organs and not enough healthy replacements -- presumed consent. In other words, if you don't tell the state you won't donate your organs, they can be harvested upon your death.

Presumed consent has been studied in California in the recent past. It's in use in many European countries now and remains controversial in others. Although British Prime Minister Brown is a supporter of presumed consent, some British medical ethicists say that presumed consent "is no consent at all." In Canada, Ontario legislators are trying to make presumed consent the law in the province ASAP. They will likely fail in that effort as the public doesn't seem keen on the idea. One Canadian, who received a partial liver transplant which is failing and is in dire need of another, said "we cannot let our fellow Canadians (die) in silence when we have all these things at our disposal." There are currently 4,000 Canadians on organ transplant waiting lists and around 200 will die this year because they couldn't get a replacement in time.

In the US, the Organ Procurement and Transplantation Network (OPTN) reports close to 100,000 candidates on waiting lists with 300 names added per day. The OPTN's numbers show that thousands are saved every year through organ donation; the OPTN also notes that thousands die each year because they failed to receive an organ for transplant in time. People can sign up for organ donation by filling out a form in compliance with the Uniform Anatomical Gift Act (UAGA) and get a donor card. Or you could identify yourself as a donor on your drivers license. The problem, even for voluntary donors, is that they don't necessarily have the final word. If your donor card or license is missing, hospital officials will normally ask the next of kin whether your organs can be harvested. If the next of kin is unaware or your desires or they're opposed to organ donation themselves, your tissues could go to the grave or crematorium with you. Adoption of presumed consent might put an end to any number of other means of procuring organs: flying overseas for that otherwise illegal operation; advertising your need; or adopting a "they're my organs and I'll sell them if I want to" market here in the US.

Tags: edited by Port1080, written by MayorBob, organ donation, presumed consent (all tags)

This story: 38 comments (1 from subqueue)
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1

Presumed, my butt!

skeeter1.

Thu Jul 31, 2008 at 07:27:50 PM EST

5.00 (astute, brilliant, astute)

"Presumed consent".  I'm sorry, but it's just one more indication that we have too many lawyers/lawmakers in the US.  What's next?  Presumed foreclosure on a paid-off house?  Presumed repo on a paid off car?  Presumed confiscation of my legal firearms?  The whole notion of presumed anything just pisses me off no end.  

there's only one way to find out...

2

prequel to 'Jigsaw Man'

gerrymander.

Thu Jul 31, 2008 at 09:18:30 PM EST

5.00 (brilliant, interesting, interesting)

I can see the CSI plot already: There's a killer on the loose! No one can find any link between the victims, until one of the intrepid investigators notices that all the emergency calls about the bodies were made from one-use untraceable cellphones. Why would the killer be alerting 911? The kidneys, of course! Some money-hungry health insurance worker uses patient records to isolate potential matches for rich clients. She lures them into unwatched areas and calls for an ambulance while her boyfriend kills them.

3

cold, hard cash

gerrymander.

Thu Jul 31, 2008 at 09:27:20 PM EST

5.00 (astute, brilliant, brilliant)

But more seriously, how would presumed consent match with freedom of religion? The government would have to start insisting people carry ID with religious affiliation to prevent a member of a "no medical treatment" congregation from having their organs donated -- and I'm pretty sure that wouldn't pass constitutional muster. (And what it they lose their ID? People don't lose their rights just because their drivers license is in a different pocket.)

You know what consent plan would work? Payment. Let people decide on their own if they want to leave their organs upon death to strangers at market rates, and the proceeds of the sale to their heirs. I'm guessing that would be far more successful at raising donation rates than any new Big Government program.

4

^ 3

Re: cold, hard cash

delete me.

Thu Jul 31, 2008 at 11:40:30 PM EST

4.50 (funny, astute)

Next on CSI - killed by greedy relatives since your healthy heart ($90k on the market) won't let you die early enough otherwise.

- derumi (del-me)
"Bobby Fischer? Man, that guy is crazy!" - Mike Tyson

24

^ 3

Re: cold, hard cash

skeeter1.

Sat Aug 02, 2008 at 01:09:30 PM EST

none

"I'm pretty sure that wouldn't pass constitutional muster."

I'm so delighted that you used the word "muster".  I've seen so many posts that used the word "mustard" instead.  I'm giving you +10 for having a well-educated brain!

there's only one way to find out...

26

^ 24

OT: spelling mistakes

gerrymander.

Sat Aug 02, 2008 at 01:30:18 PM EST

none

Much appreciated, skeeter.

The one that gets me is the increasing use of "payed" as the past tense of "pay."

28

^ 26

The two that always get my attention ...

MayorBob.

Sat Aug 02, 2008 at 02:13:08 PM EST

none

are teh vice the and loose for lose.

Illegitimi non carborundum.

27

^ 24

Re: cold, hard cash

Degee.

Sat Aug 02, 2008 at 01:32:48 PM EST

none

"I'm pretty sure that wouldn't pass constitutional muster."

I'm so delighted that you used the word "muster".  I've seen so many posts that used the word "mustard" instead.

perhaps they were changing diapers while posting.

Am I a great person? Hell no - by most metrics I'm pretty much an asshole. -TSlothrop

30

^ 27

Re: cold, hard cash

Lou.

Sat Aug 02, 2008 at 02:23:27 PM EST

none

wait, what...ewwww

It's the end of the world as we know it, and I feel fine

29

^ 24

Condiment for TnT

Lou.

Sat Aug 02, 2008 at 02:22:41 PM EST

none

The arguments here are often so subtle and fast that I can barely ketchup.

It's the end of the world as we know it, and I feel fine

36

^ 29

Re: Condiment for TnT

skeeter1.

Mon Aug 04, 2008 at 08:43:29 PM EST

none

"The arguments here are often so subtle and fast that I can barely ketchup."

Where I came from (both time and place), it was spelled catsup.  Same stuff, but I like the old spelling better.   That's the Bohemian in me, I guess.  

there's only one way to find out...

38

^ 36

Re: Condiment for TnT

delete me.

Tue Aug 05, 2008 at 03:05:26 PM EST

5.00 (funny)

I thought the difference was that catsup had sugar, and ketchup has deadly High Fructose Corn Syrup.

- derumi (del-me)
"Bobby Fischer? Man, that guy is crazy!" - Mike Tyson

6

studying the incentives

wetkarma.

Fri Aug 01, 2008 at 06:25:03 AM EST

5.00 (astute, astute)

 Under the current opt-in system, if I don't have my card on me at the time - then my organs don't get taken. However under presumed consent, if I go to all the trouble of opting out, my organs would still be taken if somehow my card was not on me/not found on me/conveniently lost at the time.

My wife supports organ donation, I don't. We're both atheists but my view on organ donation is that there is non-zero chance (as proven in quite a few medical cases) where a declared organ donor does not receive maximum effort to preserve his life in order for his organs to be retrieved.

I don't trust the state enough to make presumptive decision about me, especially when those decisions are linked to being 'dead' vs. 'mostly dead'.  

In sum: Organs mine. Not yours to take.

Memory is a strange bell, jubilee and knell.

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^ 6

Re: studying the incentives

port1080.

Fri Aug 01, 2008 at 06:34:30 AM EST

none

You know economic theory, so you obviously realize you're being a freerider on the system.  I know you generally don't have moral qualms about, well, much of anything, but I think you can see how freeriders are generally a problem as they put an undue burden on any system.  So, I have a simple solution.  If you aren't an organ donor, you can't receive donated organs.  How's that sound?  Would it change your mind about organ donation?

9

^ 7

Re: studying the incentives

wetkarma.

Fri Aug 01, 2008 at 07:53:44 AM EST

4.00 (interesting)

I'm all for such a 'pay to play' approach which requires people to commit to being an organ donor in order to benefit. Unfortunately for the world however, medical treatment doesn't work that way.

Priority is given to those most ill under the current organ process. Given that the majority of people are currently not organ donors, your proposed solution would just wind up killing more people (in the short term) than it saved.

Now in the long term, in theory people would have an incentive to sign up for being a donor, but I suspect that given the likelihood of needing an organ transplant, most people will still not sign up.

Really the best solution is to compensate people for their organs - the items have economic value and the scarcity is being driven by the lack of incentive to participate.  Going pay-to-play would create some incentive, but it still won't cause an ample supply.

Memory is a strange bell, jubilee and knell.

12

^ 9

Re: studying the incentives

Degee.

Fri Aug 01, 2008 at 10:32:49 AM EST

none

Wouldn't compensating the organ donor's heirs increase the "non-zero" chance of not getting full medical treatment in borderline life or death situations? I think that at the very least the public apprehension of the same would increase.  If so, how would monetizing organs increase supply either in the short or long term?

Am I a great person? Hell no - by most metrics I'm pretty much an asshole. -TSlothrop

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^ 7

Re: studying the incentives

gerrymander.

Sat Aug 02, 2008 at 01:28:00 PM EST

none

So, I have a simple solution.  If you aren't an organ donor, you can't receive donated organs.  How's that sound?

"Unless you contribute, you don't receive benefits." Apply that idea on a wider scale, and you've just killed Medicare and welfare. Arguably, that's not the direction you intend to go.

31

^ 25

Re: studying the incentives

JimmyHavok.

Sat Aug 02, 2008 at 09:55:30 PM EST

5.00 (astute)

Keep going that way and you've also destroyed capitalism...I can see why you wouldn't want to go there.

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^ 25

Re: studying the incentives

port1080.

Sun Aug 03, 2008 at 08:40:33 AM EST

5.00 (interesting)

Apply that idea on a wider scale, and you've just killed Medicare and welfare. Arguably, that's not the direction you intend to go.

That's not exactly analogous, because quite a few people who end up collecting Medicaid and welfare (and most people who collect Medicare and Social Security) DO pay into the system.  They may not pay in as much as they take out, but they do pay.  On top of that, if those people ever get off welfare and start making decent money (something that does happen, occasionally) they are expected to pay taxes.  Additionally, all taxpayers receive some benefit from welfare programs because (arguably) they prevent our fellow countrymen from starving or from becoming such an unhappy, desperate underclass that they attempt to revolt and overthrow the system in some way.  Welfare keeps the poor fat & happy instead of lean and angry.  These added benefits simply aren't there when we're talking about organ donation - you don't get any benefit at all from giving your organs, right now, other than the mental benefit of feeling like you're doing the right thing, and unlike welfare there's no parallel to the idea that you are paying into the system because sometime down the line you yourself may need to take advantage of its safety net.

8

^ 6

Re: studying the incentives

Lou.

Fri Aug 01, 2008 at 07:53:25 AM EST

none

declared organ donor does not receive maximum effort to preserve his life in order for his organs to be retrieved.

That's kind of creepy in a Niven-esque way.  Any links?  I'd like to read more about it.

It's the end of the world as we know it, and I feel fine

10

^ 8

hastening death to get organs

wetkarma.

Fri Aug 01, 2008 at 08:02:41 AM EST

5.00 (informative)

Here is a Feb, 2008 story where a New York doctor is alleged to have given excess sedatives to a 25 year old man to get his organs.

Another one from Los Angeles in 2007. Note the defense of this guys attorney is particularly chilling: M. Gerald Schwartzbach, acknowledged that his client may have made some mistakes but said that "he certainly wasn't the only one."

It happens -- and a lot more often than organ donation advocates would prefer to admit.

Memory is a strange bell, jubilee and knell.

18

^ 10

Not that it isn't a ghastly thing.

MayorBob.

Fri Aug 01, 2008 at 04:42:29 PM EST

5.00 (astute)

But, both those links were about the same case.

Illegitimi non carborundum.

32

^ 18

Re: Not that it isn't a ghastly thing.

JimmyHavok.

Sat Aug 02, 2008 at 10:00:50 PM EST

none

Also, "everyone does it" is a defense with a long history going all the way back to kindergarten.  Just because someone who tried to harvest an organ says that everyone does it doesn't mean that everyone does it, any more than someone who steals your milk and cookie is an expert on how many people steal milk and cookies.

13

^ 10

for fuck's sake

1fastdog.

Fri Aug 01, 2008 at 10:40:25 AM EST

none

It happens -- and a lot more often than organ donation advocates would prefer to admit.

If there are truly all of these wretched organ wranglers out there just waiting to slice you up and take your innards, I'm guessin' that they'd not give a flyin' fuck whether or not you had a signed organ donor card somewhere on your person. In other words, I'm not seein' any risk differential between the willing and the unwilling.
But hey, feel free to give in to the hysteria if it makes you feel safer.

Somewhere in my soul, there's always Rock -n- Roll... Joe Strummer

14

^ 13

organ thieves

skeptic.

Fri Aug 01, 2008 at 11:11:41 AM EST

none

If I ever felt that our society was developing a significant risk of people being killed for their organs, I would favor a much more radical solution than merely the requirement for a signed consent card - a requirement which, as you point out, actual organ thieves would ignore anyway.  Instead, we could just prohibit all organ transplantation from human donors.  Eventually, if we can work out the technical details, artificial organs or cloned organs (probably made from stem cells) are much better anyway, since they can be produced whenever needed, and will avoid problems such as immune system response, and the transmission of disease from the donor to the host.  Artificial blood, again if it is ever perfected, is also much better than donated blood.  That is the direction that medical research must take, to really resolve these problems.

In addition, organ transplantation is a relatively expensive procedure, and aside from all the other concerns, we may also have to think about efficient allocation of limited health-care resources in an over-strained economy.  But ultimately I would like to see an affluent, advanced world in which anyone needing a new organ can get an artificial one easily, and the average human lifespan is pushed well into the second century.  Until then, we have to deal with the complexities of the organ donation system.  

17

^ 10

Life/death decisions get made in the field

pO157.

Fri Aug 01, 2008 at 04:30:55 PM EST

none

I'd argue that most of the life and death decisions get made in the field. When you do something stupid and end splattered all across the pavement, or drop dead inside your house from a massive heart problem, or whatever it is usually the responding ambulance personnel who decide what to do. When I was an EMT organ donation status never ever came into deciding whether or not to "work up" somebody or leave them for the coroner (who usually rolled in several hours later which seems quite detrimental to harvesting any usable organs). In such severe cases we didn't even have time to check their wallet for any information, in fact most of those times their valuables were secured by the cops.

I know it is completely anecdotal, but that was just my experience. I never knew which of my patients (or any) was an organ donor. Furthermore, given the relatively common rates of organ transplant failure it seems letting somebody die who is otherwise savable just to get their precious bodily tissue is downright retarded. And unethical. And illegal. And a bunch of other stuff.

15

^ 6

Re: studying the incentives

ivyafire.

Fri Aug 01, 2008 at 01:17:14 PM EST

none

My wife supports organ donation, I don't. We're both atheists but my view on organ donation is that there is non-zero chance (as proven in quite a few medical cases) where a declared organ donor does not receive maximum effort to preserve his life in order for his organs to be retrieved.

I had a conversation online with someone who said they would donate their spouse's organs even if they knew they didn't want them donated, just because they believe it's the right thing to do.  I wouldn't do that, though it's a moot point, since my husband is a donor.

He, however, said he would donate mine even if I had not put the donor sticker on my license.  (I have, so this point is also moot.)  

In subsequent conversations with others, I was surprised how many people I encountered who said they  would deliberately defy their spouse's wishes regarding the disposal of their body with regards to organ donation.

So, imo, unless you can say you absolutely 100% know what your spouse will do if you die first, you may already have consented to organ donation without your knowledge anyway.

"It was an ancient rule of Hawaiians that no one should hurt another bodily, or through theft of goods or through injury to feelings.These were the only sins."

20

^ 15

Re: studying the incentives

thefadd.

Fri Aug 01, 2008 at 05:50:07 PM EST

5.00 (astute)

Wow...I'd immediately leave someone with such little regard for my wishes.

It is easy to buy small plaster models of what you think life is like.

22

^ 20

Re: studying the incentives

ivyafire.

Sat Aug 02, 2008 at 01:26:48 AM EST

none

Wow...I'd immediately leave someone with such little regard for my wishes.
The funny thing is, there are a lot of people who feel the exact same way.  

So do you leave over the hypothetical overriding of your wish when you actually agree?

The whole thing makes my head hurt.

"It was an ancient rule of Hawaiians that no one should hurt another bodily, or through theft of goods or through injury to feelings.These were the only sins."

33

^ 20

Re: studying the incentives

JimmyHavok.

Sat Aug 02, 2008 at 10:01:56 PM EST

none

A little late, at that point.

34

^ 33

Re: studying the incentives

Lou.

Sat Aug 02, 2008 at 10:06:29 PM EST

none

or you could come back and haunt them...

woooWOOOwooo

It's the end of the world as we know it, and I feel fine

5

Eliminate the presumption by requiring an answer.

MC Nally.

Fri Aug 01, 2008 at 02:16:53 AM EST

none

It seems to me that rather than presume consent, a better approach is to require an indication of organ donation preference on driver license applications and renewals.  Perhaps it works differently in Canada but in the states I've lived in in the USA the general rule is for the license to be issued without any indication of organ donation preference and for those who want to make their organs available to have to take an additional step of some sort.  Even if it's as simple as just filling out the sticker that came in the same envelope as the license and slapping on the back of the license there are still presumably some people who would consent to donation but never get around to filling out the sticker (or taking whatever step is necessary to change their answer from the default.)

So my suggestion is: eliminate having a default answer at all and require an answer in order to get or renew a license.  In a few years everyone will have a preference on record and nobody will have to presume anything.

11

^ 5

asked. answered. license printed.

1fastdog.

Fri Aug 01, 2008 at 10:25:10 AM EST

5.00 (informative, informative)

So my suggestion is: eliminate having a default answer at all and require an answer in order to get or renew a license.  In a few years everyone will have a preference on record and nobody will have to presume  anything.

That's how it works here in PA. When you show up to get your photo taken for your license pic, you must answer a couple of questions - "do you wish to be an organ donor" being one of them - before they'll take your picture and print out the license.

Somewhere in my soul, there's always Rock -n- Roll... Joe Strummer

19

^ 5

Re: Eliminate the presumption by requiring an answ

thefadd.

Fri Aug 01, 2008 at 05:48:05 PM EST

none

I have an idea for a system. If people want to donate their organs, then they can put a sticker on their driver's license saying that's what they'd like to have happen. If people don't want to do something (like say donate organs), then they don't have to do anything at all. Then, all the do-gooders who want to be up in other people's business can just go away and stop bothering everyone. I think that'd be a pretty ideal system.

It is easy to buy small plaster models of what you think life is like.

21

^ 19

Re: Eliminate the presumption by requiring an answ

MC Nally.

Fri Aug 01, 2008 at 08:34:28 PM EST

none

thefadd wrote:

I have an idea for a system. If people want to donate their organs, then they can put a sticker on their driver's license saying that's what they'd like to have happen. If people don't want to do something (like say donate organs), then they don't have to do anything at all. Then, all the do-gooders who want to be up in other people's business can just go away and stop bothering everyone. I think that'd be a pretty ideal system.
In what way would your system be superior to the one I suggested?

23

^ 21

Re: Eliminate the presumption by requiring an answ

delete me.

Sat Aug 02, 2008 at 10:00:19 AM EST

5.00 (informative)

The EMTs can add the sticker to your license when they pull your mangled body from your wrecked car.

- derumi (del-me)
"Bobby Fischer? Man, that guy is crazy!" - Mike Tyson

37

^ 21

Re: Eliminate the presumption by requiring an answ

thefadd.

Mon Aug 04, 2008 at 10:36:16 PM EST

none

Because it would require less paperwork.

It is easy to buy small plaster models of what you think life is like.

16

Donation

Lou.

Fri Aug 01, 2008 at 01:44:22 PM EST

none

I hope they get this worked out soon or we may all be facing a dark future if we choose to be organ donors.

It's the end of the world as we know it, and I feel fine

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