I can't say I've ever given much thought to the issue of how to increase the level of organ donations available, but switching from an opt-in system to an opt-out system strikes me as the obvious step to take. It would increase the number of organs available -- default rules always turn out to make a big difference -- while still clearly respecting the wishes of anyone who had strong anti-donation feelings. Offering enhanced incentives for donations of some kind, as suggested by the Post, might be a good idea, too, but I'd definitely like to see the results of simply converting to an opt-out system before doing much else -- it seems like a no-brainer to me.
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Opting Out
18 Oct 2006 11:56 am
Comments (29)
As a physician who works on both ends of the organ donor issue, I agree that an opt-in system would be preferable, but I doubt it would make a huge different. The current opt-in system is not legally binding. That is to say, if you are judged to be brain dead, your next of kin still has to consent to your organs being donated, regardless of what it says on the back of your drivers license. In the rare situation where there is no next of kin, it might make a difference, but I don't think it is all that common.
"Opting out" systems creep me out: my organs aren't on loan to me--they're mine. That is just a naive reaction, and I'm willing to believe that making organ donation the default would have tremendous benefits and few costs. But it creeps me out.
I think Austria has an opt-out system for organ donations. Also, they've had a big problem with zombies over there. Not sure if the two things are related.
> I can't say I've ever given much
> thought to the issue of how to
> increase the level of organ
> donations available
I take it then that no member of your family has ever been on an organ waiting list with a terminal condition. Which is good for you, but the problem is severe even though you haven't experienced it.
Cranky
Matt, if an idea is a "no brainer" Congress and the President are assured of making a hash of it. These are the same people that'll let millions suffer from various diseases rather than utilize clumps of embryonic cells on the way to the garbage in fertility clinics and hospitals. People die every day to further political agendas. In Iraq and here at home politicians are killing us every day. Here's how you improve organ donation policies: Figure out a way a better donor system would improve cash flow to the RNC. Then it'll happen.
You can have my liver when you pry it from my cold, de- oh wait.
Yea to an opt-out system. My mother-in-law will live for several years more because of the donor lungs she received last Jan.
To see her now--digging holes in the sand at the shore with her grand children, riding bicycles, etc--versus a year ago, when she couldn't go 100 yards without excruciating pain, has made me acutely aware of the need for better organ donor protocols.
Oh, an actual opt-out system would be great but then there is the question of overall trust towards the health care system. Given the endemic corruption of our system, mine is stricly zero.
I don't want to give any incentive to a physician towards removing me from life support, pronouncing cerebral death and hack me for organs. Intensive care units are theoretically organized to avoid this conflict of interest and I would not have this concern in pretty much any other first world country. But given the prevalence of official or unofficial kickbacks at every level of the system, American health care is far too rotten with financial interests to trust it blindly for any decision, life/death decision and subsequent organ removal being certainly at the very top of the list.
How about (quasi)tit for tat? You can choose not to donate your organs but the people who get priority for organ donation are those who have always had the "yes" box checked.
... combined, of course, with making the decision legally binding.
I'm with SCMT on this. The presumption that the state has the right to my organs when i'm done with them, while not making an actual difference, is creepy. A television campaign encouraging people to opt-in, while more expensive, I would find preferable.
> "Opting out" systems creep me out:
> my organs aren't on loan to me--they're mine.
When you are dead, there is no YOU to own the organs. Besides, if it's creepy enough, just opt out.
It will never happen.
Some religious denomiations—notably Orthodox Judaism—have restrictions or prohibitions on organ donation (or desecrating the dead, more generally). As soon as such a person inadvertently forgets to opt-out when they get their drivers' license and has their lungs removed, the opt-out system ends.
See here for a complete list that's spun pro-transplant.
Maybe Bush can insist Congress pass some sort of donor act. Wouldn't matter if it was legal or made sense. You know, maybe the "We're Taking Your Fucking Kidneys And Giving Them To Sick Republican Kids Act" and if you don't like it we'll have you rendered to Syria for some electrodes on your testicles, asshole!
While we're on the subject of opt-in vs. out, why are we still doing opt-in with 401Ks? I gather there's been a bunch of studies showing participation would go up greatly with a switch to opt-out, but nothing ever seems to get done about this.
The "creepiness" argument doesn't work. If you don't like it, for whatever reason, then you opt out. The fact that it is creepy to you isn't a mark against an opt-out system.
The opt-out system is a great idea. It should be coupled with BaalShemRa's suggestion of first giving organs to those who donate their own.
How about only making donated organs available to people who sign up as doners? That would create an incentive for people to sign up.
Also, allow people ineligible to donate (for whatever medical reason) to *sign* up as a doner. Parents could sign up their children a birth, and the kid would have the right to opt out at 18.
Seems fair to me. The only hitch is preventing people from signing up as doner once they're diagnosed with a problem that requires an organ donation.
--Beo
Might be easier, and less controversial, to just make it mandatory to answer the organ donor question on the driver's license form, so that it won't be processed if that line is left blank. If the problem is that people aren't bothering to answer at all, rather than there actually being any widespread objections to organ donation, then merely bringing it to people's attention will have the same sort of benefit as an opt-out system.
My wife is awaiting a kidney, so I have long advocated opt-in. They have this in Europe, but still have long waits as the auto death rate there has been cut drastically.
We don't even like opt-out as a way of authorizing spam. It's not going to be any more popular as a way of authorizing people taking pieces out of your corpse.
"I think Austria has an opt-out system for organ donations."
Unfortunately, we do not, though I reckon we should. It should be phased in --- everyone who turns, say, sixteen (or whatever age the doctors advise is appropriate) after the law is proclaimed is part of the opt-out system. Everyone else stays in the opt-in system.
If that's not politically possible, then some effort should be made to ensure that everyone who opts in has their wishes respected. This means restricting the family's right of veto over organ donation.
The "creepiness" argument doesn't work. If you don't like it, for whatever reason, then you opt out. The fact that it is creepy to you isn't a mark against an opt-out system.
The creepiness lies in the fact that you've given the state the default ownership of my organs after I die; it's the "default" that's doing the work. So being able to opt out doesn't really address the issue. And, yeah, I've signed up as an organ donor (assuming that the license thing is all you need to do).
This reminds me of the Monty Python sketch. "We're here for your liver."
I find the whole idea creepy as well. I'm sure you guys have heard about the Kidney of Doom, right? It's this kidney that's been passed around to multiple recipients. Each patient recovers from the transplant and the kidney takes, but then each one has developed some other problem or has been the victim of an accident. Brain cancer, suicide, car crash, etc. The patient dies and the organ is donated to someone else. Apparently it's still out there in circulation waiting to kill the next poor unsuspecting bastard.
Just Karl's point takes the creepiness arguement to a whole new level. I know you're being facetious, but still, the idea of the kidney of doom is the exact type of thing that makes people leave the organ donation form blank. Yet another arguement for strict consequentialist thinking in policy decisions. Even if the kidney of doom was something that happens, it seems pretty clear, that on a whole kidney donations save more than they kill. So, increasing the amount of available organs seems to be a sensible policy to pursue.
Also, SMCT, you haven't seemed to actually refute the point that the creepiness arguement is a classic Leon Kass like "eww thats gross it must be immoral" (http://volokh.com/posts/1159462802.shtml) arguement. This is worse than deriving ought from is, it's deriving ought from "eww". Again, i don't see how an opt out system wouldn't solve any of SCMT's issues with the state having "default ownership" over one's organs. People making this arguement have a pretty high burden to prove that this "default ownership" is somehow worse than there being more organs ready for donation, because it seems to be standing in the way of a lot of good
I bet lots of people would opt in for a $5 discount on their driver's license fee. I like the opt out idea, and the priorty list for people who are willing to donate.
Personally I might have a problem with donating tissue for purely vanity cosmetic procedures - I'm not talking burn victims, but folks who want to not have so many wrinkles. I would want some compensation for my next of kin on that one.
How about only making donated organs available to people who sign up as doners?
Using organs for medical purposes is one thing but signing people up as doners really is creepy.
(Sorry, that was obnoxious but I couldn't help myself.)
Also, SMCT, you haven't seemed to actually refute the point that the creepiness arguement is a classic Leon Kass like "eww thats gross it must be immoral"
I haven't refuted it because I haven't claimed that the creepiness makes it immoral. I've claimed that creepiness makes it creepy--morality doesn't enter into it. The default at the moment is that you have to opt-in to the organ donation system, which means that, at the moment, the burden is on you to overcome my sense that it's creepy rather than on me to argue why the system is inappropriate.
FWIW: I'm not sure why, precisely, this is different than finding creepy the alleged Mormon practice of baptizing dead non-Mormons. I can't see what harm it does, but I still find it creepy.
While we're on the subject of opt-in vs. out, why are we still doing opt-in with 401Ks? I gather there's been a bunch of studies showing participation would go up greatly with a switch to opt-out, but nothing ever seems to get done about this.
The Pension Protection Act, one of the few actual significant pieces of legislation passed this year, lifts several of the barriers to automatic enrollment (the "opt out" default). Traditionally, these barriers have included state laws against involuntary wage garnishment (which have been interpreted to cover "garnishments" that are earmarked for benefits programs), as well as a lack of guidance on WHAT, exactly, an opted-in employee would be opting in TO. There needs to be some set of default investment options for a worker who doesn't actively select them. If the employer is going to set the options, then it has taken on fiduciary duties under ERISA to ensure those options are suitable to the employee. Establishing formularies to determine such things is hardly an exact science, and without some form of safe harbor, which the PPA grants, the plan's directors would be stumbling into a litany of potentially actionable situations.
Comments closed November 01, 2006.
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Heads in the Sand
I'd draw the line at donating my brain.
Posted by Dix Hill | October 18, 2006 12:12 PM