another ethical subject - organ donation and the government

[IowaCindy]

This week's class discussion that's stuck with me has to do with organ donation. In Italy, there is a silence/consent rule. Unless you specifically sign that you DON'T want to be a donor, the presumption is you do - and at the appropriate time after 3 physicians declare you dead, your parts will be used if/as needed. (That's the Reader's Digest version of the Italian law as I understand it.)

I think I was the only in class who considered this a scarey prospect. My classmates felt this should be the American standard.

I on the other hand heard the footsteps of Big Brother. I must have been the only one listening.

My initial thoughts on this have been:

1) I don't consider my body to be a resource for the government.

2) Just as there is a problem now with available organ donation that is linked to a lack of 'informed consent' and education of the general public, doesn't the Italian law use that lack of education to procure organs without informed consent?

3) I'm not sure how this fits but it's nagging at me - if many claim that the government shouldn't tell a woman what to do with her body (abortion), how can the government enforce this?

4) I think this is just another step down the 'slippery slope' - could this lead to non-treatment of persons deemed to have little value in life (MR, Alzheimer's, etc) in order to have a source of organs? I know that's a far-fetched supposition but I think it's a reasonable concern.

I think that there should be a vastly increased education process through which hopefully many, many people would consider organ donation. Of course, I realize that this would have to go with increased education in STDs, birth control, the hazards of smoking...all those health issues and more that can result in increased human misery. And where would it happen? Who's going to fund it? etc., etc., etc.......

I have signed my driver's license and discussed my wishes with my family so should the occasion occur, they'll respond as I've directed. I believe in the absolute value of organ donation.

However, the Italian protocol scares me.

What do y'all think? Wanna discuss?

[jnette, ASN, EMT-I]

With me, its the idea that the state has the RIGHT to your body once you die unless you specify otherwise. Thats not how civil liberties work. If you want to do something, then you choose TO do it, not tell the government that they can't. To me that just sounds backwards. We should be very careful what rights we give up, because if we were to give a little, the goverment would be more than happy to take 5 times as much.

I understand it would save more lives, but I don't agree with the price. I'm all for better education.

yeah...... actually, the more I think about it, and the points you make, the more I tend to agree with you guys here. I guess initailly, I thought it was a pretty fair idea seeing as so MANY ppl just don't educate themselves enough to even care one way or another.

But I'll have to concede.. I do think a greater push on the education front is the better way to go with this. When and where to start? How to make folks aware...? ALL our citizens, not just the "educated"... so that each individual will indeed be prepared to make an informed decision in a timely manner?

How to create that "conscious awareness" ? So many have never given it the first thought.... then there are those that have no driver's license for whatever reason... how do we reach ALL ?

[psychomachia]

This week's class discussion that's stuck with me has to do with organ donation. In Italy, there is a silence/consent rule. Unless you specifically sign that you DON'T want to be a donor, the presumption is you do - and at the appropriate time after 3 physicians declare you dead, your parts will be used if/as needed. (That's the Reader's Digest version of the Italian law as I understand it.)

Presumed or "silent" consent is not new. France enacted a policy in 1976 and other countries, such as Spain, Finland, Belgium and I think a few others have similar laws - unless you opt out, your're in.

However, that does not mean that one is not informed. The person who "silently" gives consent has to be shown to have known (not sure how) about the law. Also, it seems that opt laws do not make a big difference in Belgium and Spain since the relative wishes are obeyed (http://www.nkrf.org.uk/pages/awareness/indexa.htm).

Perhaps actions are better than laws. When 7 year old Nicholas Green was shot by bandits in Italy and died 2 days later after being declared brain dead, his parents donated his organs. Seven Italians received organs from Nicholas and the result was a huge increase in the donation rate for a country that had been historically very low.

[Nurse Ratched, RN]

I'm okay with the idea that your parts are up for grabs once you're gone unless you specify otherwise. As someone else said, what do you need them for at that point?

[psychomachia]

I'm okay with the idea that your parts are up for grabs once you're gone unless you specify otherwise. As someone else said, what do you need them for at that point?

I agree that no one "needs" their organs after death, but the problem comes when the government takes something against your will. There are some who refuse donation on religious beliefs/practices and others who are simply unwilling regardless of their belief. They should have that right. By stating that YOU have to "opt out" is too easy for the government because NO ONE is entitled to ANY part of you or me without our permission.

With that said, I also feel that should I choose to be an organ donor, my family had better allow my wishes to be honored. It seems as though many would like to donate, but their relatives have other plans. Too many physicians are more afraid of the relatives' lawyers than they are of the patients'.

[talaxandra]

Surveys demonstrate that the majority of people agree in principle with organ donation, but only a tiny number of us take the steps needed (register, indicate willingness on our drivers license, talk about our wishes with friends and family). Because it's not something that's often talked about, particularly by the optimal donor pool (healthy young people), families are often left with no idea about what the potential donor's preferences were, and opt for the less squeamish option.

In an opt-in system (as used in Australia, NZ, Canada, the UK and the US, among other countries), most people have only a sketchy idea of what's involved, and few people consider what they would prefer.

The idea behind opt-out donor policies is that it obviates some of that uncertainty. A by-product is that, as donation becomes a norm rather than an exception, more people become familiar with the concept - they know (or know of) someone else whose organs were donated. The idea of organ donation becomes less hidden, there's more community discussion, and people become more comfortable with talking about it. Part of introducing an opt-out system is public education, which also contributes to informed debate and decision-making.

People who decide against donation make their decision known the way people on opt-in systems do - tell their family, note it on a drivers license, or include it as part of an advanced directive.

[jnette, ASN, EMT-I]

You explained it far better than I could have worded it, but these were my thoughts exactly... just didn't know how to get it on "paper". Thanx.

Am still undecided, however. I like it in many ways, but there were some issues raised above which gave me pause... still gotta think this through some more.

At any rate, my choice is clear on my license... and family knows as well.

Just wish that (as you said) the great majority would spend more time and thought on this as well.... and that we could find a way to really educate the people. ALL people.

[BeachNurse]

Our 10 year old son is alive today because someone signed an organ donor card...that person's family gave consent. Our then 11-month old baby received a liver transplant on 4/18/1994. Today he is an active, healthy boy and to say we are grateful is an enormous understatement. This year is his 10th year with the "new" liver..we are having a party!

Our family members are all organ donors. I do believe that people should give consent. The problem with the organ shortage needs to be addressed with more awareness programs. I have volunteered and spoke at some places in this regard.

[psychomachia]

People who decide against donation make their decision known the way people on opt-in systems do - tell their family, note it on a drivers license, or include it as part of an advanced directive.

But the government is placing the burden on the individual to STOP something rather than to INITIATE. As individuals, we have the right to not have ANYONE do ANYTHING to us without our consent - we don't have to tell everyone who may decide they want something from us they can't have it - IF we choose to share something with others we DONATE it - individual freedom is far more important than increasing donation rates, which as I posted previously do not increase significantly with an opt out system.

A generous gift from a seven year old and his family did more for organ donation than any government plan ever could. Perhaps the issue should be spent on education and acknowledging the actions by donors and their families rather than an unneeded government intrusion into our privacy.

[athomas91]

I agree that no one "needs" their organs after death, but the problem comes when the government takes something against your

do you have a "will" when you are dead?? LOL

[psychomachia]

do you have a "will" when you are dead?? LOL

???????????

[Spidey's mom, ADN, BSN, RN]

If only a tiny number of people "opt-in" because it isn't talked about how is changing the system to "opting-out" going to change anything regarding educating folks about their options? People are still going to be reluctant to talk about it and people are still going to be under-educated about it. Have you ever tried to do any patient teaching and then find out later that the person took in about 1/10th of what you said?

I'm with the folks here who think the government needs to get my consent before they do anything with my body and with those who think once I've signed the donor card, my family should have no say.

Fix the system in place now and do more education instead of giving the government more power. Dead or alive.

steph

[fab4fan]

This is a terrible idea. How many places will one need to have it doumented if he/she does not wish to donate?

I am not a donor, for my own reasons. This should be a personal choice, and no one should demand an explanation as to why someone does not donate. A person's choice should simply be respected, whether or not you agree/disagree with it.