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?

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

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.

Great point . . . . how many places will one need to have it documented?!

steph

[fergus51]

I think it would be great. A central list shouldn't be to hard to maintain, and if people feel strongly they can opt out. I just don't believe in letting people die on principle (stopping rather than initiating). People are much more likely to have their wishes to donate be ignored. Unfortunately this type of system will never happen in the US. Anything that is for the common good AND involves the government brings out worries of socialism, and that is the kiss of death in America.

I also feel that people on the opt-out list shouldn't be ever put on waiting lists, but that's another story.

[psychomachia]

I think it would be great. A central list shouldn't be to hard to maintain, and if people feel strongly they can opt out.

And I say they can "opt in" if they feel strongly. What's next, "opt out" plans for euthanasia?? Sterilization?? I admit it sounds far-fetched, but if you trust your govt. that much, well maybe you wouldn't mind if they take your house / car / money / belongings when you die...'cause you're not going to need them, right??

I just don't believe in letting people die on principle (stopping rather than initiating). People are much more likely to have their wishes to donate be ignored.

Did you read my post about the problem other countries have with presumed consent?? The families still get their way with the corpse, and you can bet that will happen just as much here as it already does.

Also, how does one protect a patient's right to be FULLY informed. Can you truly expect our government to implement a program of informing the entire populace?? And what will you do when a presumption of consent turns out to be a mistake?? Ooops...sorry...

Unfortunately this type of system will never happen in the US. Anything that is for the common good AND involves the government brings out worries of socialism, and that is the kiss of death in America.

It won't happen because one of the fundamental rights in this country is the right to privacy and property. If you think socialism is a better choice....well......Bye!

Speaking of common good, are you aware that the higher the level of education, the more likely the person will be an organ donor? Why don't you spend my tax dollars to improve both the education level and the organ donation rate of this country??

And what if presumed consent doesn't meet the demand?? Will you continue to demand for the patient's right to autonomy and consent to be eliminated??

The government is merely a servant -- merely a temporary servant; it cannot be its prerogative to determine what is right and what is wrong, and decide who is a patriot and who isn't. Its function is to obey orders, not originate them. -- Mark Twain

[fergus51]

Wow, take a breath! Yeah, I am in favour of instituting socialism in America and opt out programs for sterilization and not educating people and taking organs from those who have expressely said they didn't want it done just to meet demand.... Believe it or not, I am not a nutcase.

There are already presumed consent set ups for medical studies in the US. It isn't so far fetched or out there.

No, i don't think opt-out rules in this case would mean that the government will try to steal my family's inheritance or apply it to sterilization or euthanasia or anything else. (In case you didn't notice, I don't even think they will apply it to organ donation).

I think laws can be written so that the person's who has died will have their wishes respected, rather than defer to the family. There could be mistakes, but that's true of any system and doesn't generally make me decide to give up an idea as useless. It makes me want to know how proponents plan to deal with the possibility of mistakes.

As far as education... Unfortunately i don't get to decide how to spend your tax dollars or mine for that matter. I would be thrilled with making education more available to people.

And no, if presumed consent doesn't meet demand I will not advocate mandatory organ donation from people who do not wish it. I find it pretty insulting that you would even suggest that when you obviously don't know me. Just because I think an opt out system is a good idea doesn't mean I am some crazy organ snatcher.

[jkaee]

The problem I have with "silent" consent is the following scenario (now, I know this may be far fetched and maybe there are clauses in the law in this situation, but it's the first thing that popped in my mind).

The law states that people need to tell the government "No" to organ donation, otherwise their organs will automatically be used. What about children? What parent, as soon as they bring their infant home, runs out and decides about organ donation? So, God forbid something happens to this tiny baby. Well, the parents didn't decide one way or another, but now it's too late. Since they didn't register "no" for their child, their childs organs are automatically taken?

Granted, maybe they have clauses in place for situations like that, but if organ donation is running low, who's to say they can't "unclause" the law? Who's to stop them from doing pretty much anything?

I say stick with the present way....there's too much left for corrupt people to abuse in the silent consent law.

[Gldngrl]

After seeing many of whom were able to obtain transplants despite noncompliant histories, minimum abstinence from substance use, and those who've gotten transplants, rejected, gotten another,etc. I and several of my colleagues have second thoughts about organ donation. I realize not all programs are alike, but these experiences I believe create ethical questions for further consideration.

[Robinette]

"Don't take your organs to Heaven. Heaven knows we need them here."

I understand what your concerns are. Organ donation can be a hot and often misunderstood topic. Personally, I like Italy's method and wish it were so in the U.S.

[fergus51]

I have a t-shirt with that written on it Robinette. It's quite a conversation starter. I think I have personally done my job about educating people cause they always say things like "But, then can't they use your body for experiments?" and "But, they can use any part of your body then can't they?".

[BeachNurse]

Those of you "re-thinking" organ donation because of all the non-compliant patients, please think of the innocent children like my son who was born with a liver disease. He received an adult "cut-down" liver...2 days before I was to undergo surgery to donate a portion of my liver to him. These kids go through so much.

[Headhurt, ADN]

I think that many people do not address their own preference to organ donation is that because it is addressing their own mortality...and most Americans seem to have problems admitting that they are going to die. Some people look at it as "if I don't talk about it, it's never going to happen".

Speaking from personal experience, most families are quick to decline donating their loved-ones organs in that emotional time because that alone is conceding that there is no hope for a recovery for their family member. "If you take her heart or lungs, then she is never going to have the chance of living (even though docs have declared that person brain-dead)."

I've been on all sides of the arguement: a family member being asked to sign a consent for organ donation for my dad, the best friend of a girl who needed a kidney transplant, and the staff member talking to a patient's family about organ donation (only because they asked me what I thought).

I declined donating my father's organs, and it is a decision I have regretted ever since.

Just because you're an organ donor, doesn't mean the doctors are not going to do everything in their power to save your life when the need arises. I think some people get the idea that once you sign your card, you essentially sign your life away.

I agree the U.S. should adopt a practice similiar to Italy, but with stipulations (such as age and circumstance).

[Nurse Ratched, RN]

Just because you're an organ donor, doesn't mean the doctors are not going to do everything in their power to save your life when the need arises. I think some people get the idea that once you sign your card, you essentially sign your life away.

Exactly - there does seem to be a misconception (not here, but in the lay public) that having an organ donor card marks you as "spare parts" in the event of an emergency, rather than a patient.

Ashes to ashes; what does it matter what happens to your shell after you're gone? Unless you have very specific religious concerns (and those folks would be sure to "opt out" and should also be precluded from receiving organs) then seems like once you're gone, your body should go toward some useful purpose. Hubby already knows - organ donation, science experiments, medical school cadaver, fertilizer, whatever; I am an avid recycler in life; it would be way cool to think I could do it one last time.

[Love767]

The way this would work is that if you agree to donate your organs you would be placed in a higher priority status should you ever need an organ. Obviously, this wouldn't apply to kids, or the mentally impared. I am already a donar, but if I was on the fence (or just lazy) knowing that being a donar might mean that I could more easily get a kidney or liver (in the event I needed one) would probably push me over onto the donation side. Also, I think that the government should consider offering incentives for healthy living donars of a kidney, part of the liver, or bone marrow. If I could have part of my student loans forgiven I might give a kidney, and would certainly consider risking part of my liver . In fact I think many people would do this for free, but offering some compensation wouldn't be a bad thing considering the likely lost work (and considerable risk) involved.

Also here's another related question. Why can't parents donate the placentas from their children for stem cell research? My microbiology professor said that there was virtually no difference between the stems cells that come from foetuses (aborted) and those that are available in the "cord blood" of placentas. It seems like a whole lot of cord blood (and the stem cells inside) are being wasted. Plus, I'm not aware of any ethical objections by anyone to using cord blood which would just be thrown away anyway.