Presumed consent in organ donation

Or his charge sheet.

 

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In one sentence? I'm not a sweet old lady you know.

I would of course presume in reality any organs from a crime scene are not to be re-used prior to a completed investigation. So the trick is not to make it look like a crime, or to bribe the coroner.

Ok sensible time:
Regardless of whether or not a dead person needs their organs, they're technically still their organs, and taking without consent should be considered theft. It's why we don't use presumed consent when it comes to taking someone elses car for a drive. I know a lot of people are just too lazy to sign the consent forms, but presumed consent just seems wrong to me. It should be a conscious decision made by the donor, we just need to encourage it better and make it easier for people to opt-in.

 

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It's a disgusting idea and would just be another abuse of government power.

 

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You underestimate Islam

Are all principles applied generically, or does circumstance carry any weight? In the case of the latter, is there a significant difference, as you see it, between a living person and a dead one?

The greater good underpins the entire concept of the ummah. To the other, the mullahs and imams are not the final word in Islam; that authority belongs to Allah. If any Muslim is mistaken in their understanding of that authority most high, they will have their day of reckoning. As with any faith, Islam's significance is individual; how each person experiences the divine and understands Its instructions is entirely their own. We tend to forget or overlook this in these fearful days of war and terror, but history teaches this result nonetheless. Ana al Haqq. What was heresy to the authority of its day persists nonetheless, because it is a truth that cannot be objectively refuted.

When we restrict people to contemporary definitions centered around immediate perceptions, we tend to identify them too narrowly, and thus wrongly.

As such—

—we might also say that those who are not willing will also have their day of reckoning with Allah. The underlying question of societal obligation seems hard enough, but one thing about religions critics often underestimate is their flexibility over time. It is not impossible that Islam can be reasonably interpreted to instruct the faithful in such a manner that they would be willing.

 

And this is where market forces come into play. Why do you think power plays such an important role for organ donations? Why is the kidneys of poor people which are sold with greater frequency than those of the idle rich?

And indeed they are. Blood, bone marrow to name a few.

I am approaching the issue from a pragmatic viewpoint. We are not talking about giving consent for organ donation. We are discussing a procedure to opt out of it. We already live in a society where prima facie if a doctor is faced with two bodies in the ER, one which is medically dead and the other which requires an emergency transplant to survive, it is the second which will have priority as a patient. At that point, if I were the medically dead, it would be ridiculous [and medically impossible] to ask me if I want to take my organs with me, rather than offer the choice of survival to another - my family or the law may prefer to keep me attached to machines a la Schiavo without my consent. I have seen cases in the ER where people have watched their family, their children suffer and die because so many dead people would rather take their organs with them to the compost heap. If we live in a society where we cannot trust the doctors medical opinion because he is looking at his profit margin [or that of the insurance industry] we have only to look at ourselves why the society is biased/based in such a fashion. A self centered individualistic society cannot be one that looks to the society at large.

If we now want to establish ownership than we are bartering organs and our own organs should be on the market place if there is to be an equitable market

Islam is all about choices and motivations. You make your choices and face the consequences. Thats utilitarian enough. Personal responsibility should be equivalent to personal rights.

How many people would opt out of organ donations if it meant they could never even receive a blood donation from someone else?

Indeed and I would ask any of these Muslims if they would too refuse a donation which was the blood, marrow or organ of another.

Or direct them to something like this:

Ultimately, its a personal choice.

I've already offered my suggestion. If you opt out of organ donation, you should disqualify for one.

Again, all opt out forms should disqualify the opt-outer so that there are no misunderstandings

 

I am in favor of an opt-out system. The problem is that people do not decide to opt in or opt out rationally, We *think* we do, human beings are not rational in a strict sense and typically take the default outcome in these situations no matter what it is. There is a "framing bias" in cases like these.

See for example, this video where the discussion of organ donation starts about 5:05: http://www.ted.com/talks/dan_ariely_asks_are_we_in_control_of_our_own_decisions.html

The whole video is worth watching and tends to back Hume's belief that "Reason is, and ought only to be the slave of the passions, and can never pretend to any other office than to serve and obey them."

 

Sure that's a benefit. More organs lower, but no doubt still appealing, prices on organs. But this doesn't really address my point. At this point organ donations are not working for the greater good, nor will they be after this legislation. We are still talking about a misappropriation of funds and other resources once the situation of poor people is brought into play. Yes, more organs would be available and this would drive down prices, but they would still be high for many non-westerners. However the operations themselves will still be prohibitive, and by the standards of many, perhaps most world citizens, hysterically high, and many more could be saved if instead of the operation issues poor people deal with were tackled first. A consistent greater good approach would remove organ donation, at least for the near future, from the table. The issue is moot now.

Did you really not understand what I meant? Further bone marrow is not 'an organ' and while sometimes the blood IN TOTAL is considered an organ no one donates all their blood, so they have not given you 'an organ'.

Not quite a response to the issue I raised. General good arguments can be made for harvesting organs from, for example, prisoners on death row. One killer could save five people, restore sight to at least one more and so on. But we do not do this. Most people do not fully work from greater good principles and generally they don't because of human feelings.

I tend to agree, however it seems that there is some controversy within the Muslim community about organ donation and the family of the dead person's right to withhold consent.

Irrelevent.

Sure, but the point is that what is happening is that a significant minority of religious people do and will have objections to the proposed law. After you have convinced them with your arguments, we will be in a different situation. Further you keep missing one point. The proposal means that we will have situations where a dead person is presumed to be available. We cannot at that point, in most cases, see if they were consistent in their beliefs.

Right and I have some respect for that idea, though I could see pacifists running into problems with that kind of logic. Since they can be seen, often, as reaping the benefits of soldiers, it seems they could have certain rights stripped in and after wartime.

 

Hence my "opt out and disqualify yourself" suggestion.

No there isn't. I don't know of any Muslim community that bans organ donation, do you? There may be individuals with opinions which are not mainstream, but then, there always are. I doubt that Leicester, UK qualifies as one of them.

That does not need a change in law to happen. Like the draft or the patriot act.

 

A Hippocratic Hitch?

Opt Out/Disqualify: A Hippocratic Hitch

Presumably, if few enough people opt out, there would eventually be more organs available in the U.S. than needed. Thus:

A doctor receives a patient who is critically ill. The patient requires a new liver. There is one available; the operation can begin within a matter of hours. However, the patient is one who opted out of organ donation. Should the doctor refuse to perform the transplant?​

We can presume that the transplant organ is not needed anywhere else at the moment.

What I'm asking about, specifically, is the position such a scheme puts doctors in. There are, foreseeably, times when doctors would be expected to deny lifesaving treatment as a matter of public policy. We presently have enough problem wrangling with the issue of treatment denied by insurance companies, and what a doctor should do in those times. Generally speaking, we support those doctors who fulfill their oath, criticize those who do not, and revile the institutions that put the choice in front of them.

Would I deny the patient, was I a doctor? No. And if they came for my license, so be it. Of course, ask me again if I'm ever a transplant surgeon facing the loss of my practice for such a decision.

 

Your prerogative, of course. I have seen conflicting information regarding "official positions" of various religions, sects and churches on organ transplantation.

For example:

By the way, I have seen the "Orthodox Jewish" objection pop up several times, but if you check "official sources", it appears to be a myth, at least according to public statements.

Nonetheless, the Judaism objection is still alluded to, even from reputable sources - Mayo Clinic Facts:

(Emphasis mine.)


More frequently, I see references to resistance from "the masses" based on their interpretation of "God's will" and the sanctity of the human body. The articles don't seem to cite the source of this conjecture, but this "objection" is mentioned numerous times in articles regarding implementation of legislation. Hence - speculation, at least at this point.

And one for you:

Surely you are not advocating that people avoid hospitals because doctors make mistakes, right?

The Mayo clinic seems to address your concerns, directly on point:

Maybe you consider this an appeal to authority, but I highly doubt that the error rate is greater than (or even approaches, IMO) that of the overall percentage of "oops" as mentioned above per the Institute of Medicine as quoted by CBS News. People screw up, doctors are people, doctors screw up, people die. This can not be used as a be all, end all reason why opt-in is better than opt-out.

I doubt this - can you back up the implication? If we were talking about harvesting of black-market organs, in the sense mentioned below, I would wholeheartedly agree with you. In this case, assuming absolute veracity in the relating of the story, it still sounds more like an (unfortunately) all too common, yet mundane, screw up - similar to those mentioned above.

From your "Blackmarket donor compensation" link:

Emphasis mine. If you are contemplating paying people, directly or indirectly, with money or some other compensation, don't you think that approach is going to pour some water on the "slippery slope" and put in a little quicksand at the bottom for good measure? Perhaps we should first try making the "opt-in" approach a little easier, there seems to be some difficulty in this area (USA Today):

I could mention unfounded speculation, but that would be counterproductive. I welcome your thoughts. Specifically, why do you hold this to be true? I've offered religious beliefs, I concur with the possibility of corruption, others have mentioned "no more governmental intrusion". What is your opinion? All I see, and perhaps my sight is dimming, is a greater likelihood of mistakes. A valid concern, but as I have already pointed out, I doubt the rate of "mistakes per donor" would be any higher than the normalized rate of potentially lethal "mistakes per patient" that I cited earlier. In fact, a case could be that the ratio would be lower.

As an aside, I ran across this perspective in USA Today as relates to governmental intrusion:

Couldn't the same be said about "ignoring" or "missing" the opt-in option? Mistaking "Opt-in" would only (potentially) cause someone's death, as opposed to the converse - after all, missing the "Opt-out" might result in the desecration of a corpse. Hmmm...

I missed the part about where we discussed limiting relatives' input on the decision. As you pointed out, doctors "routinely" ignore DNR requests, I'm quite sure that the family will still have a say in overriding an "Opt out" - probably more so than with an "Opt-in". Don't you agree?

(Emphasis mine) They can't? Why not? "Uhhh, I misread the chart, could've sworn the "opt in" box was checked, you know, kind of like that DNR I, ummmm, "misinterpreted" last week?" Please. Explain why a doctor is more likely to misread "Opt-out" vs "Opt-in".

True. You don't need any reason at all to hold an opinion, I just expected more from you. Not sure why at this point, but I feel like I am touching a personal nerve here. I apologize. I won't ask for future substantiation of your opinions on this issue.

Sure it is. No requirement that you should state your own reason(s).

That would be dependent on your definition of "service". Now wouldn't it? Plus, read what you wrote - it's a money making machine for everyone except the two most important participants. One (in many cases) received the gift of life, the other (in many cases) was already dead. If you object to transplant teams making money, or as much money, than address that problem. Don't hide behind fallacies disguised as "Opt out" arguments.

I call bullshit. Here is a partial list of funding sources for transplants in the US. There are other private foundations in existence to help with the costs as well. These sources may not cover every penny, may be difficult to be accepted in, but they definitely invalidate your assertion.
* insurance
* Medicare and Medicaid
* charitable organizations
* advocacy organizations
* Veterans Administration
* fundraising campaigns
* prescription drugs assistance programs
* TRICARE (CHAMPUS) and the Veterans Administration (VA)

Irrelevant.

That argument is so spurious as to be laughable. Please expound or retract.

Lots of "services" are "cash cows" for hospitals and doctors. Look at MRI's, etc. Are you suggesting the medical establishment should not receive a return on their investment in education, technology, brick and mortar, time invested etc.? Does this attitude extend to the whole of capitalism, or do you just have a hard on for people in the medical field?

Lovely - errr, not really, I would like to express my sympathy here. I can only relate in the form of reiterating and expounding on my Mother's situation - different facts, yet similar doubts on my part. It was quite clear that she thought she wanted her DNR wishes complied with - they were in writing, she wore a med-bracelet, she told my sister an I numerous times - for God's sake, the woman had a sticky note on the inside of her front-door's window - the message began with: To any EMS or other medical team... You can imagine the rest. None of that mattered during the 3-4 seconds that a 12 person trauma team came to an abrupt halt in the E.R. and all eyes were on me. Did she mean what she said? Did she know what she was saying? 4,3,2,1 - we need to know now! I followed my heart...

This sort of thing happens with many new drugs - remember Thalidomide and the "flipper people"? I do not believe we can let fear determine our choices and advancements in the medical field. (Or other fields for that matter). This first-hand anecdote does offer enlightenment into your personal views however, and I thank you for sharing.

I'm sorry, I thought you meant "legal" obligation, it now appears that you are referring to a "moral" obligation. In which case I would agree with you.

Geee.... I wonder whatever could be done to alleviate that need for more donors...

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Wow. Geez, you need to calm down. In fact, I got the same perception from your responses as applied to me. However:

Milkweed, I'd like to end by apologizing for any condescension that you may have perceived. It was unintentional, I assure you. I responded to your original post specifically because of the interaction we have had in the past and I respect your opinion.

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No offense, but f**k the herd. I do believe in informed democracy, and I also believe we will get to Opt-out at some point, when we join Singapore, Austria, Belgium, Denmark, France, Italy, Greece, Norway, Switzerland, Spain and Sweden in leading the world to a more rational view of organ donation.

"The rights of the living outweigh those of the dead"

Finally, I recommend the following article - it addresses many statistics related to the issues we have raised:http://www.firstcoastnews.com/news/health/news-article.aspx?storyid=158094&catid=10

 

An opt out works like a DNR [do not resuscitate]. Any organ transplant surgery requires consent from the patient or the his/her family. For that matter any treatment requires consent and yet people ignore this when it comes to A&E in the ER. A pre-rearranged form opting out of organ donation is how doctors would know that this particular patient is not available for harvesting [no matter how many are dying in the vicinity for lack of organs]. Similarly if opting out disqualifies a patient from donation [which would obviously require INFORMED CONSENT on the form] then it would act as an a priori consent form to deny organ transplant, as much as a DNR would.

 

Hey SAM, Tiassa and others...

You raise good points, but I am somewhat fatigued over the debate with Milkweed. I put over two hours into researching and writing Post 70. I hope he shows back up.

Meanwhile, should the rest of you wish to comment, please feel free. At least all that work won't go to waste...

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Thanks...

 

You've made pretty good points overall, so I am not sure what kind of comments you need me to make.

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That one works great, especially from you SAM! :bravo:

 

Boundaries, functions, and, possibly, semantics

I see a functional—or perhaps it's merely semantic—difference between a DNR and the opt-out. Specifically, the doctor looks at a patient in a state of arrest and says, "Do not resuscitate, according to patient order."

With the opt-out, though, the doctor looks at a patient who is alive and says, "Palliative care only, according to public policy."

There are certain roles people undertake in life and society that transcend questions and judgment of who deserves what. A doctor has long been considered one of those.

Theoretically: Would I have operated to save the life of a Nazi? Yes. One of the Americans who coordinated or abetted the internment of Japanese-Americans? Yes. Ariel Sharon? Yes. Shah Reza? Yes. Triage priority for any of them? Standard, according to need. This is what I've learned about how doctors are supposed to function. Perhaps it is factually mistaken. Perhaps in a real circumstance, I would balk at one or another patient for personal reasons. But I would, theoretically, try my best for history's great villains. How could I turn away from someone who refused organ donation after his death? Compared to humanity's great monsters, he's not even a petty crook.

It's not that I don't see the logic of the opt-out/exclusion proposition. Rather, it is my understanding that doctors function beyond that boundary, and my belief that they should.

 

Snipped unrelated content and religion speculation.

It is an appeal to authority. I posted links to people who narrowly avoided having their organs harvested. And the oklahoma case states he heard the talk about organ donations before he could respond. While we can wonder if that is an accurate reflection of what occurred in this hospital, its not the only case of a coma like person waking up and describing conversations going on. Once they take your heart/lungs/kidney there isnt a turning back point. So while there is no proof it happens, there is proof they missed the signs and they were wrong about this brain dead teen in a rush to harvest.

It was a question, not an implication. A fair question when the typical start (testing for need) to fininsh of the transplant (not including after care drugs) is 1/2 million. $500K

comment quote from another article:

john201054 (10 months ago)

My Dad died from a pulmonary embolism 6 days after emergency back surgery, in the hospital, right after a dye injection. SNIPPED CONTENT What struck me as wrong, is that as my Dad was an organ donor, donating just limited organs due to radioactive dye and blood clots, that is, bone marrow, eye and skin tissue, the hospital earned $47,000 handling those limited organs. The hospital bill was only $11,000, less than 1/4th what the hospital made handling the 'donated' organs. That hospital had one gigantic financial motive to let people die. Over the years after, I watched the obits and someone about his age died every COMMENT ENDED I assume due to comment space limits.

http://www.cnsnews.com/news/article/53534

http://www.newsweek.com/2009/01/09/not-just-urban-legend.html

I will guess the next argument will be, if we have more dead people donating, this will remove the living donor quest.

No it wont. In the newsweek article (and in others I have read just this past two days), your survival length of time is twice as long for living donor kidney vs cadaver kidney. There is motivation for finding a live donor.

But the proposal isnt a legitimate incentive to people who MIGHT be willing to donate, it is presumed consent. I have no quarrel with the DL office asking me each time I renew if I want to be an organ donor (and they do). If I do, I say yes, if I do not, I say no. But there is no presumed consent. And if they forget to ask, it is presumed no. As it should be. You have no idea if the person at the licensure bureau didnt read the card and check off his status. Or has been diagnosed with some aggressive cancer and isnt aware that he/she shouldnt be a donor, (remember ovarian cancer kills men in transplants too) Or didnt hear the question. Or was distracted by other things and not paying attention.

Or worse yet, was under the impression you were, the screening catches these issues.

It seems to me you are exactly what Cass Sunstein target projects:
“To ensure that people’s decisions align with the government policy of more organ donors, Sunstein and Thaler counseled that governments should follow the state of Illinois’ example and try to influence people by making organ donation seem popular.”

My state asks each time I renew my DL. It has not always been that way and honestly I cannot remember if there was a check box the first time I became licensed. I have no quarrel with that as long as it is presumed no. I can tell the DL people "I dont know" and they tell me answer yes or no. If I wont answer, they mark NO. That is the requirement and its a good one. They are not in a position to answer detailed questions about organ donation. Simply put, if I dont know, I am not informed enough about the issue to give consent.

“With mandated choice, renewal of your driver’s license would be accompanied by a requirement that you check a box stating your organ donation preferences,” the authors stated. “Your application would not be accepted unless you had checked one of the boxes.”

“Recall that people like to do what most people think is right to do; recall too that people like to do what most people actually do,” they wrote. “The state is enlisting existing norms in the direction of lifestyle choices.”

Rocco F. Andriola is a co-founder of Save Lives Now New York and a former chairman of the New York Organ Donor Network. Not quite an unbiased opinion there.

QUIT with the religious rhetoric! You have no idea if the reason is desecration of the body. You assume that is the motivation.

I don’t believe you missed it, I believe you’ve never looked further than opinion columns that support your idealism/morality. The fact is the DL opt in is a binding contract and doctors can ignore the families wishes. The only place that does not apply is in states whos laws specifically require the family must also give consent. In my state, they do get the families consent also. This is why so many organ donation FYI sites specifically say list organ donation in both a living will and a DL, so families are clear they were your wishes. Of course, this protects the doctors/hospitals if they harvest the organs against the families wishes too.

“Where the laws are enacted, the hospital and the organ procurement organization has a legal right to follow a deceased person’s written organ donation wishes and does not require them to approach the deceased person’s family for permission to remove the organs.”

Page 33 http://www.ahc.umn.edu/img/assets/26104/Organ_Transplantation.pdf

It is talked about in the cnsnews link above. Peer pressure. Guilt trips. Awe common, if your family member wanted out he would have said so. Or maybe he never told his family he has been exposed to hep c. Maybe she didn’t understand that bad pap smear and HPV is early stage cancer. Maybe he/she didnt know it was an organ donation issue. Nope, the donor should make a conscious choice to mark Yes, not the other way around. And potential donors should be aware of the rules/best practices of organ donation before donating their tissue to already sick people, who will be additionally stressed by the anti-rejection drugs.

Spending time on the net with a few nurses and docs discussing helmet issues (in the past) the joke comes out... You know what we call bikers who dont wear helmets? Organ donors. That is the mindset. Head injury sucks. The chances of survival can be very limited. It is likely when a doc sees this situation, in a mandated organ donation state (OPT-in) their first reaction is going to be "call the organ donor network, we have a candidate", and actually, after reading some links, this seems to be the law (in some states). They begin to prep your body/your family member for transplant within minutes in some cases of death (state dependent again).

“The family is contacted and approached regarding donation as a matter of course should there be no donor card, but meanwhile ALL preparations proceed as if consent has been given....short of yanking the organs out.”

http://allnurses.com/certified-registered-nurse/organ-harvesting-anesthesia-258257.html

It is the odds and knowing how important it is to get the organs to the patient does influence their bias's. This is normal human behavior. The recommended wait time between brain death declaration and organ transplant is only 6 hours in the USA. I don’t believe this is a law, it is a AMA type recommendation. Families are pressured to react quickly to a diagnosis of brain death and that diagnosis is fallable, as I have shown in previous responses.

The stats used to promote auto Opt-in are Lookie approx 90% support it [organ donation idea]. I support the idea. I am not a donor. My mom was fine with her husbands donation. She is not a donor either. We have both spent many hours weighing the pros and cons and decided the obligation was to not donate organs for transplant. So it is misleading to promote the idea that because 90 % support the idea this automatically means they think its a good idea to use their organs. This is not true.

Yes, it is subjectively my definition of service, just as your definition of ‘service’ is subjective. To argue that it is a fallacious argument on presumed consent is false.

If you didnt need funding, they wouldnt have so many .orgs raising money to fund transplants would they?

BTW, I did see this stuff and thought about mentioning that I do fund transplants via my taxes paid to medicare and medicade. But I dont have insurance so I would need x-% up front before I could be on the list. A fact that is missing from your response and these potential funding sources. Basically, your response is a fallacy. It does not prove that no funds doesnt exclude you from transplant. It only points a direction to possible (not guaranteed) funding sources.

May 2008 Minnesota heart transplant patient confirms, no money, no listing:

http://bobsnewheart.wordpress.com/2008/05/21/pay-up-or-die-no-money-no-transplant/

From link within blog:
“That's because under federal law a potential recipient must show the ability to pay for surgery, life-long follow-up care and anti-rejection medicines before he or she can be placed on the United Network of Organ Sharing's national wait list.”

http://smu.edu/newsinfo/excerpts/cardiac-donation-ethics.html

And I have to choose to partake in those 'services'. I have to agree to take part in those services. Informed consent. Interesting that you bring up MRI's as I was just in a discussion about that with a friend. Her husband had one and the insurance papers came in. Normal cost of MRI, $5000 Insurance negociated the cost down to 800 something, it was close to 900 dollars. What pissed her off was her 40 year old son lost his part time job and does not have health insurance. Why should it cost him more to get the same treatment from the same hospital? On top of that shes questioning why she has to pay almost $600 a month (for the two of them) if they are reducing costs to less than 1/4. Why is this related? Because I fund medicare/medicade so I am paying for transplants. So is she. So is her husband.

But her son wont get on a waiting list if he needs a transplant because he doesnt have insurance. $47 K to take the eyes, skin and bone marrow from the deceased. Its not really a donation of life, its a profit taking harvest. Soylent green anyone?

Yes. Guinea pigs for the cash machine of US healthcare. Mandated Opt IN!

Get rid of mandatory seat belt laws. Quit protecting the kids from accidental death. Ride free, Die hard.

The 'shortage' of organs is twofold. First, more people qualify for transplants than before and second various laws (and improved trauma care) have kept more people from being in death assured accidents.

http://www.upenn.edu/ldi/issuebrief2_5.html

Yeah. And the surviving family has a right to decide what happens to their kin. Not some senator from New York, not some doctor whos hospital will gain organ recovery funds. The surviving family wishes trump outside wants.

From the article:
"People are dying in New York this week because we have failed to create a system that maximizes the opportunities to keep them alive,"

No. People are dying of organ failures, some of them accidents, some of them genetics and some of them from a lack of money to afford getting on the lists.

The author of the bill has self interests. His daughter inspired his legislative efforts not his altruism. Yes it is often a personal crisis which inspires a change of heart. So, where is the legislation for those who cannot get on the list because of money? Its not about organs for those who need them, its about organs for those who can afford them. See, we do sell organs in this country.

It is an altruistic donation, the donor families gift. And that is the only piece of this that is altruistic. So its not about the 'greater good'. This new york senator just didnt like the fact he had to wait on the altruism of people. And he wants to take that away. Do I blame him for his emotional reaction to the potential death of his child? No. Absolutely not.

Let him mandate the NY DL bureau asks you Yes or No on donor on licensure renewal/issue rather than relying on whether the applicant has read the card. But if the applicant does not know or isn’t sure, then its auto no. The applicant is obviously not in a position to give informed consent and the DL bureau people are not trained in organ donation screening and therefore not qualified to answer important questions about the issue. Allow Donor info during drivers edu (part of MN drivers training now) but make damn sure you include the issues of not acceptable organs so if some 16 year old finds themselves Hep C positive at 24, they know they should not be a donor. Those are things with a real potential for passage. But auto opt in? forget it. Its not based on informed consent.

 

How is opting out of an organ donation [to/for] a matter of public policy?

Doctors are highly individualistic. There are many who would ignore DNRs just as there are many who would see a near fatal accident victim and choose to convince their near and dear to give up organs for transplant. Its usually up to the administrative and legal departments to protect the doctors from their tendencies to want to abide by the Hippocratic oath.

 

To be honest I have a concern in regards to "Causality" (Cause and Effect), I guess this could be seen similar to a religious concern but if I became an organ donor, it means I would have to have died (or been led down a dark alley way to have my organ stolen). It can be taken further, afterall for someone to have an organ replace means they would of had an organ fail.

There is also the other factor that some people like Alcoholics go out of their way to drink, replacing their organs when they get damaged doesn't give them a second chance at life as for the most part they keep drinking destroying the replacement organ.

Organs when replaced also have a high probablity of failing over time, afterall they aren't genetically compatible and to stop them "desyncronising" with the rest of the body requires a lifetime supply of drugs.

Ontop of all this I'm pretty sure I would be classed as a Transhumanist, because I want to see technology be able to replace damaged organs rather than parts of other people. I'd rather have one replacement than many replacement attempts using many different peoples parts (Mary Shelley would of had kittens)

As for the subject of people assuming everyones an organ donor...

Seems unfair? Well thats what you are asking of people under a forced donor system.

 

(Insert Title Here)

Such a system would require the force of law. Without it, any doctor or facility honoring the opt-out exclusion would be subject to malpractice and civil rights lawsuits. If that lawsuit resulted in no fault on the part of the doctor and hospital, the program would become at that moment a matter of public policy, backed by the force of law.

Those who ignore DNRs—except under genuinely extraordinary circumstances—shouldn't be doctors.

I'm not sure what to make of this statement because, to the one, there is an aspect about it that is absolutely correct, yet to the other there are frightening implications. In the case of ignoring DNRs, some resuscitations will lead to extended existence in pain. Still, the phrase, "protect the doctors from their tendencies to want to abide by the Hippocratic oath", is ... well, I can see how it could be controversial. Throw that one into the abortion debate and see if we can find heads and tails, for instance.

 

I was going to bring up something along those lines, if we don't stop those who willingly destroy their own organs I imagine some people would always remain reluctant to donate. I'm sure there are many minor reasons that add up to a significant proportion of people who don't donate.