Monday, April 23, 2012
Long-standing readers know that I support organ donation, and have long favored policies that would encourage organ donation. In law school, back in 1985, I wrote a paper on developing regulated but nonetheless fundamentally transparent markets for transplantable organs. As I recall, the title was "What you don't know won't hurt you."
More recently, I was frankly appalled to learn how few New Jerseyans agree to be organ donors when they renew their driver's license, even when asked directly. I was also surprised to learn how few of our readers have checked the organ donor box, and how many opposed policies to promote organ donation or sale.
Regardless, Governor Awesome spoke today on the subject, pushing ahead the cause in New Jersey and no doubt irritating unreconstructed social conservatives elsewhere in the country.
My own views have evolved on the subject since my posts of a couple of years ago, so I no longer support an "opt out" system. Instead, my view is that adults who check the organ donor box before they have need of an organ donation themselves should get automatic priority over all competent adults on the waiting lists who did not check the box before they learned they needed a transplant. Point is, the system should encourage participation by acting like an insurance cooperative, awarding benefits to the public spirited people who agree to help others before they know they need help themselves. (Obviously, we would need exceptional rules for children and incompetent adults, but that is a detail.)
As always, your comments are more than welcome.
As I've told you before I'm an organ donor but I've been unsuccessful at persuading others to be. My daughter, as an example, refused because she believes medical authorities will begin removing organs before actual death and somehow, deep down in her sub-conscience, she's convinced she will be hyper-aware of this invasion of the body snatchers, and it'll be painful. Once she read the appalling stories of Chinese government executions of people to supply organs on demand, where the story specifically reported the organs needed to be removed prior to actual death, lest they begin rapid deterioration, she turned from an objection based upon semi-superstition to opposition based on evidence. I hate that sort of opposition!
Nevertheless, I persist.
I donated a kidney to a family member in 2008. During the screening process I met with a surgeon from the hospital's transplant team so that he could explain the procedure to me. At that time he told me that as someone who had already donated I would be be given special priority on the list if I ever needed a kidney myself. I wouldn't necessarily be bumped up above certain priority groups (such as children), but I would be given some special consideration for being a donor.
I never really investigated whether that claim was applicable for other waiting list regions or even applicable for different hospitals (I lived in a different part of the country than my family member, and the surgery was done at her hospital), but I thought that was a nice thing for them to do.
I also like the idea of giving priority to people who voluntarily choose the organ donation option when they get their driver's licenses. However, I think another problem is that even with that box checked the hospital still has to gain consent from the next of kin. I have heard that there can often be a disparity between what the person selects and what their family wants, and that can delay or halt the donation process. Is this true, or a myth that I picked up somewhere? If it is true, maybe something needs to be done to make that check box more legally binding.
I don't have the box checked but I like your idea and it would make me much more likely to consider being an organ donor. Currently I believe there is some non-zero chance that a medical professional could hurry the family of an organ donor to go ahead "pull the plug" when there would be a chance of survival or the physicians mind might be more on making sure the organs are salvagable instead of doing everything possible to save the patient. The number of premature from well intentioned professionals wanting to make sure organs are harvested as soon as possible might approach zero but since I have nothing to gain by giving an organ and a potential huge but unlikely loss I don't see the profit in donating. If my potential but unlikely loss was offset by an unlikely but conceivable gain by assuming that slight risk then I would have to strongly consider it.
I wish your idea was current policy. I have consented to organ donation when renewing my license as long as I can remember and today I find myself undergoing evaluation to determine if I am a good candidate for liver transplantation.
I've never understood why someone would refuse to make a gift that costs them nothing and grants life to its recipient. It is a shame we must consider ways to motivate people to donate beyond the ability to make such a difference in someone's life. However, with demand for organs so far exceeding supply, we must do something.
Thank you for shining a light on this issue.
Dots on drivers' licenses are a little silly. If you seriously want to donate organs after you're thoroughly dead -- not just mostly dead -- then tell your next of kin, or whomever you have appointed to make decisions for you when you are incompetent. (You DID remember to draft a living will, right? Because not taking care of THAT is a much bigger issue than whether you donate organs or not.)
That way someone you trust 100% will make the decision, and you can be as sure as it's possible to be it won't be anyone with any stake in the outcome other than what you want.
Why on Earth would anybody willingly leave such an important decision to the state, or one of its actors? That's nuts, and the objections of any rational person to this idea are perfectly respectable, considering what lies in the balance.
If you want to donate, tell your wife, your mother, your son, or your best friend (and preferably all of them), and lay out what organs, and under what conditions. Putting a dot on your license is superfluous.
I would be rather upset if your proposal was turned to law. I think it is too simplistic to assume that those who don't check the organ donor box do not wish to be organ donors. A few years ago, I chose to remove the donor notice from my licence. I told my family that I want to be an organ donor, but I want them to have complete control over how my body is used. I'd rather that be the case than have someone else make the decisions overriding my families desires based on what they infer from a checkbox.
I think that organ donation is a wonderful gift. As a funeral director, I would like to see more transparency in the whole process. I believe that the "harvest companies" are making money on the organs, bones, ligaments, arteries, etc. that are being harvested. Everyone assumes that the donations are truly that, but I know that the "parts" cost money for the recipient, and that someone is making money on the deal. I also know that it is not the family of the decedent.
Great idea, except...lawsuits would be filed by those bumped, politicians would eventually get involved, new laws written, and eventually our government overlords would choose "winners and losers" based on political donations (just look at what's happened in the business world). Better to leave it voluntary, and focus on educating the masses.
I am currently on a waiting list for a kidney. I'm lucky-- I'm not yet on dialysis and I still feel pretty good. I have to point out, though, that anyone being considered for a transplant has to jump through more hoops than a vaudeville dog act. If you smoke, use drugs, or drink to excess, if you fail to show up at your medical appointments, if you have cancer, heart disease, HIV, hepatitis or any of a long list of diseases, if you are obese (BMI > 35) you will be turned down for a transplant. A dot on your driver's license will not mean a tinker's damn to the transplant center's screening committee.
As a family member who signed to "pull the plug" on someone I love dearly last year, I agree that it should be left up to family and not to the state or some other "disinterested" actor.
No dot on a DL or a living will for me, yet I fully support organ and tissue donation even if some middleman does profit. (Given the clandestine way I was approached about tissue donation, I have wondered about kickbacks. But it was still worth it for my family in this situation.)
What I'd like to see more well known is how utterly insensitive doctors and nurses in intensive care units can be when talking to the family about donation even (perhaps especially?) when the family brings up the subject. They are not prepared. (My experience was in a large hospital in a large city, so let's not hear the "small town" excuse for this.)
What I do know for sure is that the donors that we are in such a shortage of are young healthy accident victims with massive head injuries where the rest of the body is relatively unscathed.
No matter who signs what form where or when, we're never going to "wish" for an increase of donors of this type.
Most organs simply are not suitable for donation by the time their original owners are through with them. Tissues perhaps... organs, not so much.
One other thing that stood out was how easily I was able to talk to the people in the coroner's office and the tissue donation people about everything. Perhaps it's because the hard decision to pull the plug had already been made, but it could also be because there was no lingering thoughts in either party's mind as to whether everything that could be done had been done.
In the case I'm talking about those lingering thoughts were much more likely to have been on the medical team's side than mine. There's general anger at general circumstances and then there's pissed off at specific ones. A few of the staff exhibited pissed off... and that's why I quite easily forgave them almost all of the insensitivity they also projected.
I'd hate to walk a mile in their moccasins.
SO... to put this in perspective, should I have greater access to corneas or heart valves or whatever tissue because I signed over my son's tissues?
Should my sister have greater access to... say, a liver because she donated bone marrow to her son?
Should my alcoholic brother have had greater access to a liver because he checked off "donor" on his driver's license even though none of his organs or tissue would be "donatable" because of his drinking?
Many years ago, I knew a man who died of kidney failure. His was a tragic story. When he was 12, an accident seriously injured one of his kidneys and it was later determined that the injured kidney should be removed.
He got a bad surgeon and a bad surgical team. They removed his good kidney. He always joked that it was given to a Saudi Prince who paid the doctors millions of dollars for it. (And there's an inflation lesson for you -- today it would be trillions!)
Sometimes, during dialysis he would talk about a kidney transplant. He didn't really want one, he said. He worried that because his condition was caused by a medical mistake that he might get a kidney that some 12 year old kid could make better use of.
While there are many ways to approach this, fairness (I vow to give, therefore I should receive) isn't one I'd endorse. Fairness is WAY over-rated.
And over-hyped. The only fair solution is that every one who needs another kidney or liver should get one. That's fine by me when we figure out to grow them on 3-D printed scaffolds. I hope that dream comes true. Soon. Hearts and lungs too, OK?
Until then, the current method of who can make the best use of whatever organ or tissue for the longest period of time is good.
Your reasoning is simplistic. Consider an example.
I have coronary artery disease, several annoying allergies, and crippling chronic diseases due to an overactive immune system. None of these conditions are curable, though all are treatable, to a point, and the treatments do make life tolerable, albeit expensive. Although they haven't actually killed me (yet), my organs are miserable specimens. I wouldn't wish them on anyone.
Because I can't in clear conscience donate my diseased and crappy organs to any unsuspecting person, are you seriously suggesting that I should be moved to the end of a waiting list when one of them finally does fail?
Not a bad proposal, but the organ shortage could be solved if it were simply legal for a donor to receive compensation. Forget about the "icky" factor that keeps conservatives in opposition to a market solution. In this case, lives are on the line, and we should use market incentives to encourage donation. A lot more people would check that box if they knew their family members would actually receive a benefit from the transaction. Not to mention living donors for kidneys, etc.
I have spent most of my life being looted by public mooches that seem to hate me. In death, I hope to [partially] deny them their sadism. If I can earmark who qualifies to receive my organs, no problem, but otherwise, piss off!
Registered organ donors in the United States can get priority access to organs by joining LifeSharers. Membership is free at www.lifesharers.org. There is no age limit, parents can enroll their minor children, and no one is excluded due to any pre-existing medical condition.
Giving organs first to registered organ donors creates an incentive for non-donors to register. More donors means fewer people dying waiting for transplants.
Israel also has a system of priority access for people who have signed organ donor cards.
I don't trust the powers that be when it comes to organ donation:
I'd agree to be a donor in a heartbeat if I could be sure that I would be safe.
For all the smugness and sanctimony that the pro donation people aim at everyone else, they never properly address the issue.
We're just meant to trust that (1) the criteria that they use to determine brain death are sound and (2) that they'll follow them religiously. No, really. Pinky swear.
It requires a level of trust and credulity that I don't think is a good idea for anyone.
You pose in interesting ethical problem. Let me present one in return: Could you with a clear conscience receive an organ ahead of someone whose immune system was less likely to over-react and reject the organ and less likely to have other organs that may fail and so negate the value of even a successful transplant?
Best wishes and hope that you need never face the question except as a hypothetical one.
I live in New Jersey and was an organ donor until the last time I renewed my Driver's Licence. I did not renew my registration.
While at the MVC, I reviewed the donor information, and it turns out that if you check the box, you give the State of New Jersey the right to do whatever they want with your body when you die, including using it for medical training or research.
In years past, you could sign up as an organ donor without giving up that much control. So the State of New Jersey moved past a line, and that is why I am no longer registered.
So for the Governor of the State of New Jersey to now harangue us to register, without admitting how it was his own policy that led to the problem, is a little frustrating.
Organ transplants are hugely expensive, and probably not cost effective. Above normal medical costs are incurred for the rest of the transplantee's life, not to mention the half million or so dollars for the initial surgery. Who is going to pay for all this? It is not sustainable.
I oppose organ donation because it only encourages more transplants. This is your death panel speaking.
your going to trust a government entity to make the decision on when to call your lights out and harvest your organs...
Dude..you have way more faith in govt then I do...
I can see a cost benefit analysis being done..with the value of your organs in new bodies and their life values being weighed against continuing medical care to save you...
not something I want in the hands of some govt doctor...
I like your idea and believe everyone who can should be volunteering for this, but there need to be some other conditions. For example, I was a registered donor, but as a cancer survivor would most likely not be eligible. I'm not able to donate blood anymore either. I would hope that this wouldn't count against people like me if they ever needed a transplant.
"and no doubt irritating unreconstructed social conservatives "
I'm as unreconstructed a social conservative as there is, but my donor box has been checked since I was a teenager. Not sure what you are referring to here.
You do not help a good cause when you take gratuitous swipes at potential allies.
Folks who donate organs to strangers without compensation are fools.
You are depriving yourself, your loved ones and your heirs by so doing.
Furthermore, by donating, you are supporting the forces that prohibit a market in organs. Hobbling any market is a sin against those who need food, energy, sex and organs.
If there were a free market in organs, organ donation could be encouraged on the basis of charity; without a free market, it is participation in a system of human cruelty.
Read some Milton Friedman, Like Free to Choose.
Call me SamW.
I have registered with a medical school to be a specimen when I am dead. I think that is the last useful thing I can do with my life. I have no objection to organ donation,but I was 69 years old at the time of that decision (71 now) and my organs surely are wearing out. Here in Georgia, the funeral industry has got "dibs" on bodies. The medical school wants a different embalming procedure for specimens than that performed by the burial industry. Making that happen is difficult. My Doctors and my family are all aware of my wishes but will they be able to prevail over the system that exists ? The legislature favors the funeral "bidness".
I've been marking that little box on my Virginia driver's license ever since I first qualified for it. Additionally, I just went through the living will exercise and I explicitly stated my wishes to donate my organs as well as use my cadaver for teaching purposes. My defined "will he recover?" time period is pretty short, so I'm not too worried about some doctor deciding to pull the plug ahead of schedule to save some rich dude in California. In short, I definitely support your efforts to encourage more organ donation.
I even went one step further than most and bought a motorcycle. :)