Controversy: Mandatory Organ Donation, No Exceptions.

I am looking forward to the response to this blog because of all the controversial ideas we have tackled, this may generate the most heated discussion.  And — discussion is what I want to generate in my quest to increase the number of organ donors.  Please read, tell your friends about this blog, ask them to read and comment and, of course, comment yourself. Your thoughts are important to other readers. Bob Aronson  

In a recent blog, I suggested that we fire UNOS and adopt an entirely new system.  I suggested a program of presumed consent combined with some kind of financial incentive.  There are many options we can consider besides the combination I suggested.  Among them are: 

  • Maintain the status quo of depending on “altruistic” organ donation
  • The LifeSharers concept — organ donors should receive organs first
  •  Requiring people to make a choice when they renew drivers licenses
  • Presumed consent.  Instead of our current “opt in” system, we would adopt one where people are presumed donors unless they “opt out.”
  • Payment for organs, either on a regulated basis or based on and regulated by the marketplace.
  • Mandatory organ donation.  No choice in the matter.  When you die, your organs will be taken if they are healthy and acceptable.

 This blog concentrates on one controversial option — mandatory donation.  So who supports such an un-American sounding idea?  Consider mandatory donation for a second, is it fair for us to condemn others to death because we want organs that are of no use to us, to be buried with us?  If someone could make the case that a cadaver has use for its organs I am sure they could attract a great deal of support.  To this point, though, I have not heard of any physician, scientist, ethicist or philosopher that makes that case.  Heavens, even the POPE is an organ donor.    

Consider this:  Aaron Spital, and James Stacey Taylor (Department of Medicine, Mount Sinai School of Medicine, New York, New York; and {dagger}Department of Philosophy, College of New Jersey, Ewing, New Jersey) have written a persuasive paper on the subject of mandatory organ donation.  Their proposal is simple:  

 ”We propose that the requirement for consent for cadaveric organ recovery be eliminated and that whenever a person dies with transplantable organs, these be recovered routinely. Consent for such recovery should be neither required nor sought.”   

Language like this is likely to have a negative impact on most Americans so if this proposal is going to be considered by anyone the language must be sandpapered.  Telling Americans they are required to do something does not usually meet with much cooperation unless, like taxation, vaccinations, autopsies for criminal investigations and the military draft, it can be shown to be necessary.  But this blog is not about language so let us consider the thoughts behind the idea.  

A recent Washington Post article suggests that UNOS (United Network for Organ Sharing) has artificially inflated the number of people who need organs in order to make the situation look worse than it is.  I am not going to argue that point now — maybe later.  What is important here is this; no matter what UNOS does to the numbers they cannot hide the fact that there is a far greater need for organs than what is available at any given time.  That is an undeniable fact!  Even UNOS’ massive fudging does not change that.  

The paper by Spital and Taylor goes on to say:

 “We believe that the major problem with our present cadaveric organ procurement system is its absolute requirement for consent. As such, the system’s success depends on altruism and voluntarism. Unfortunately, this approach has proved to be inefficient. Despite tremendous efforts to increase public commitment to posthumous organ donation, exemplified most recently by the US Department of Health and Human Services sponsored Organ Donation Breakthrough Collaborative many families who are asked for permission to recover organs from a recently deceased relative still say no. The result is a tragic syllogism: nonconsent leads to nonprocurement of potentially life-saving organs, and nonprocurement limits the number of people who could have been saved through transplantation; therefore, nonconsent results in loss of life.”  

Let me add that while in the majority of states it is the law to follow the organ donation desires of the deceased as stated on their driver’s license, some hospital officials insist on telling families they have a choice in the matter.  Many of those families then, deny recovery of organs, and someone or several someones somewhere die as a result.  Even laws have proven to be ineffective because some medical professionals insist on ignoring the law and giving families a choice anyway. Whether that provider attitude is one of ignorance or arrogance is beyond me. Think of the position in which that puts an Organ Procurement Organization (OPO). There is no way, even though organ recovery would be legal, that the OPO can insist on donation when a grieving family has been advised that they have a choice and as a result decides against donation (this is not speculation, it happens more often that you would imagine).  But I digress; let us talk more about the Spital and Taylor paper.   

“Routine recovery would be much simpler and cheaper to implement than proposals designed to stimulate consent because there would be no need for donor registries, no need to train requestors, no need for stringent government regulation, no need to consider paying for organs, and no need for permanent public education campaigns.” 

 I want to be clear that I am taking no position here.  I, as a blogger, am trying to be as objective as possible but I see no suggestion in the paper we are discussing, that the deceased not be treated with respect.  To the contrary, the burial services I am sure, could continue to be the same as they have always been and in an open casket funeral, there would be absolutely no evidence that the person was missing his/her organs. Furthermore, I see nothing in the Spital and Taylor paper that suggests any change in operating room or care procedures.  The people who care for the patient and the people who recover organs do not work together until there is a declaration of death by independent physicians.   

Like most Americans, my initial reaction to any governmentally mandated regulations about my body is extremely negative, but I believe that a non-emotional discussion that focuses on the logic of the concept could be helpful in terms of leading us to doing what is right for both donors and recipients..  Unfortunately, I have no idea how to keep a conversation concerning life and death and one’s body parts from becoming emotional.  It is an emotional issue.  I do think, though, that a national discussion of all the options is absolutely necessary.  A real discussion where all sides are heard and considered.   

 If you do not like being told what is right and what is wrong then you should be a little tired of UNOS telling you that for the last 24 years.  They have not allowed or encouraged any public discussion of the options to their “altruistic” and failed effort.  Who are they to tell you what you can and cannot do with your body?  Think about it.  

Your comments are welcome and encouraged whether pro or con.  



About Bob Aronson

Bob Aronson is a former journalist, a Minnesota Governor's Press Secretary and talk show host. For nearly a quarter of a century, he led the Aronson Partnership, a Minnesota-based communications consultancy that prepared corporate and government executives for crisis situations, regulatory testimony, media interviews and Presentations. Among his clients were all three U.S. Mayo Clinic locations, 3M, general Mills, CH2M Hill, the U.S. Department of Energy and scores more. In 2007 bob had a heart transplant after suffering from idiopathic dilated cardiomyopathy for 12 years. Shortly after he got his new heart he founded the now 4,300 member Facebook support group, Organ Transplant Initiative. At the same time, he established the Bob's Newheart blog where he has posted nearly 300 columns on organ donation, transplantation and other health related issues. The Viewpoint blog was started in late 2016 and bears the name of the Radio Talk show Bob did from 1966 until 1974, when he resigned to become Minnesota Governor Rudy Perpich first Press secretary. Bob and his artist wife Robin, live in Jacksonville, Florida with their two dogs, Reilly and Ziggy. Bob is also a woodworker and makes all of the furnishings for Robin's art festival booth. He also makes one of a kind jewelry or "memories" boxes that he donates to select transplant patients, caregivers, donor families and others who have somehow contributed to making life easier for the ill, the elderly and the less fortunate. Bob is in the final stages of editing two full-length novels that will be available on Kindle when ready for release sometime in early 2017. One is a sci fi novel about an amazing discovery near Roswell, New Mexico and you will be surprised to find it has nothing to do with the Roswell story everyone knows. It features a woman scientist who investigates impact craters for the U.S. Department of the Interior, Dr. Rita Sylvester and her female student intern. The other book is a political thriller that introduces a new hero to the genre, Fargo Dennison.

Posted on March 26, 2008, in Mandatory organ donation. Bookmark the permalink. 23 Comments.

  1. Hi…thank you for your comment. You need not worry about Christian hate comments. I require civility in all communication. If, though, something slips by me please let me know and I will deal with it. Your comments are greatly appreciated.

    bob aronson


  2. As a christian, I am in full support of hepling those in need and loving a stranger. I believe in voluntary organ donation. The problem we are trying to solve here is how do we make ( for the most part) selfish people care about others. Truly, the answer is to change the heart of man. Jesus Christ came into my life at the age of 17 and has been changing me from my selfish past(a very self centered person) to a person who would sacrifice so that others would feel loved and benefit in life. This is the kind of change we need. Mandatory organ donation is a plan B to teaching people to share Gods love. As a side note, Mandatory Donation of anything is a contradition of terms. Check it out. A donation is the act of making a gift, or present; a free (no strings attached) contribution. It involves a persons free will choice. With this understanding, how can it be made mandetory?
    Please, no unnecessary christian hate-on comments… just logical responses to the arguments put forward.


  3. I am on the organ donor list.
    However, I am against this. Why? Because I intend to take myself off this list if I ever have the money to pursue a life insurance policy granting “cryonics”.
    The body is basically a machine, and if you can ever fix the parts you can make it work again, and then the person would be alive.
    But they can’t do that if all my organs are taken from me when I’m legally declared “dead”.
    The bar for legal death has moved before. It used to be when the heart stopped that was it you were legally dead, now they have ways to restart the heart. Someday they will have ways to repair the cellular tissue in the body if it has been well-preserved enough. Look up “nanotechnology”. We are getting closer and closer to being able to be extremely precise about how we do medicine. At that point it will be clear that any person who stands a chance of being “restored” after cryopreservation isn’t really dead. At that point had we made organ donation mandatory and stopped people from pursuing “cryonics” we would look back and realize that all of those people who had been prevented from using “cryonics” were murdered by the state.


  4. Jason Maslin

    You’re all making a big deal about how the gouvernment is trying to take control of our body parts. GOD! 1) You are dead. You don’t need them! 2) Who do you want to deal with it?? Your grief striken family!? WHy would you wish that upon them!!?? This means they don’t have to chose between cutting upon the one the love and being a selfish, ignorant, disgutsting, god-acting creature who decides that they have enough power to decide their loved one should keep the useless organs and that some poor unfortunate soul should suffer longer when they have a chance at life again!!!!!! 3) The organs aren’t for the government, they are not taking them to be all-powerful! they are taking them to give to dying humans!


  5. If you believe in mandatory organ donation, then you clearly believe that people are nothing more than slaves. Only those who believe in totalitarian states with total, absolute power over helpless subjects could actually support such a monstrous concept.

    MY BODY IS NOT THE PROPERTY OF THE STATE! Nor that of my loved ones. What kind of sick, twisted, power-crazed control freaks are you people? Where do you people get the idea that you can just use the power of government to take whatever you want from strangers?

    Although the Framers of the Constitution could never have imagined such a vile degree of organized barbarity, they were wise to include the Second Amendment so citizens could protect themselves from such Nazi-like attitudes.


  6. First of all Who are the ones who are suggested these kinds of laws, in this case the law to force organ donation away from the free and sovereign choice of each and every individual, whoever these people are… their names must be publicized for all to see the face of a traitor….a traitor to the constitution…a traitor to the declaration of independence…and a traitor to the bill of rights….these people’s names should be made an example and should be arrested and imprisoned and never to serve the public interest on any level….at any capacity….and I have a new law that should be passed….and that should be


    “any person …or any group…or entity…or any form of government who so much as suggests any law that takes away the choice of any individual for whatever reason…must and shall be arrested and imprisoned for life….without parole….for the crime of treason against the will of all or any individual’s free and sovereign right to choose according to their own will…not the will of anyone else or government…in addition all other laws that now exist that are contrary to this law shall be abolished and forcefully removed…and nullified….any employee of the state or those who are not employed by the state who insists on enforcing any other law that violates this law….shall be considered an enemy of the state and it is the right of all or any citizen to enforce these rights and remove them from their hired position either through peace or by force…without due process…the courts…or judgments….the citizens shall also have the right to withhold any or all taxes and funds that pay for these enemies of the state….for all employees of the state shall enforce the will of each individual and not any law that contradicts it…or any government agenda…if they refuse to acknowledge the right and free will and free choice of any individual then their powers shall be nullified and dissolved without any due process or courts or judgments…and they themselves shall be arrested by the citizens …..stripped of their assigned powers and imprisoned…

    it is this due process of the courts and the legal system that is the bureaucracy that actually prevents and prohibits the will of the people from being fulfilled…it is this process that perpetuates the tyrannical powers of the state and all forms of government….the state and all forms of government shall have no rights…no due process…. no court procedures….except the people and each and every individual….who have complaint against another individual….it is the will of each individual that shall dictate the fate of all service providers…(government)…..government shall not dictate nor make the decisions for any person…government shall now be rendered as simply service providers who are subject to termination by each individual who hires them without due notice or reason…or process….the concept of government shall be eliminated….it’s status shall be lowered and limited to hired employee or service provider…


    • I think that your “new law” goes much too far with the traitor thing and nullification of the government…does stripping people from their assigned powers and freedom not contradict with your law and implement a totalitarian government? Everyone has the freedom to their opinion and who are you to take it from them? To legalize forced donation is a monstrous concept, but going too far in the opposite direction is just as bad.


      • Aaron Shurmon

        the way democracy is meant to work is having ultimate freedom without impeding on other’s freedom. government should have little to no power, being only allowed to sustain foreign affairs and a national army.


  7. I am doing a research paper on this and I thought i made up Mandatory organ donation! As I was doing some research I am so excited to see others believe this as well! Like people making comments about the rich not being able to take it with you(money) the love of money is a sin, so give the gift of life. Who would you be hurting? It’s helping someone…. you would be someones angel. I personally have never known of anyone in need of an organ. Can you imagine the families in need? I would not want to feel that pain. Would you? Think about this for a moment…. You cant live without it because your already gone, so giving someone in need who really cant live with out it can.


    • Aaron Shurmon

      you would be hurting yourself. one change of the term “legally dead” would be all it would take to implement harvesting centers for anyone in a temporary coma.


  8. I. Slartibartfast

    I agree with what you said.


  9. Alex and Jamal,,,you guys are insensitive jerks. Why don’t you look at your own lives and evaluate your own short-comings before you insult someone that you know nothing about. We need to stay on topic and save your preschool insults for your own circle of imbeciles.


  10. I CANT:'(


  11. I belieav that the induction of a manditory organ donation into the laws of our nation would be a popular choice for most families. expecially the ones that spend an amence amount of time in a health cair pradiciment. this new law wold suxceed in inhancing our nations gratest health cair perdicament.which is the need for new healthy organs.


  12. Samantha Burnfield

    If the United States were to accept mandatory organ donation I believe that it would be great. Imagine all of the lives that could be saved. Once we are dead our bodies are just left there, doing nothing. Instead they could be put to a better use & save the lives of over 99,000 (+) people around the world. Of course there will always be exceptions in which religion doesn’t permit you (ex. Shinto) to touch the body once deceased. But can you just imagine…… lying in your death bed with a malfunctioning liver, you’re married, have kids, & you still haven’t done all the things you would like to do like go sky diving or parasailing. Wouldn’t you want to be saved. But as a result you can’t because your case is not on the top of the list & you die waiting for your transplant because there aren’t enough people in the world who are willing to donate their organs (which are useless to them but can be helpful to another).

    Think about it…..


    • VERY TRUE!!


    • Aaron Shurmon

      sorry, no. While it is a terrible tragedy that so many people need organs, the numbers are no doubt fluffed up a bit. is that to say that its not a problem? no of course it’s a problem, but its not such a big problem that we should take aware our rights to keep our bodies in one piece after death. i myself am an organ donor, but i am against the idea that organ’s could be harvested at any time just because “someone else needs it.” lets say im in a coma, with the prospect of “living” being months off. a doctor or the government could come in and say they are going to harvest my organs, because by a new definition of legal death they would no doubt implement, i would be “legally dead.” am i dead? no, im not, but if they take out my heart, i most certainly damn will be. if the idea of “human life is all equal” is truly applicable, then why must i give up my prospect of living for someone else to have a prospect of living? the idea of mandatory organ donations is wrong, immoral, and against everything american.


  13. Why would you make people that have been denied healthcare their entire lives give the government their organs when they expire? It’s not only unethical it’s ludacris.


  14. My point of view on this is that Presumed Consent would be best, allowing folks to opt out.

    There are some religions that forbid Organ Donations, and we cannot force their people. Some Shintos, in particular, very sensitive to Organ and Tissue Donation. For Shintos, there is a belief that damaging the body beyond its state at death disrupts the relationship between the deceased and their loved ones.

    I also know of some people who, in conscience, would reqiure that they or their families approve of the recipient of an individual’s organs for religious or other reasons. One patient told me once that he would donate anything so long as he could be assured that his organs wouldn’t go to a convicted criminal who was incarcerated for life; he didn’t feel that the criminal deserved the gift of life.

    While I don’t personally agree with any objection to Donation I have heard posed, I do accept that there are some that would object, and find forced donation to be a harbinger of, potentially, worse things to come.



  15. James Stacey Taylor

    Thank you for the fair and accurate outline of the paper Aaron and I wrote–I hope it generates discussion!


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