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 Department of Philosophy, College of New Jersey, Ewing, New Jersey) have written a persuasive paper on the subject of mandatory organ donation. http://cjasn.asnjournals.org/cgi/content/full/2/2/300. 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.