Dead enough
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I'm certainly capable of making up a slippery slope argument where people are being off'd for their organs. It just doesn't seem like people willing to do that would be detoured very far by someone's lack of organ donor status and even if nobody but organ donors were to be off'd prematurely, it's probably low down on the likely reasons I'll get off'd for someone else's benefit.
I figure I'm much more likely to die waiting for an organ than to be off'd for mine even well into the gray zone of organ harvesting.
In the tech scene there is a particular aversion to facing up to the realities of life. People tend to think that waiting for technology to improve will take care of all of life's problems and death is just another one of those, so if they just hold out long enough death will surely not happen to them.
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I think a sane default is to require opt-out for organ donation after brain death (what Europe does now, I believe) with an opt-in "sliding-scale" for the rest of the possibilities.
We're talking about people in permanent, machine supported comas. If a doctor offs someone that the doctor knew had a chance for survival the doctor should get tried for murder.
That's precisely why I am not an organ donor.
I don't want to put anyone in the position of making these decisions based on probability and likelihood. Harvest the organs of the willing only after clinical death has occurred.
I'm concerned that one day a poor person could sustain a traumatic brain injury and just so happens to be a tissue match for someone who is rich, famous, politically connected or influential who needs an organ.
The chances of that happening to any one particular person are quite small.
The wealthy in the current system already have an unfair advantage by being able to 'multiple list', a path not open to those of lesser means. It's all perfectly legal, of course.
Call me selfish, antithetical to society, or whatever. If I really was in a state where there was no chance I could recover, I would gladly give my organs to help save someone else. As it is, I don't think a random E.R. doctor should make that determination based on a note found in my wallet.
I don't think live harvesting is common (or allowed) in the US.
To do so, first we should revisit all that stem cell debate.
It's kind of hard to argue that stem cells are more sacred than organs harvested from still breathing body.
I would not be so sure. I don't think that laymen understand the difference between evil baby-harvested stem cells and my rightfully own adult stem cells, and that hurts research & funding.
One example from a quick google search: http://www.ncregister.com/daily-news/adult-stem-cell-therapi...
It will be a milestone, not having to wait for someone to die to get a functioning heart or liver. Maybe no more immuno-suppressant therapies for transplantations. Questioning ourselves too.
I think the worry is that even if the particular doctors in her ER would always try their hardest, there might be other doctors in other ERs who might not.
What's difficult is that there's really very little way to truthfully ascertain if someone did in fact try hard enough. How do you really quantify effort? It's very similar to programming, if someone creates a bug was it an accident or was it on purpose? You'd like to believe that it was always an accident but you can never really know for sure.
What happens when organ donation is seen as a moral imperative and only a few percent of people choose not to participate? Might doctors not try as hard to save them as "punishment" for being "anti-social" or something?
There are a lot of thorny ethical questions surrounding organ donation, death, and drawing hard lines where things are squishy.
IMO, if you want to opt-out of donation, doing so should opt-out of the receipt of donated organs as well.
More what I was trying to talk about was the idea that organ donors and non-donors might receive different standards of care "because organ donors are better people" in a future where almost everyone is an organ donor and societal expectations have shifted significantly.
First, there's not an ongoing, nationwide shortage of blood - we have enough of it, so people aren't dying needlessly because they can't get it.
Second, requiring an invasive medical procedure on a live subject is hugely different to cadaver organ donation.
We already have an ethical framework in which the government at least partially controls post-death use of the body - autopsies, regulation of burials, etc.
That's how they drive up supply. When it gets too low here in the US they'll actually use phone banks to call regular donors to ask them to come in. I'd imagine the UK has something similar.
> if The Simpsons is even slightly realistic (!) sometimes people in the US give blood for cash?
I believe it's illegal to pay donors for blood, but plasma donation can be paid. It's problematic. http://www.theatlantic.com/health/archive/2014/05/blood-mone...
It might not be in your best interest (a painless death) to be painfully cooled down by a freezer to reduce the fever that can occur after severe aneurysms - while waiting for the brain infarct that will induce a "brain death."
The cynical might say that it's for saving your organs rather than for your survival, and it's hard to tell how much pain is experienced, but looking at the reaction of the body,it's apparent that it hurts as hell.
I understand fears such as your own from a human point of view, and they should absolutely be addressed if they're stopping people from becoming organ donors, but I do think it's unfortunate. So many lives could be saved... Hopefully more and more countries will adopt an 'opt-out' system going forward, because it seems to make a huge difference. And as for this article, I have no problem with clarifying the definition of death. If there's no electrical activity in my brain, I see no harm (literally "no harm" in the Hippocratic sense) in removing my organs before I'm taken off life support.
If there is nothing to gain (no financial reward, or reputational bonus, or so on) or there is but they have the appropriate morals to turn it down, then they aren't going to risk the nagging of their own conscience and/or looking bad by letting you die.
If there is something to gain (and they are mentally capable of letting themselves take advantage of that) then it is going to happen whether you are a registered donor or not. If they can convincingly let you die without recompense they can hide your organs in the paperwork so it doesn't look like a non-donor organ has intentionally been used.
So whether or not you are screwed in a situation where this discussion is relevant is not at all determined by whether or not you are registered as a donor. By choosing not to donate you are not controlling any such situation in the way you hope you are.
There is the grey area where, for example, you have a 20% chance of survival but with the transplant someone else has a 60% chance - then things get a but more tricky depending on your paranoia level, though IMO the chance of that is rather small (the chance of getting hit by a bus on your way home from work or shot by some loon in a movie theatre is so much higher that it doesn't make sense to be committing time to thinking about this) and to be honest I'd probably not mind all that much if it did happen... Then again some might discount my opinions here because many don't seem to understand my reasoning in the following point of view: If I were in a permanent vegetative state or riddled with dementia or similar I'd gladly shuffle and donate my organs to help several others (who still have a chance of some desirable quality of life) on the way out. The only thing stopping me registering as "FFS just let me go when I get close to that sort of state, because I'm no longer me and there is no point throwing time and money at keeping the husk that is no longer me going" is that there is no legal way of doing so.
Cost benefit analysis to save the most people.
"He is already pretty much dead. We could keep trying and maybe damage the organs, or go ahead and call time of death and get these organs to save 3 other people."
For me, the bigger issue is that of the 'beating heart donor' where your organs are harvested while you are brain dead but your body is still alive. I don't trust our understanding of brain death enough to say that pain isn't felt (consider the rare cases of people who are anesthetized enough they appear unconscious to the instrumentation but are able to recall parts of the operation including sometimes feeling pain).
Prestige and money. When a millionaire is dying of heart failure, do you think s/he goes to whichever doctor has an opening on the schedule or do you think that s/he will seek out the doctor who has the best record for saving people in his/her position?
There is the grey area where, for example, you have a 20% chance of survival but with the transplant someone else has a 60% chance
There's nothing grey about it. Unless the donor explicitly authorized the removal of the organs before the onset of clinical death it's unethical.
I don't care if it's 1% versus 99.99%, my organs are mine.
A definite Win! for society, right? In a utilitarian sense.
Morally, yes. Legally, no. You can't sell your organs because you don't own them. You don't own yourself because who knows why? It's the government's way of solving a variety of problems regarding people who aren't exactly in their right mind.
Sadly it has some other unfortunate outcomes as well, like you can't legally take your own life no matter how much you're suffering.
That's not entirely accurate. I can give them away, because I do own them.
I could give someone one of my kidneys. I could give someone a lobe of my liver. I can and one day may give someone some of my bone marrow. I can and have given away some of my blood.
The doctor reports on the patients chances of survival/waking up etc and this is checked against the patients donor status including any permission to harvest organs if there's no or only a tiny chance of survival.
Of course there's a number of hypothetical situations where this falls apart - if there's only one qualified doctor available in a tiny hospital or if there's no access to patient records/pre-recorded desires. However, it's a place to start.
Until there are better options available or a series of well publicized abuses I will continue to be an organ donor because, to put it simply, the golden rule.
There is of course the issue of trusting people to make that call for me, but I'm pretty sure I trust an awful lot of people to not kill me unreasonably.
One of the big problems really is to determine the odds.
I can't draw that line for anyone else, though. From my perspective, the moral thing for the government to do is to make it legal and require an extra opt-in above and beyond the typical DDR version of organ donation enrollment we have now.
Disclaimer: I didn't read the entire article so my concerns may have been covered.