Presumed Consent - A Needed Strategy?, page

Hello everyone it's been a while since i made a thread but there is something i'm rather passionate about, organ donation.

Currently in the UK we have an opt-in system where people choose to have their organs donated upon their death. This seems like a good idea but only around 27% of people are on the register while surveys suggest up to 90% of people are willing to give their organs. It seems like people just don't get around to donating their organs.

So here is where presumed consent or an opt-out system would come in. The problem with this system is that lots of people just seem to have an irrational fear of it, either they think doctors won't save them because they want the organs or they are religious and are worried their organs will be taken against their will.

Now the religious people feel so strongly that you can be sure they would opt-out and so that problem is sorted easily, the other problem is based on the idea that doctors are desperate for organs. Well if the opt-out system were in place then doctors would no longer be desperate, but despite this the idea that doctors would not work hard to save someone is ridiculous.

So i'm wondering what others on ATS think. Which system do you prefer? Would you support presumed consent? This would be for donation purposes only and not for medical research.

To give context to these figures there were around 8000 registered for a transplant and only around 3500 donors, 1000 people died waiting for an organ.

www.uktransplant.org.uk...

reply to post by silo13

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The UK medical system doesn't make money from organ donations, you raise an interesting point though because i guess in the USA financial motivation may cause some shady behavior.

The new system would simply mean your organs are taken when you die, unless you choose to opt out and then you get to keep them. At the moment it's the other way around.

The ideal donor from the point of view of getting usable organs, particularly heart and lungs, is one who is brain dead, on life support.

I had been in a coma, on life support for a week, (after prolongued annoxia during a back operation,) when the doctors in Monash Medical Centre decided to remove life support before my children can to see me so they would not be able to put up a fight to keep me in intensive care. This was Christmas day, 10 years back.

I had been tending to float off and be unaware of physical reality at the start of that week, but had determinedly worked to keep my mind in the present, listening to everything, and solving maths problems to make my nrain work again. So I was aware and listening to the discussions about killing me, and listened to them being hurried forward when the hospital, having been unaware I had any relatives who were interested, found my kids were coming in to see me.

I still couldn't communicate in any way, but in desperation, after the tubes were removed from my nose, I managed to start breathing again. I had to; my kids still needed me and this was going to be such an unbearably cruel way to wreck their Christmases forever.

That incident proved doctors cannot be trusted when it comes to certifying a patient brain dead, and I wonder how many people who could have recovered have actually, (unintentionally,) been murdered for their organs.


Naturally I'm now against any presumption of consent.


Btw, I presumed this thread was about sex when I opened it. I would have argued against presumed consent laws there, too.



Edited to add a good link about organ donation statistics.
Organ & tissue donation facts

reply to post by ImaginaryReality1984

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I agree with you, i think this is the way forward, my mum died in 94 when she was 51 and i was 25, she had a brain haemmorage and after three days was declared brain dead after conclusive tests, i really FELT for the doctor, who after telling us our mother was dead, had to ask about organ donation, my mothers sister who is a staunch catholic said she was against it but gave me the final word because i was the next of kin, and daughter. I know that if the opt out scheme was in place and i felt so strongly against organ donation, i would have said so, i am content in the knowledge now that five people are alive now because of my mum, and i dont think for one minute, in the uk at least, that anyone would be allowed to die for their organs, i would like to believe that the ethics of the NHS are higher than that.

Originally posted by ImaginaryReality1984
Hello everyone it's been a while since i made a thread but there is something i'm rather passionate about, organ donation.

Currently in the UK we have an opt-in system where people choose to have their organs donated upon their death. This seems like a good idea but only around 27% of people are on the register while surveys suggest up to 90% of people are willing to give their organs. It seems like people just don't get around to donating their organs.

So here is where presumed consent or an opt-out system would come in. The problem with this system is that lots of people just seem to have an irrational fear of it, either they think doctors won't save them because they want the organs or they are religious and are worried their organs will be taken against their will.

Now the religious people feel so strongly that you can be sure they would opt-out and so that problem is sorted easily, the other problem is based on the idea that doctors are desperate for organs. Well if the opt-out system were in place then doctors would no longer be desperate, but despite this the idea that doctors would not work hard to save someone is ridiculous.

So i'm wondering what others on ATS think. Which system do you prefer? Would you support presumed consent? This would be for donation purposes only and not for medical research.

To give context to these figures there were around 8000 registered for a transplant and only around 3500 donors, 1000 people died waiting for an organ.

www.uktransplant.org.uk...

edit on 31-12-2010 by ImaginaryReality1984 because: (no reason given)

Honestly, all of this will become a moot point in a decade or two. Right now, we have researchers in the area of stem cell research who have been able to take cell samples from a biological organism and custom grow an organ in a vat -- lowers the chances of rejection, so on, so forth. The future of medicine is in that field.

reply to post by Kailassa

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You were not dead therefore they couldn't take organs, so in your case presumed consent wouldn't have made any difference.

Originally posted by Jenna
As far as your idea goes, I honestly don't think it's a good idea. People barely pay attention to what day of the week it is. It isn't realistic to expect them to pay enough attention to know they need to opt out of donating.

Well the idea would be a big advertising campaign to make sure everyone who wanted to opt out would do so, the people who really care about it would most certainly hear about the scheme.

Originally posted by DankNugs
Honestly, all of this will become a moot point in a decade or two. Right now, we have researchers in the area of stem cell research who have been able to take cell samples from a biological organism and custom grow an organ in a vat -- lowers the chances of rejection, so on, so forth. The future of medicine is in that field.

Please tell the families of the 1000 people who died last year that this is a moot point. The research you speak of is of course the way forward but it's at least 10 years away from being viable for humans. So until that time something needs to fill the gap.

reply to post by ImaginaryReality1984

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I think this is a better idea.
I think people make a choice on consent forms because they have too, without really considering the issue with any great detail.
In my country consent is usually done along with the renewal or application of a drivers liscence. You tick the level of donor applicable to your choice and I think this makes people decide purely because they have too.
I think an opt out decision is more productive from a health care perspective and I would wager less people would opt out.
Organ donation is such a touchy subject. People are not used to considering their own death and at the time of ticking donor level consents I believe people are more inclined to be reluctant to consider donation purely for selfish reasons, which is normal IMHO.
I have read articles and studies that found that an unwillingness to donate was based on the thought that donors were charged for the removal of organ and this would be passed on to their families, that donors would not recieve full ER/AE attention when brought in or in other words if medical staff knew they were organ donors their care would be neglected in order to farm organs. also many believed that even if they were brain dead or severely injured and comatose, they may still recover and so were reluctant to consider organ donation.
I'll try to find them and post them here.

I think opting out as a choice is easier and a little less confronting. I think that people are asked essentially not to help, it may change the mind set, if you know what I mean. You are making a dicision not to help as you are already placed in the position as a helpful donor, which is totally different to making a decision to help in the first place when you are in a position with no percieved obligation.
Interesting thread.

Originally posted by ImaginaryReality1984
reply to post by Kailassa

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You were not dead therefore they couldn't take organs, so in your case presumed consent wouldn't have made any difference.

I was certified brain dead before life support was removed.
In other words, as far as the hospital was concerned, I was dead.

That's all the hospital needs, plus permission, to take your organs.

Originally posted by ImaginaryReality1984

Originally posted by Kailassa
I was certified brain dead before life support was removed.
In other words, as far as the hospital was concerned, I was dead.

That's all the hospital needs, plus permission, to take your organs.

However organ donation doesn't factor into it here, if they think you are brain dead and you are not a donor then they will still take you off life support, so being a donor wouldn't provide any advantage or disadvantage to a brain dead patient.

Please show some proof that a patient who is supposedly brain-dead will be removed from life-support and allowed to die, as in heart stopping, naturally, before being taken into theatre to have organs removed.

I believe you are misunderstanding the whole process, not realising the importance of having the heart stop beating for as little time as possible.

Organ retrieval procedures

The timing is critical. If patients take a long time to die when breathing machines are removed, their organs are no longer suitable for donation. The quicker organs are retrieved after the patient dies, the more likely they are to be viable. So, in many cases, patients are taken to the operating theatre while still alive, machines are switched off, and surgeons are ready to operate as soon as the patient is declared dead.

There are also some procedures that improve the viability of organs. For example, in the recently reported cases, donors were given prior to death drugs that help preserve their organs (eg heparin), and had catheters placed so that immediately after death cold fluid could be infused into the body. One concern about these pre-mortem procedures is that they have no benefit for the patient, and so some worry that they may breach the principle of non-maleficence. In other cases, surgeons have put the bodies of organ donors onto bypass machines – after death, so that organs could be sustained while the surgical teams prepared to remove organs. One concern about this, is that if a patient has ‘died’, and then their circulation is restored by being put on a bypass machine (including circulating the brain), they aren’t really dead any more.

So, by these procedures, I could have been put onto a by-pass machine, and my organs taken while I was still alive, concious, able to hear everything and able to feel everything.
And nobody would ever have known that a live patient had just been slowly, agonisingly dismembered.

reply to post by Kailassa

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This is why very recently they found that brain scans can show whether a person is actually concious despite being in a pesistant vegetative state. This stuff you speak of is already happening with the opt in system so in the end there is no real difference between presumed consent and the system as it exists already with the situation you are talking about.

Lets consider the opt in system first, lets say your family gives permission for your organs to be taken, well then according to the link you posted you may be put on bypass and cut up, with the presumed consent system the exact same situation takes place.

So tbh there is no real difference, what is needed are better tests to determine if someone in concious. But reading the link you provided it seems they are talknig about letting the patient die, no circulation and then putting them on bypass. Therefore we know they are dead.

You might be interested in this

reply to post by ImaginaryReality1984

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from the above link:

In other cases, surgeons have put the bodies of organ donors onto bypass machines – after death,

Death is declared, in the case of heart donors, not when the heart (circulation) stops, but when the brain has stopped functioning, and that's a measure which I found, from experience, can be wrong.

reply to post by Kailassa

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You've picked out a small part that makes it seem like the circulation doesn't stop. The full qutoe is important.

From the link

In other cases, surgeons have put the bodies of organ donors onto bypass machines – after death, so that organs could be sustained while the surgical teams prepared to remove organs. One concern about this, is that if a patient has ‘died’, and then their circulation is restored by being put on a bypass machine (including circulating the brain), they aren’t really dead any more.

So their circulation has stopped, it may be that UK law is slightly different from US law on this issue. However i'll say again that it doesn't matter whether it's presumed consent or an opt in system because in both cases the procedure is the same. The only way to prevent what you are concerned about from happening would be to abolish organ donation completely or find ways of making sure the person is brain dead.

Originally posted by ImaginaryReality1984
reply to post by Kailassa

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You've picked out a small part that makes it seem like the circulation doesn't stop. The full qutoe is important.

From the link

In other cases, surgeons have put the bodies of organ donors onto bypass machines – after death, so that organs could be sustained while the surgical teams prepared to remove organs. One concern about this, is that if a patient has ‘died’, and then their circulation is restored by being put on a bypass machine (including circulating the brain), they aren’t really dead any more.

So their circulation has stopped, it may be that UK law is slightly different from US law on this issue. However i'll say again that it doesn't matter whether it's presumed consent or an opt in system because in both cases the procedure is the same. The only way to prevent what you are concerned about from happening would be to abolish organ donation completely or find ways of making sure the person is brain dead.

Your part of the quote, you might notice, begins with, "In other cases".
It does not qualify or negate the earlier statement I quoted.

Of course presumed concent will make a difference, because it will mean many more people could land in this situation, including people who never actually wanted to donate their organs.

There is presently no law in any country to say that brain death cannot be used as the sole criterion of death, or to specify how a diagnosis of death is made. This is left to the medical establishment, in which you appear to have a great deal of trust.

I.M., you obviously want to promote organ donation, so you are creating an imaginary reality for yourself with selectively interpreting what you read to fit the reality you want, and imagining there are laws in the UK or the US that will prevent the sort of mistakes they can currently make.

If one huge hospital with a great reputation can misdiagnose brain death and turn off life-support for purposes which are in their own best interest, and not in the best interests of the patient, what's likeliest, that I'm unique and the only person this has ever happened to, or that this is something that sometimes happens?

The attitude behind the proposed legislation is that other people have a right to your organs when you die. However any putative right must be put on hold when the present system makes it likely that tragic mistakes are occurring.

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