Goodhart's law: When a measure becomes a target, it ceases to be a good measure.
Spain is at the top of the ranking because the medical staff have a huge economic incentive to convince donors/family (2k euros) and conduct transplants (e.g. from 10K euros to 15K euros for a liver transplant). The Spanish model has been criticized for many years for being a shady procedure controlled by even a shadier organization that is barely regulated by the government. When the success of the transplant is taken into account Spain loses a lot of places. Spain is at the bottom of Europe in terms of blood donation. The Spanish Model is definitely not one to be imitated.
But there’s nothing that stops countries from being within 5% of each other at top of that ranking. The main point is the large difference between the countries.
If you ask a lay person from any human culture how do you know when a person is dead I think you would get similar answers along the lines of:
- no heartbeat
- no breath
- their body temperature falls to ambient temperature
- blood pools on lower half of body
- onset of decomposition
- etc
When organs are removed from a person for donation, none of those conditions apply. In order to accommodate this fact the concept of brain death was created. But really brain death is an example of taking a word representing an ancient and well understood concept, death, and applying it to something completely new.
Really it's a form of deception. I don't think it's a malicious deception but when the doctor comes in and says your loved one is brain dead that person is not dead in the ways understood by a typical person.
I'm in favor of organ donation in general but until the medical community has some very frank discussions about the medical definitions of death I'm opposed to any form of mandatory or opt-out organ donation.
A friend from University has spent the last ~15 years working in the organ donation site of ER medicine.
They actually spend more time trying to revive a donor and doing everything they possibly can because of misconceptions like what you said above. She is quite certain that if anything, being a donor actually increases the likelihood of you being revived by medical staff, who would much rather revive you than have to deal with people telling them they didn't try hard enough.
>She is quite certain that if anything, being a donor actually increases the likelihood of you being revived by medical staff, who would much rather revive you than have to deal with people telling them they didn't try hard enough.
Is there any kind of (independent) check for this? In my country (Germany) there has been collusion to get ones patients on the top of the recipient list. I wouldn't be surprised of there were similar collusions for the donor side.
I've also heard that recovery procedures differ from organ prevention procedures (at least you don't want to apply medication which potentially damage organs for a potential donor). How does one get assurances that the latter are not applied prematurely if you are a donor?
....That's some disturbing shit there. Please let me know where this hospital of horrors is so I can avoid getting in a car accident near it unless I have my organ donor card on me and there's an angry 'dey took er organs' mob outside.
Maybe the place should start handing out bonuses for each successful patient revival, that'd really get those ethics kicking.
That seems like a bad situation. It can cause rumors like that hospital staff doesn't try as hard to save donor patients because they can harvest their organs can spread.
This isn't what a physician described to me. They waited there and did all these tests for death. Not just waiting for the heart to have stopped but for there to be no response to pressing hard on the fingernail and such. It sounded very much like they do absolutely wait until the person is deceased in all meaningful forms.
He once said that this team of expert transplant specialists who flew in are just waiting and waiting because this one person's heart would just keep starting back up on its own, so he had to be exceptionally careful to pronounce him actually dead.
The fact that no money is involved is a critical part of this system. It also is the fact that no money is involved in RECEIVING an organ.
This makes the system purely altruistic a removes the kind of questions of "how much should an organ cost", "could I accelerate the process paying more for an organ?", "could I sell my organs, or the organs for my just deceased relative for more money?" "Is this enough money for selling my organs?"
Eliminating the money from the equation makes this simple. You don't win or lose anything for donating. If you don't want to, is cool. But if you want to, is totally selfless. Which strangely, makes more people be cool with the default and donate more. Because the only thing involved is feeling generous and helping others, unless you have some sort of religious feeling or fear. But, again, nothing to earn.
Some countries have it opt-out on gaining a driver’s license.
The family however can always override it.
There is another factor and is cause of death and age which directly is tied to doner suitability as well as if there is infrastructure to support organ donation across the nation and other process related issues.
I would strongly suspect that Spain managed to solve the infrastructure and process related problems rather than it simply being a cultural factor or that Spain has somewhat more non-toxicity, cancer/congenital or massive trauma deaths of otherwise healthy people between the age of and 20-45.
> Dr Matesanz rejects the idea of a Spanish miracle or a unique store of generosity in the hearts of his compatriots: “We have asked the same question in various surveys over the years and every time 56% or 57% say they would donate their organs after dying; roughly the EU average.” On the role of Spain’s transplant law, which presumes consent unless otherwise stated, Matesanz is also dismissive, pointing out that families always have the final say and that the only country in the world to enforce such a rule is Singapore. “Spain has not been a leader in surgery or research; we have hardly chalked up any firsts in transplant operations. What we have brought to this area is organisation. Following a philosophy that states that donors do not simply fall from the heavens, we have provided organisation and professionalisation.”
> transplant law, which presumes consent unless otherwise stated
The same law is being applied in France, you have to be registered as not a donor in a national database. But, as the doctor said, the problem is with the available organisation, not the laws that are applied.
For example is familial consent is required and the answer is usually yes even in Spain AFAIK.
But that doesn’t mean they are all equal the time that it takes to contact a family and get consent plays a critical role so is who contacts them as in a professional that can explain to them the process and increase the likelihood of consent being given to some busy administrator asking them that as btw....
Also are all hospitals equipped for organ harvesting? Do they have free surgeons and free surgical staff and rooms for that? Can all hospitals handle transport and distribution of organs?
How fast is donor decision can be made after harvesting?
These are all critical factors for organ donation in cases that do not involve a vegetable state patient where organ donation can be planned.
I don’t know about the UK but I have knowledge of another opt-out system in a different country and in the case if the family couldn’t be contacted in time for the organs to be harvested the reason for why not would be recorded as the same as the family refused and that is “consent was not given”.
So to me the % difference can be just that Spain is quicker at contacting the family and is more prepared for organ harvesting and distribution for ad-hoc cases in which time is critical.
From my understanding (although second-hand), the law theoretically describes an opt-out system, but this is (due to legal uncertainty about the details?) not acted on by the healthcare system, which instead relies on explicit consent.
Yes make it opt-out by law, with central database and (formless) opt-out pass, which people can carry around. If neither is found relatives need to be contacted.
I think this is great for them. I think that depending on national culture, a person may want to die with what they came into this world with. I know that some world religions are against the practice. I say this with full realization that some folks will read that and think “how selfish!!” Regardless of any of our beliefs, organ donation is a very personal choice.
Personally, I wouldn’t go about the issue by shaming nations that don’t belief in the practice. I would instead go about it by having a campaign of information on the life saving benefits of helping others. Undoubtedly someone will tell me that these campaigns exists, but I’d say they don’t do a good enough job yet.
a person may want to die with what they came into this world with.
Reminds me of the grandmother in Uri Orlev's book, who insisted on burning every fingernail clipping, as otherwise their souls would be stuck on Earth seeking for them after death.
In the end, nobody old enough to make that decision dies with what they came with - the body changes too much over the years. But then again, we allow everyone to destroy their organs with drugs, dangerous sports, sitting for most of the day, etc. It would be hypocritical to deny others the equivalent choice.
Well sure, but the fact that it is personal belief doesn't make it less selfish.
As long as it is opt in you won't get much success, because there is no benefit and people are lazy by nature, which is normal.
I don't think paying organs donors should be a thing, so maybe have a priority list for organs where donors get higher? Seems fair: you promised to help society, and in exchange society promise to help you first instead of the selfish non participants.
Organ donation attracts a lot of scum elements and dubious practices which require government policy frameworks and oversight. Then the hospitals need to confirm to a lot of paperwork/trail which is cumbersome. If i’m waiting for a kidney, i can wait in a queue to receive it from someone who’s dying or i can “bring my own donor”, maybe a relative. Is the relative really related to me or have i lured him/her with money.
If there are no boundaries or rule structures, then the incentives often (always?) bleed into some involved party not having a choice, or a Hobson's choice.
Is having an Hobson's choice worse than having no choice at all?
Someone having to choose between selling a kidney or starving is terrible. But the solution shouldn't be to deny the first option - that just leaves starving. It should be to give them a third option.
That said, obviously "no rules" would still be dangerous, but no legal sale is done without any rules.
Yeah, but I think in this case there's an issue where the choosing party lacks the ability to make an informed decision. The risk-weighted long-term medical costs of removing a kidney (in less-than-ideal operating conditions!) and living with just one (probably in an environment where kidneys work overtime due to low-quality resources!) make it a rather expensive proposition. It would've been easier to scrap/work/beg for food than for the potential medical after-care they'll need over time, in terms of the total long-term cost of maintaining their life and/or health levels. But those that understand this are withholding that level of understanding and forcing it to look like a rational Hobson's choice to the donor.
But if one has so little income that he is starving, selling an organ would only postpone the inevitable. You can do this only a single time. As well, this certainly will create perverse incentives.
There's little reason for anyone to submit to organ harvesting to eat. The idea that our society is just enough for individuals to face that choice is kind of laughable.
Of course the best thing is to make artificial organs work, but that's not something most potential organ donors have much influence over.
This isn't a very popular opinion, but I agree. I feel that people should be able to become donors in exchange for some sort of payment to heirs (kind of like life insurance). The doctors and hospitals are making money from life saving transplant surgery, why not the donors? I think the waiting list would get real short, real quick if this happened. (Note: I'm a registered donor)
What is the bottleneck to organ donation? 46 out of 1 million seems atrocious, not laudable. How many people are willing to donate but medically unable?
They main bottleneck besides opt-in laws in some countries are the average age of the deseased. You really want young healthy accidental deaths, car or motorcycle accidents are the best. You don't that care much about older organs of sick people.
The second most important factor is good organization and infrastructure. That's Spain's and now also Croatia's strength. You really need to be able to transport the organ fast and cool to the next hospital where the organ is needed. And you need to have the recipient on call also, who should not have eaten something in the last 6 hours.
You cant tell until it comes to it I had a kidney transplant last year and only one kidney was usable. I was the better match - so the guy on the bed next to me had to be told sorry and had to go home
Also some kidneys can be problematic I passed on one where the donor might have been HIV+ - I had gone on the list prior to needing diyalsis so it wasn't like I needed one immediately.
This is one of those interesting questions where almost all laymen agree it should be altruistic, and almost all economists, from every school of thought including Marxism, agree there should be a market.
Iran is currently the only country with a legal organ market. It also happens to be the only country with no shortages or wait lists. Both facts were true in India and The Philippines until the sale of organs was prohibited in those countries in 1994 and 2008 respectively.
There are clearly some ethical concerns with creating an open market for organs. The Israeli system I think is a great compromise. In Judaism, corpses are sacred so even autopsies can be controversial in some circles. Therefore the organ donor rate was very low. The solution? Whoever is a registered organ donor receives priority over those who aren't. Since there are so few organ donors in Israel, having priority is crucial and can mean the difference between life and death. Therefore the number of organ donors have skyrocketed. I think it is an ingenious system.
Am I the only one not so very enthuastic about organ donation ? Except for cornea, it means a life long of heavy immunosuppressive treatments (which are not free afaik), leading to higher cancer rates and many other side effects. Things are rarely a pure win, there are downsides (even though they are suspiciously rarely mentioned). I don't think we have such a shortage of people that we have to save every and each one no matter the cost.
So yes, I for one am not interested at all by donating my organs (here it is an opt out). I'd rather be dissected, as I learned a lot on (in my case animal) cadavers.
Well, I believe in Denmark if you opt out you are put in the end of queue in case you will need donor in the end (and you can't be never sure about that). I think that's fair system which could be adopted in other countries.
First, Spain is only good because doctors get paid quite a bit per time they take the decision to transplant. I'm pretty sure this is coming everywhere, and makes the following comment far worse.
As for the first or last on the waiting list, that's a cool soundbyte, but that doesn't matter at all. It is still the case that most transplanteable organs are thrown away.
Now granted, that's not 100% true in all cases. If you're on dialysis and need a kidney, that might happen. But a true necessary organ, like a lung or a heart, beginning of the list, end of the list, doesn't matter. Even then, compatibility is an enormous restriction.
And of course, there's the counterargument everybody's silent about : if you're an organ donor, doctors will not make the same efforts to keep you alive. The decision to donate organs cannot be made postmortem, but must be done before the patient dies (at least 15 minutes or they won't even attempt transplant, ideally hours). Granted, if you're braindead for 2 months, not an issue.
If however you come in after a car accident with heavy internal bleeding, a doctor has a choice : you're, say, 80% likely to die, but in 30 minutes or so, not immediately. But if they extract your heart now, they can prolong the life of someone else by ~5 years with odds of some 50% or so (can be higher, can be lower).
At that point, a doctor will make the decision to throw away the 20% and ... well kill you.
But it gets worse : they won't use sedation (and though it's likely you're unconscious, it's not certain, certainly the level is uncertain (because there is more states between awake and coma than you'd think, some of those states involve paralysis, or you may be conscious but have severe nerve damage), as that would significantly reduce the odds of a successful transplant.
Now I'd hope they'd at least inject an overdose of morphine once the organ's out (because the patient at that point will, of course, die, no need for suffering).
Sadly, if accurately informed, I believe nobody would volunteer to be an organ donor.
And yes, the Spain thing is true in the worst possible case: doctors get paid, thousands of euros, for every time they declare a patient beyond rescue and go for organ harvesting instead. So not only is there a terrible incentive in the first place (the same as elsewhere, organs available for harvesting save lives of course), there's an even worse incentive in Spain's case.
I dont have a source for this, but I've been told a couple times that doctors who get cancer tend to decline chemotherapy/treatment because of what the treatments do to the body. It was described as aging your body to a frail old person (not matter what your initial age was), that is not reversible.
Or think about this on the extreme end: I think many people would choose a time to die peacefully rather than sit in a semi-vegetable state in a hospital bed for the rest of their life.
> "[...] I've been told a couple times that doctors who get cancer tend to decline chemotherapy/treatment [...] [Chemotherapy] was described as aging your body to a frail old person (not matter what your initial age was), that is not reversible"
Maybe in some cases, but as an overall statement it seems seriously misinformed. Not all cancers or their treatments are the same. My mom had breast cancer surgery followed by chemotherapy and it certainly didn't age her or make her body frail.
I am a kidney transplant recipient. I received my transplant 9 years ago.
My immunosuppressive treatments is a walk in the park compared to the 6 months I was on dialysis. I got married and had a kid after my transplant, none of which I even considered while I was on dialysis.
Which is to say, you are horribly misinformed. :). I hope you will read more about organ donation before making the decision to not opt in.
Also idk your personal reasons for need of a transplant but common reasons for acute renal failure are diabetes melleitus, vascular disease, and immunological diseases. Many in each category have a genetic component. I wouldn't dare to pass such risk to offspring but to each his own I guess.
To grossly sum it up, we end up putting new kidneys in people who fucked up their own because they got diabetes (ok, a small share is congenital, which also sucks a lot). I don't feel like sustaining that and I don't feel guilty the slightest.
Are you seriously suggesting anyone who has renal failure shouldn't have children?
What next - siblings of renal failure should be sterilized because they might be at Y% higher chance of X unknown disease?
Your choice if you don't want to sign up for organ donation, and I respect your choice. Everyone should make their choices about their bodies.
However, your choices are coming from horrible misinformation.
I don't think it's very wise but there's no obligation. If you want to have children risking to suffer from the same life altering conditions that's your choice. But what happens when everyone in your lineage is dependent on organ donation or more generally lifelong drug dependance? Is that alright or should we act when it's preventable (genetic counseling etc)?
Also what is misinformed? Are you living without treatment? Do you indeed carry any risk for offspring or are you in the slight share of patients who got acute renal failure thanks to some bacterial infection? Since you didn't address it and the odds are not in favor, I don't have much doubt on the answer. I don't think much is factually wrong, rather that you're displeased with my conclusions : not worth enabling.
As someone who has lived more than an extra 10 years of life due to receiving a transplant, I am very happy to take my daily immunosuppressant medication.
For context, I was in my 30s when I had the transplant. If I was 70+, then perhaps I might pass.
I hope you are never in the position of being on a waiting list for an organ donation, but it is much easier to dismiss an abstract idea of saving some unspecified life versus facing short term uncertainty about your own continued life.
High five! I received my transplant at age of 24, nine years ago. I hope many, many years of life to you.
I hope anyone reading this thread considers signing up to be an organ donor. There is very few free lunches, but organ transplant is one of them.
Also, this line from the parent post requires a response:
> I don't think we have such a shortage of people that we have to save every and each one no matter the cost.
Organ donations are huge net positives for society. In a world with no organ transplants, the renal failure patients would be spending an average of 5 years longer on dialysis, which ties up hospitals, patients and caregivers mush longer than a transplant operation plus+ immunosuppressive treatments do.
Signed up long ago.
Why not, I mean why would I care what happens to my organs, if I am dead? So if someone can benefit, good for them and good for you!
Spain is at the top of the ranking because the medical staff have a huge economic incentive to convince donors/family (2k euros) and conduct transplants (e.g. from 10K euros to 15K euros for a liver transplant). The Spanish model has been criticized for many years for being a shady procedure controlled by even a shadier organization that is barely regulated by the government. When the success of the transplant is taken into account Spain loses a lot of places. Spain is at the bottom of Europe in terms of blood donation. The Spanish Model is definitely not one to be imitated.
https://elpais.com/elpais/2018/06/22/opinion/1529691789_6524...