[grecy]

My first thought has always been to just make it mandatory, or at the very least opt-out instead of opt-in.

I realize those are both very controversial, so I wonder why we don't have a monetary incentive.

i.e. We will pay $1000 for every organ of yours we take to a person you nominate.

[dmm]

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.

[grecy]

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.

[chopin]

>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?

[furgooswft13]

....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.

[bjourne]

That implies that ER personnel can tell organ donors from non-donors apart. Is there any evidence that they can?

[grecy]

Given the donor team are usually standing right outside the door waiting, I would say they know.

[bjourne]

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.

[Waterluvian]

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.

[RobertoG]

>>"If you ask a lay person from any human culture how do you know when a person is dead [..]"

If you ask a lay person from any human culture very probably the most significant part of the definition would be "non-reversibility".

That works for brain death too.

[jaimebuelta]

(Spaniard here) No sorry. No. Just no.

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.

[dogma1138]

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.

[severine]

edit: sorry, I hadn't read the article, I see it says more or less the same than my link

> Spain managed to solve the infrastructure and process related problems

That's correct, the Organizacion Nacional de Transplantes is the main culprit.

You can read about it here: http://www.newsweek.com/2015/02/20/spain-has-become-world-le...

> 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.”

[baud147258]

> 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.

[dogma1138]

Exactly there might be a lot of other factors.

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.

[LeifCarrotson]

A monetary incentive results in people getting blackmailed into selling their organs and nominating the thugs as the recipients of the money.

[flother]

Iceland passed an opt-out organ donation law recently. It comes into force from 1 January 2019.

http://icelandreview.com/news/2018/06/07/all-icelanders-are-...

[saosebastiao]

I would prefer the incentive be that you can't be on a list for a transplant if you have previously opted out of donating.

[mediascreen]

Sweden has an opt out system, but still has very low participation: https://www.bbc.com/news/health-41199918

[croon]

I don't know where BBC got that information, but it is very wrong. It's entirely opt-in.

You need to either:

1) Register your wishes with the National Board of Health and Welfare

2) Fill in a donor card and carry it in your wallet

3) Notify next of kin/will etc

Upon your death you need to be pronounced dead twice with at least 2 hours apart, sometimes after a brain scan.

The low participation is indeed true, but according to a 2010 poll, 83% Swedes were positive to organ donation, but very few register as such.

Edit: Actually the participation doesn't seem that low [1].

[1] https://ec.europa.eu/health/sites/health/files/blood_tissues...

On the Swedish system, in Swedish:

https://www.socialstyrelsen.se/donationsregistret

http://www.socialstyrelsen.se/pressrum/nyhetsarkiv/sverigeha...

[detaro]

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.

[Kurtz79]

For "low participation", do you mean that the majoritiy of population actively opted out?

How is the decision to opt out made?

[singularity2001]

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.