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Main Forums => Politics => Topic started by: sanglant on May 09, 2010, 11:43:40 AM

Title: forced organ donor status
Post by: sanglant on May 09, 2010, 11:43:40 AM
http://happeningnow.blogs.foxnews.com/2010/04/28/what-do-you-think/ i can't believe anyone would even think of doing this, what of people that have "things?" that we don't know how to detect? i'll edit post after i find a link to the vid. the video (http://video.foxnews.com/v/4170376/organ-donation-controversy).
rest of my thoughts(for now at least) are below.


edit: already happened (http://www.foxnews.com/story/0,2933,311220,00.html)
Title: Re: forced organ donor status
Post by: MillCreek on May 09, 2010, 11:50:59 AM
The proposed law does not require mandatory organ donation.  The proposal is that rather than signing a consent form allowing organ donation, you would have to sign a consent form refusing organ donation.  Several countries have 'opt-out' systems like the New York proposal.  The experience of those countries is that an 'opt-out' system apparently does not significantly increase the rate of organ donation.  What often happens is that whether an 'opt-in' or 'opt-out' system is used, family members often refuse to allow donation, despite the wishes of the donor.  

Having seen a number of people die while waiting for various transplants, I am in favor of any legal and ethical means to increase donation.  One such hot potato issue being debated is a payment to the donor or donor's family.  Another idea is to put organ donors on the priority list should they themselves ever need a transplant.  I myself have been a donor for 32 years now. 
Title: Re: forced organ donor status
Post by: sanglant on May 09, 2010, 11:59:43 AM
a better article (http://www.marginalrevolution.com/marginalrevolution/2010/05/presumed-consent.html).

MillCreek, what bothers me is "the first step would end the right of the next of kin to challenge the decisions of their dead or dying relatives to donate their organs." so if, as in my edit added link above. some one has caught something but not been tested yet, there family knows but has no way to do anything about it. and well to tell you the truth, people like me. they have no idea what's wrong and there's no way to know if saving someone by using one of my organs, is going to condemn them to suffering the rest of there life. in my view, having to opt-in gives the donor the chance to think about these things before hand. i know i would have checked that box before, but won i made sure it was marked no the last time i had my DL renewed. or why would i try to put more people in my hell, just when i was getting out?
Title: Re: forced organ donor status
Post by: MillCreek on May 09, 2010, 12:12:31 PM
^^^ Are you referring to the possibility of an organ donation transmitting a disease?  Organs are tested up the wazoo, but there have indeed been cases of disease transmission by organ transplant.  If family is available, they are asked if the donor has any significant medical history or any risk factors for various diseases.  Depending on the need for the organ, sometimes a choice is made to use it despite the possibility or actuality of disease transmission.  

If I was dying and needed a heart, and a donor organ was offered to me with the possibility that the donor had hepatitis, for example, I would take it.  

Even if a donor is unsuitable to provide solid organs, often items like skin, bone and corneas can still be used.  My philosophy is that once I am dead, I want to be stripped for any parts that can be helpful to someone else.  I have made sure to let my family know of my wishes in this regard.
Title: Re: forced organ donor status
Post by: MicroBalrog on May 09, 2010, 12:18:46 PM
For a variety of personal and moral reasons, I do not have a donor card. If such a law existed where I lived, I would opt-out.
Title: Re: forced organ donor status
Post by: S. Williamson on May 09, 2010, 12:22:45 PM
Heck, hollow me out.  Not like I'm using them anymore anyway...  =)

In my will, though, it is specifically stated that I do not be embalmed (aside from whatever stuffing they use after my hollowing, if there is going to be a viewing/open casket service).  Direct cremation only.

Ashes to be released into Galway Bay at sunset.
Title: Re: forced organ donor status
Post by: lupinus on May 09, 2010, 01:18:48 PM
They can have everything with the exception of my eyes.

I want those in a pickle jar on top of my urn  =D
Title: Re: forced organ donor status
Post by: Sergeant Bob on May 09, 2010, 01:19:53 PM
I personally don't care if they remove all my parts after I'm gone however, that is my decision, not theirs.
Title: Re: forced organ donor status
Post by: sanglant on May 09, 2010, 01:24:31 PM
MillCreek, let's say it's a little more then hepatitis. let's say you'll have headaches that nothing less then oxi will touch for the rest of your life. you'll be unable to go outside without a hat and dark sun glasses. a storm going through will mean your in bed in a dark room with blacked out windows, you can't concentrate on anything for more than 30 minutes at a time, with out making it so bad it takes a day or too to get back to where you were at. and the drugs only work for a few months at a time? oh and there's no test that will show it before the transplant. still want that patient added to the donor rolls without having a chance to consider it? >:D it took 2 times through getting my DL with it checked before i realized just what it would be doing to someone. :facepalm: all i'm after, is to have a reason for people to think it through before hand. and opt-in has more agreeing to it simply because they don't have to think about it. i suspect the real reason for this law, is a democrat having his child saved by a transplant and jumping in to "do something" with no thought to the outcome.
oh and to the healthy donors, think you. =D
and no i won't be receiving anything related to this post. refusing treatment i'm close to. ;)
Title: Re: forced organ donor status
Post by: MillCreek on May 09, 2010, 01:34:21 PM
^^^ Absolutely.  The clinical scenario you describe above is most likely not due to anything transmissible by bacteria, viruses or prions.   Has a qualified physician advised you not to donate blood, semen, tissue or organs as a result of this condition as substantiated by the results of diagnostic tests or medical history?  If not, then you are probably good to go as a donor. 
Title: Re: forced organ donor status
Post by: MillCreek on May 09, 2010, 01:44:43 PM
I have not seen the actual text of the proposed New York law.  But putting on my healthcare risk management hat for a moment, if they are removing the ability of the family to refuse organ donation, then the physician and hospital need to be immunized against liability for removing the organs. 

Otherwise, if there is no immunity, and the family threatens to sue the physician/hospital, most healthcare facilities will not remove the organs.  It is not worth the cost and hassle of a lawsuit.  So if the intent of the 'opt-out' law is to increase donation, I hope the folks in Albany keep the immunity issue in mind. 
Title: Re: forced organ donor status
Post by: sanglant on May 09, 2010, 01:47:03 PM
i'm just not willing to risk it. there's nothing that shows up in mri's cat's x-rays, etc. they really have no idea what it is. i can not gamble with Someone Else's life. =|
Title: Re: forced organ donor status
Post by: Leatherneck on May 09, 2010, 04:24:18 PM
Quote
One such hot potato issue being debated is a payment to the donor or donor's family.
I wonder how that would work? =D

TC
Title: Re: forced organ donor status
Post by: sanglant on May 09, 2010, 04:44:32 PM
a u-haul behind the hearse? (http://www.youtube.com/watch?v=ynELR4a5L1M) i plan on having one rented, and hauled behind me on that ride just for fun. [popcorn]
Title: Re: forced organ donor status
Post by: MillCreek on May 09, 2010, 04:57:59 PM
I wonder how that would work? =D

TC

A payment to the living donor who gives a kidney or lobe of the liver.
Title: Re: forced organ donor status
Post by: Brad Johnson on May 09, 2010, 06:06:51 PM
The proposed law does not require mandatory organ donation.  The proposal is that rather than signing a consent form allowing organ donation, you would have to sign a consent form refusing organ donation.   

Which is, by definition, de facto consent FOR donation.  Don't sign the form and your organs are harvested, under penalty of prosecution for non-participation, whether you intended for them to be or not.  That consitutes mandatory participation.

I am a donor but I signed up by choice.  Forced donation is non of the governments damn business and they can, and if I have anything to do with it will, butt the hell out.

Brad
Title: Re: forced organ donor status
Post by: Matthew Carberry on May 09, 2010, 06:54:07 PM
If the government is taking my organs without consent they better be paying my estate the fair market value as set by the Mexican who stole my kidney that Spring Break.
Title: Re: forced organ donor status
Post by: S. Williamson on May 09, 2010, 07:01:57 PM
Because this thread needs more Monty Python.  =D

Organ "Donor" (http://www.youtube.com/watch?v=aclS1pGHp8o) (might be NSFW)
Title: Re: forced organ donor status
Post by: seeker_two on May 09, 2010, 08:01:45 PM
I would donate my organs.....but I'm giving the whole kit & kaboodle to the Body Farm....

http://en.wikipedia.org/wiki/Body_farm (http://en.wikipedia.org/wiki/Body_farm)
Title: Re: forced organ donor status
Post by: Tallpine on May 09, 2010, 08:03:06 PM
I'm just going to use everything up before I die  :P
Title: Re: forced organ donor status
Post by: Waitone on May 09, 2010, 08:14:42 PM
I have a real problem with "donating" organs.  I find it curious that the only person who doesn't get paid in the chain that enables a successful organ transplant is the one who donates the organ.  Everyone else gets paid.  Am I missing something?  Why not make organ payments part of the deceased's estate?  Seems to me Walter Williams, Thomas Sowell and others have made a reasonable case of paying for organs as opposed to donating them.

I don't agree with implied consent drunk driving laws and I sure don't agree with implied consent organ donation.
Title: Re: forced organ donor status
Post by: MillCreek on May 09, 2010, 10:18:13 PM
Which is, by definition, de facto consent FOR donation.  Don't sign the form and your organs are harvested, under penalty of prosecution for non-participation, whether you intended for them to be or not.  That consitutes mandatory participation.

I am a donor but I signed up by choice.  Forced donation is non of the governments damn business and they can, and if I have anything to do with it will, butt the hell out.

Brad

That would depend entirely upon how the form is worded and the role of the family, if any.  I doubt very much that if you verbally withdraw consent for donation, the organs will be harvested nonetheless, even if you sign a form.  I doubt very much that if you revoke the 'opt-out' form that you will be a forced organ donor.

Even for those of us who sign up to be donors, the usual and customary practice is to ask the family for permission. If they refuse, your wishes to donate are usually ignored.  In an 'opt-out' system, I suspect that the family will still be asked. 
Title: Re: forced organ donor status
Post by: taurusowner on May 09, 2010, 10:29:38 PM
They can do whatever they want with my husk when I am gone, I care not.
Title: Re: forced organ donor status
Post by: KD5NRH on May 09, 2010, 11:15:13 PM
I have a real problem with "donating" organs.  I find it curious that the only person who doesn't get paid in the chain that enables a successful organ transplant is the one who donates the organ.  Everyone else gets paid.  Am I missing something?  Why not make organ payments part of the deceased's estate?  Seems to me Walter Williams, Thomas Sowell and others have made a reasonable case of paying for organs as opposed to donating them.

Therein lies my problem with it; the doctors don't donate their services for free, so why should the person providing the most critical part of the process not be compensated?  Given the cost of the procedure, a few thousand extra tacked on for the donor wouldn't even be noticed by the recipient.
Title: Re: forced organ donor status
Post by: taurusowner on May 09, 2010, 11:31:29 PM
Therein lies my problem with it; the doctors don't donate their services for free, so why should the person providing the most critical part of the process not be compensated?  Given the cost of the procedure, a few thousand extra tacked on for the donor wouldn't even be noticed by the recipient.

Once you're dead, value is meaningless.  A doctor's time is valuable to him because he is alive.  The nurses, hospital, anesthesiologist, etc all are being paid because their time and education has value to the one paying.  You are dead, you organ is either going to rot away or get used.  The donor is the only one in the process who doesn't get paid because the donor is the only one in the process who doesn't exist anymore.  So I assume you're saying the donor should be paid beforehand, while he or she is still alive?  Well then, your kidneys for example wouldn't really be yours.  No more alcohol for you.  How about your heart that has been purchased by another.  You traded it's value for money.  I hope you don't like eating fast food or drinking soda or beer.  The health of your cardiovascular system is no longer only your concern.  You damage your own heart after selling to to someone, you are destroying their goods.

The current system is the only one that makes sense to me.  Once I die, my body is like a mine or a forest.  Resources that are wanted and needed by others and can be harvested at will.  Those who do the harvesting and processing should be paid for their efforts by those who want the resources.  I don't consider a dead body to an actual party to the donation any more than I consider a gold mine as a living being with a stake in mining.  The only difference is whether I choose to let myself be treated like a resource when I'm dead, while I'm still alive.  If I make that decision, after I'm dead, have at it.
Title: Re: forced organ donor status
Post by: KD5NRH on May 09, 2010, 11:55:25 PM
Once you're dead, value is meaningless.

Next time someone in your neighborhood dies, move into their house and take their stuff.  See how meaningless that value is to their estate.

Quote
You are dead, you organ is either going to rot away or get used.

Most kidney and marrow donors are still alive.  Even for other organs, if I am able to state in my will how the rest my property is to be disposed of, why is my body the only thing I have that can't be sold and the proceeds given as I choose?
Title: Re: forced organ donor status
Post by: Brad Johnson on May 10, 2010, 02:23:10 AM
That would depend entirely upon how the form is worded and the role of the family, if any.  I doubt very much that if you verbally withdraw consent for donation, the organs will be harvested nonetheless, even if you sign a form.  I doubt very much that if you revoke the 'opt-out' form that you will be a forced organ donor.

Even for those of us who sign up to be donors, the usual and customary practice is to ask the family for permission. If they refuse, your wishes to donate are usually ignored.  In an 'opt-out' system, I suspect that the family will still be asked. 

In "suspecting that the family will still be asked" you presume the fed.gov has both conscience and ethic.  Therein lies the problem. 

At it's inception the rule may be both well-meaning and promoted by those with some sense of order, ethic, and personal dignity.  Once it becomes law, or at least regulation, a "verbal opt-out" means nothing and the entire mess falls into the realm of bureaucratic oversight.  That, unfortunately, removes any ethic, presumption of dignity, or sense of basic humanity.  If it's not on paper, signed, in triplicate, notarized, and properly registered, any verbal agreement for or against is meaningless in fed.gov legal terms.  They will harvest first and ask questions later (the formal version of asking forgiveness rather than permission).  Presumption means nothing.  It's whatever the fed.gov interprets the regs to be no matter the personal or ethical boundaries that may be overstepped.

Brad
Title: Re: forced organ donor status
Post by: MillCreek on May 10, 2010, 08:16:50 AM
^^^^Uhhh, not to rain on your  [tinfoil] parade, but the OP was describing proposed legislation in New York state.  Not Federal law.
Title: Re: forced organ donor status
Post by: Tallpine on May 10, 2010, 10:48:46 AM
Quote
So I assume you're saying the donor should be paid beforehand, while he or she is still alive?  Well then, your kidneys for example wouldn't really be yours.  No more alcohol for you.  How about your heart that has been purchased by another.  You traded it's value for money.  I hope you don't like eating fast food or drinking soda or beer.  The health of your cardiovascular system is no longer only your concern.  You damage your own heart after selling to to someone, you are destroying their goods.

And how does that differ in essense from this proposed mandatory donor status?

Since we're planning on taking your organs anyway, you better start taking care of them  :police:
Title: Re: forced organ donor status
Post by: MicroBalrog on May 10, 2010, 10:55:53 AM
Quote
You are dead, you organ is either going to rot away or get used.

There's also cryonics.

Title: Re: forced organ donor status
Post by: MechAg94 on May 10, 2010, 11:25:28 AM
What's the problem with donor's or the donor's estate getting paid?  It would likely increase the number of potential donors.  If the estate was going to get paid a chunk of money, the family might be less inclined to block the donation. 


Just a question about an urban legend I heard years ago:  Who pays for removal and handling of the organs?  I had someone tell me years ago that sometimes the families of the donors get stuck with that cost.  I've never heard anything about that part.
Title: Re: forced organ donor status
Post by: Brad Johnson on May 10, 2010, 11:36:03 AM
^^^^Uhhh, not to rain on your  [tinfoil] parade, but the OP was describing proposed legislation in New York state.  Not Federal law.

Then simply replace fed.gov with NY.gov.

Brad
Title: Re: forced organ donor status
Post by: MillCreek on May 10, 2010, 11:56:55 AM
Just a question about an urban legend I heard years ago:  Who pays for removal and handling of the organs?  I had someone tell me years ago that sometimes the families of the donors get stuck with that cost.  I've never heard anything about that part.

The insurance company of the organ recipient pays for the costs of transplantation, which includes the harvesting, preparation and transport of the organs.  The total costs are well up into the six figures.
Title: Re: forced organ donor status
Post by: MechAg94 on May 10, 2010, 12:12:15 PM
The insurance company of the organ recipient pays for the costs of transplantation, which includes the harvesting, preparation and transport of the organs.  The total costs are well up into the six figures.
Thanks.  Are there ever cases were organs that can be donated are removed, but no donor is there?  I guess that would be a good thing.
Title: Re: forced organ donor status
Post by: MillCreek on May 10, 2010, 12:42:53 PM
Thanks.  Are there ever cases were organs that can be donated are removed, but no donor is there?  I guess that would be a good thing.

UNOS, or the United Network for Organ Sharing, coordinates every organ transplant done in the USA.  They have a nationwide database of who needs what.  Generally speaking, priority is given to the person in the most immediate clinical need in the region in which the organ is being donated.  If there is no suitable recipient in the region, UNOS starts expanding the search until there is a match between donor and recipient.  Once there is a match, UNOS coordinates the surgery times between donor and recipient and the transportation arrangements, so the organ has a minimal transit time. 

It is not unknown for some organs to be shipped all across the country.  Organs have a 'shelf-life', and some of them cannot be transported long distances and will tend to stay in the same region in which they were harvested.

Some regions have more organs available than others, and people in those regions will often have shorter waiting times for an organ.  This is why Steve Jobs went from California to Tennessee to get a liver for transplant.  There are many nasty allegations of money and politics playing a role when these sort of things happen.  I have read of people in Seattle waiting for a heart that have moved down to the Bay Area, where the waiting times are shorter for a heart. 
Title: Re: forced organ donor status
Post by: Tallpine on May 10, 2010, 03:01:57 PM
Quote
I have read of people in Seattle waiting for a heart that have moved down to the Bay Area, where the waiting times are shorter for a heart. 

Yeah, I've heard that lots of people have left their hearts there  ;)   

 :lol:
Title: Re: forced organ donor status
Post by: MillCreek on May 10, 2010, 03:48:43 PM
This was published today (5/10/10) on CNN:

California, New York mull changes to organ donor laws

By Madison Park, CNN
STORY HIGHLIGHTS
Bill in New York would make everyone who doesn't opt out an organ donor
California bill is less far-reaching, but has backing of governor and Steve Jobs
Supporters say better encouragement of organ donations are needed
Opponents cite infringement on rights of privacy and property
(CNN) -- A California bill may soon create a living donor registry -- the first for any state.

Spurred by Apple co-founder and transplant recipient Steve Jobs, the bill has gained support from major politicos, including California Gov. Arnold Schwarzenegger, and is expected to land on his desk this summer.

Meanwhile, on the East Coast, a far more sweeping transplant bill would make every person an organ donor who doesn't opt out. This would create an organ donation system in New York similar to the ones used in several European countries, but the measure is already facing opposition.

The two states have vastly different bills, but their intents are the same.

With more than 100,000 U.S. patients waiting for organ transplants, better methods of encouraging organ donations are needed, supporters say.

California

This bill creates a living donor registry for kidneys. Read the bill (enter SB 1395)

Patients who need kidney transplants often have friends or family members who are willing to donate their organs. But sometimes, these organs do not match.

Registries have been set up on the Web or by transplant centers where kidney patients and their donors seek to swap organ matches.

Having a state registry would "take it from a process that has been spontaneous and driven by the Web into a more organized fashion, that allows transplant centers to feel a greater degree of security and confidence," said Dr. Bryan Becker, the president of the National Kidney Foundation, which supports the California bill.

The registry might increase the number of transplants, he added. About one-third of U.S. kidney transplants come from living donors.

Jobs, the CEO of Apple, was a major player in bringing the bill to the forefront, said Schwarzenegger, in a March 19 press conference.

"He's a wealthy man," Schwarzenegger said at the news conference. "That helped him get a transplant. But he doesn't want that -- that only wealthy people can get a transplant."

A pancreatic cancer survivor, Jobs received a liver transplant at Methodist University Hospital Transplant Institute in Memphis, Tennessee, last year.

Livers are scarce, as only about one-third of the people on the national transplant waiting list receive one. Jobs' transplant stirred controversy about whether celebrity and wealth gained him an advantage.

"He wants every human being -- if you have no money at all or you're the richest person in the world -- everyone ought to have the right to get a transplant," Schwarzenegger said. "This is why he has talked to my wife; he has talked to me to put the pressure on us to get this bill going so there's enough organs available for all the potential recipients."

Jobs spoke at the conference and noted that more than 400 Californians died waiting for a liver transplant.

"Last year, I received a liver transplant. I was very fortunate because many others died waiting to receive one while I received one..." he said. "I was almost one of the ones who died waiting for a liver in California last year."

The bill is expected to be at the governor's desk by July or August.

Also under the proposal, residents would be asked whether they would like to become organ donors when they receive or renew their driver's licenses or identification cards. If they leave the box unmarked, a clerk will verbally ask the question.

New York

A New York assemblyman whose daughter's life was saved by two kidney transplants said he wants more organ donations. One of Assemblyman Richard Brodksy's most controversial ideas: Make everyone an organ donor unless the individual opts out.

This is also known as "presumed consent" -- a marked departure from what's done in the United States. Several European countries, such as Spain, France, and the Netherlands operate on this concept. Brodsky said this would save more lives.

"We can trust the decency of the American people," Brodsky said. "But the government needs to come up with a program that lets people express that decency. That's what's missing -- a connection between the fundamental goodness of the American people and a system that is not producing the organs that save lives." Read Brodsky's bill here

Every year, 500 New Yorkers die waiting for an organ transplant, he said.

Another one of Brodsky's bills would prevent relatives from overriding organ donation decisions made by the deceased.

He became inspired by his 18-year-old daughter, Willie Brodsky, who had transplants because of an autoimmune disease.

Watch Brodsky's CNN interview

While sympathizing with Brodsky's perspective, Tarris Rosell, a chairman at the Center for Practical Bioethics in Kansas City, Kansas, said presumed consent infringes on individual's rights.

"The saving of life is a deep, American value, but in this sort of situation, such as presumed consent, it goes up against other American values, like right to privacy, even property rights, which begins with our bodies and a deeply inscribed individualism," he said.

Some religious and cultural beliefs value the integrity of the body and oppose organ donations, he added.

United Network for Organ Sharing, a nonprofit organization that administers the nation's organ matching and placement process, does not support presumed consent, because of "inadequate safeguards for protecting the individual autonomy of prospective donors."

These recent proposals in New York and California do not mean that public opinion toward organ donations is changing, said Sheldon Kurtz, a law professor at the University of Iowa who has drafted organ donation legislation.

"You can't assume because bills are pending that public opinions have changed," he said.

 
Title: Re: forced organ donor status
Post by: Scout26 on May 10, 2010, 06:22:15 PM
As someone who has sat down with a "We put the FUN in Funeral" Director and planned his own, I was  :O  when I saw "Donation of Body to Science - $2725.00" on the Menu price list of services.

They can have whatever parts they want and may be useful when I'm gone.  I'm going to be planted at Abe Lincoln National Cemetery, but Mrs Scout drew the line when I point out that a Fibreboard box is only $375.....

She was not amused when I pointed out that we might get Nike to pay for it, if we put a "Swoosh" on the sides......  Mr. FUNeral Director had to excuse himself from the room......

Title: Re: forced organ donor status
Post by: MillCreek on May 10, 2010, 06:31:20 PM
^^^ Huh.  I wonder what is involved in the donating of the corpse to science such that you have to pay $ 2725 for it. 
Title: Re: forced organ donor status
Post by: S. Williamson on May 10, 2010, 06:36:31 PM
Is it legally possible to request in your will that your body be sold on the black markey?  :laugh:
Title: Re: forced organ donor status
Post by: Viking on May 10, 2010, 06:38:15 PM
Is it legally possible to request in your will that your body be sold on the black markey?  :laugh:
I'm going to have a Viking funeral when I die, with a proper burning long boat and everything =D.
Title: Re: forced organ donor status
Post by: Northwoods on May 10, 2010, 09:40:53 PM
With this thread, I can hardly believe no-one has posted this (http://www.youtube.com/watch?v=aclS1pGHp8o&feature=related) yet.
Title: Re: forced organ donor status
Post by: Scout26 on May 10, 2010, 10:11:59 PM
With this thread, I can hardly believe no-one has posted this (http://www.youtube.com/watch?v=aclS1pGHp8o&feature=related) yet.

S. Williamson, post #17 beat us to it.  I was going to when I saw the thread title......
Title: Re: forced organ donor status
Post by: Scout26 on May 10, 2010, 10:13:34 PM
^^^ Huh.  I wonder what is involved in the donating of the corpse to science such that you have to pay $ 2725 for it. 

The embalming and body prep. 
Title: Re: forced organ donor status
Post by: MillCreek on May 10, 2010, 10:24:23 PM
The embalming and body prep. 

Wow.  And here I thought they would have attached a toe tag, zipped up the body bag and called the University to send the van for pickup.
Title: Re: forced organ donor status
Post by: Headless Thompson Gunner on May 10, 2010, 10:43:07 PM
Another idea is to put organ donors on the priority list should they themselves ever need a transplant.
That's not a bad idea.
Title: Re: forced organ donor status
Post by: S. Williamson on May 10, 2010, 11:06:11 PM
Imagine if a kidney or somesuch was transferred from patient to patient over a very long period of time...

I seriously wonder how long one could keep that up?  ???
Title: Re: forced organ donor status
Post by: Scout26 on May 12, 2010, 12:26:02 PM
Imagine if a kidney or somesuch was transferred from patient to patient over a very long period of time...

I seriously wonder how long one could keep that up?  ???

That's why you ask for the lifetime warranty.....
Title: Re: forced organ donor status
Post by: sanglant on May 12, 2010, 02:57:31 PM
that's how there doing alternators now. you can get new, but you have to wait on it. the ones in stock are rebuilt. =D and you can pay more for one that will last. never get the cheap one, it's just good for a year. :facepalm:
Title: Re: forced organ donor status
Post by: S. Williamson on May 12, 2010, 03:21:42 PM
That's why you ask for the lifetime warranty.....
I was thinking more along the lines of, say, 200 years from now, someone has a kidney installed whose original... host... was born 200+ years ago, and as time passed, and people died for whatever reason, it kept getting transplanted.  =)
Title: Re: forced organ donor status
Post by: alex_trebek on May 12, 2010, 03:31:09 PM
Quote
Having seen a number of people die while waiting for various transplants, I am in favor of any legal and ethical means to increase donation.  One such hot potato issue being debated is a payment to the donor or donor's family.  Another idea is to put organ donors on the priority list should they themselves ever need a transplant.  I myself have been a donor for 32 years now. 

I disagree with this. I, for whatever reason, prefer for the transaction to be a gift. I wouldn't want my family or anyone else to profit from my gift. Doctors et al are the obvious exception. I have life insurance for that reason.

I had no idea that family members could override the deceased on this matter. I think that should be corrected, if a deceased person is a donor then their organs are fair game as far as I am concerned.

 
Title: Re: forced organ donor status
Post by: Balog on May 12, 2010, 03:51:56 PM
I assume that if one has a proper will etc stating the preferrence to donate, one's family can't stop it correct?
Title: Re: forced organ donor status
Post by: MillCreek on May 12, 2010, 04:06:11 PM
I assume that if one has a proper will etc stating the preferrence to donate, one's family can't stop it correct?

No, that is not correct.  Although it is usually not explicitly required by law or regulation, the typical practice is to ask the family members for permission to donate, even if the donor has a donor card, living will or other healthcare directive.  Some states do have an explicit legal requirement that the family be asked for permission.  

It would be a very rare healthcare facility that would harvest organs against the wishes of the family based solely on the donor signing a donor card or the like.  Most facilities would have an ethical problem with this or would be concerned from a liability perspective.

So the moral of the story is to not only sign a donor card, but tell your family that you want to be a donor, and make sure that the family member asked for permission says yes.
Title: Re: forced organ donor status
Post by: Balog on May 12, 2010, 04:07:34 PM
 ???

So if I have a legal document stating my wishes, the hospital will still ask my family and might go against my wishes? What if I'm estranged from my family and explicitly state in my living will that they not be consulted?
Title: Re: forced organ donor status
Post by: alex_trebek on May 12, 2010, 04:17:06 PM
Sounds like it boils down to a basic business decision. Needlessly risk a lawsuit which will cost at least 50kish, even if they win; or do nothing, and hope someone doesn't have to die.

How disapointing. I always thought that if something bad happened to me at least there was a chance of helping someone else.
Title: Re: forced organ donor status
Post by: red headed stranger on May 12, 2010, 04:43:41 PM
???

So if I have a legal document stating my wishes, the hospital will still ask my family and might go against my wishes? What if I'm estranged from my family and explicitly state in my living will that they not be consulted?

IANAL, but in that situation, I would consider granting power of attorney to someone I really trusted.  However, I'm still not sure that would help if one had family that really wanted to push the issue. 
Title: Re: forced organ donor status
Post by: MillCreek on May 12, 2010, 05:39:50 PM
Balog, again yes, depending on your state.  If you live in a state that has a 'first-person' consent law on organ donation, the family cannot override the wishes of the organ donor, if the donor has clearly communicated (signed donor card or other legal instrument) his or her intent to donate. Fortunately, a majority of states now have these laws. However, even with these laws, if the family is adamantly against it, most facilities will not harvest the organs.  This is because they think it would be unethical, even though the law may permit it.

Here is an article from a medical journal on ethics that gives some background and explanation as to current practices:


Family Disagreement over Organ Donation
Commentary by Douglas W. Hanto, MD, PhD, Thomas G. Peters, MD, and by Richard J. Howard, MD, PhD, and Danielle Cornell, BSN
The sound of Sam's pager suddenly awakens him. A third-year medical student, Sam is in the midst of his trauma surgery rotation. He rushes to the trauma department and learns that his next patient, Justin Lewis, is a 20-year-old male who was in a major automobile accident. Tested en route to the hospital, Justin had a Glasgowcoma scale score of 3. As Justin is brought to the trauma room, the paramedics tell the attending physician, Dr. Hardy, what they know about the accident. According to the EMTs, Justin fell out of a car that was traveling 70 miles per hour and landed on this head. After an extensive emergency room workup, Justin is declared brain dead. Prior to disconnecting him from the ventilator, the ER staff discovers that he has an organ donor card in his wallet. Familiar with the organ donation procedures, Sam calls the organ procurement agency while Dr. Hardy tells Justin's family the news.

An hour later, Mr. Sterling, a representative from the organ procurement organization arrives at the hospital and introduces himself to the family. Justin's father tells Mr. Sterling that his son definitely wanted to donate his organs, but Justin's mother interjects. She is adamantly opposed to anyone's taking organs out of her son.

Meanwhile, Sam asks Dr. Hardy what the plan for the patient is. Dr. Hardy says that Justin will remain on mechanical ventilation until a final decision is made regarding donation of his organs.

Commentary 1
by Douglas W. Hanto MD, PhD

When the death of a patient is imminent or has occurred, as in the case of Justin, all hospitals that receive Medicare and Medicaid dollars are required by the Conditions of Participation published by the Centers for Medicare and Medicaid Services to have protocols in place for notifying the local federally designated organ procurement organization (OPO). This notification is mandatory whether the patient has a signed organ donor card or not. In Justin's case, even if the ER staff had not found an organ donor card in his wallet, Sam would have been correct in calling the OPO. The OPO determines the medical suitability of the potential donor and usually sends a trained organ donation coordinator to the hospital to review the patient's records, speak to the family, clarify health-related information, and request permission for organ donation. Some OPOs have specially trained family counselors who request permission for donation from the family. If the family gives permission, the donation coordinator assumes the medical management of the donor, and all medical costs from the time of declared brain death are billed to the OPO, not to the patient's insurance or family.

The refusal of families to grant permission is a major impediment to organ donation. Several factors have been shown to improve family consent rates. First, the request for organ donation should be separate—or "decoupled"—from the declaration of brain death. This allows the family time to understand and accept the concept of brain death. In this case, Justin's mother may simply need more time to adjust and accept the death of her son. Second, the request for organs should be made by a trained OPO representative along with the hospital staff as a team. It is best that the physician or nurse caring for the patient not discuss organ donation with the family prior to OPO involvement. The hospital staff and OPO donation coordinator can work together to determine the best time to talk to the family. Third, the request should be made in a private and quiet setting. Higher consent rates have been shown to occur when these 3 procedures arefollowed [1].

Even when a patient has a signed organ donation card, the OPO oftenseeks family permission to proceed with donation. The Uniform Anatomical Gift Act (1968, revised 1987) established that a signed organ donation card is sufficient to proceed with donation, and it has been confirmed recently that such documents function legally as advance directives. In the UnitedStates, however, it is customary for the OPO to request permission from the next-of-kin due to fear of litigation.

Recently, several states have passed legislation establishing "first-person consent" whereby the family cannot override an individual's documented desire to be an organ donor. Some states have established first-person consent registries for people interested in being deceased organ donors. This is based on the strong belief that the donor's wishes should be adhered to. It is not dissimilar to a last will and testament that disposes of our personal property and assets after we die. Each year more states are passing first-person consent laws that are strongly supported by the OPOs and the transplant community.

Had Justin died in a state with first-person consent laws, the OPO would have informed the family of his pre-existing declaration to be an organ donor and would not have sought the family's permission. First-person consent removes a burden from family members because they do not have to come to a decision while attempting to cope with the very stressful situation of the death of a relative. First-person consent also avoids the problem of family members' disagreement, and it may benefit families later on: more than one-third of families whomade a decision themselves and declined to donate the organs subsequently regretted their decision [2].

In a case such as this one, where the mother and father disagree about organ donation, the donation coordinator would ask the mother why she was opposed to donation and would try to address her specific concerns. The coordinator would emphasize that her son had expressed a desire to donate and that his gift could save and improve the lives of several seriously ill patients. The coordinator would also try to dispel any myths about organ donation that Justin's mother might have heard. It is important for her to understand that her son's body will not be disfigured and that donation will not affect funeral arrangements or viewing of the body. Often times a hospital social worker or pastoral care representative can be called to counsel the family and resolve their disagreement. One of these individuals might have been able to help Justin's mother agree to donation.

Because of the continued shortage of organs for transplantation, it has been argued that we should go beyond first-person consent and adopt the principle of "presumed consent." Presumed consent has been legislated by many European countries with a resulting increase in organ donation rates [3]. Presumed consent is an "opt-out" policy in which everyone is considered an organ donor unless he or she registers opposition. This process contrasts with our current, "opt-in" system, in which the individual or next-of-kin must give explicit consent for organ donation. Individual choice is not removed in either case, but persons opting out have the additional responsibility of documenting their decisions. A recent analysis showed that the opt-out countries had a much higher organ donation rate than opt-in countries [4]. And in an online experiment, responders' decisions about organ donation were dramatically influenced by whether the question was presented as an opt-in or opt-out choice; rates for donation doubled when the default position was opting out and documentation was needed to opt in; that is, to donate.

Once permission has been obtained, the donor is managed medically to maintain optimal organ function [5]. All organs are evaluated for their suitability for transplantation, the donor is screened for infectious diseases (eg, hepatitis, HIV), and blood and tissue types are obtained. The donor information is then entered into the national computer database maintained by UNOS (United Network for Organ Sharing) where it is matched with wait-listed patients. The computer produces a list of the potential recipients for each of the organs ranked by priority as determined by national organ allocation policies. At that point, the donor coordinator calls the transplant centers where prospective recipients are listed to ensure a recipient will be available and waiting for the organ. The organs are then removed in the hospital operating room, often by several surgical teams from different transplant centers in a manner that is respectful of the decedent and his or her family. The young patient in this case could potentially donate his heart, both lungs, liver, pancreas, both kidneys, and small intestine for transplantation,thereby benefiting as many as 8 recipients. He could help many more patients by being a tissue donor (corneas, skin, bone, blood vessels) as well. Many times families report great satisfaction after organ and tissue donation from knowing that so much good can result from so much pain.

References
Gortmaker SL, Beasley CL, Sheehy E, et al. Improving the request process to increase family consent for organ donation. J Transpl Coord. 1998;8:210-217.
DeJong W, Franz HG, Wolfe SM, et al. Requesting organ donation: an interview study of donor and nondonor families. Am J Crit Care. 1998;7:13-23.
Gundle K. Presumed consent: an international comparison and possibilities for change in the United States. Camb Q Healthc Ethics. 2005;14:113-118.
Johnson EJ, Goldstein DG. Defaults and donation decisions. Transplantation. 2004;78:1713-1716.
Wood KE, Becker BN, McCartney JG, D'Alessandro AM, Coursin DB. Care of the potential organ donor. N Engl J Med. 2004;351:2730-2739.
Douglas W. Hanto, MD, PhD, is the Lewis Thomas Professor of Surgery at Harvard Medical School and chief of the Division of Transplantation at Beth Israel Deaconess Medical Center in Boston, Massachusetts.
Title: Re: forced organ donor status
Post by: MillCreek on May 12, 2010, 05:59:02 PM
Somewhat on point to this thread, I had a case just last week in which a patient in the hospital needed to be discharged to a nursing home.  The patient has dementia and is not legally competent.  The patient has no surviving family and was admitted to the hospital by the person who holds a durable power of attorney (DPOA) for healthcare for the patient.  While the patient was in the hospital, the person holding the DPOA suddenly and unexpectedly died.  The DPOA document made no provision for another person to take over as the DPOA. There is now no person who has the legal authority to make decisions for the patient.  The nursing home will not take the patient if he has no guardian or appointed DPOA.  This means that we have to go to court, at our expense, to have a guardian appointed for the patient.  Our Adult Protective Services tells me that it is my problem and my cost, since this all happened while he was in the hospital.

The nursing staff asked me if we could 'get one of those emergency court orders overnight, like I see on TV'.  I had to tell them that it does not work that way in real life, at least in our county.  It will take several days to even get an emergency guardian ad litem appointed, and several weeks for the permanent guardianship to be done.  Meanwhile, the patient is all better but has to remain in the hospital, and we will be eating that cost, since Medicare will pay little, if any, of it.

The moral of the story is that if you have no family to make decisions for you, and you are smart enough to have a durable power of attorney for healthcare, make sure that the DPOA document is written in such a fashion that someone else takes over if something happens to the first holder of the DPOA.

Title: Re: forced organ donor status
Post by: Brad Johnson on May 12, 2010, 06:09:30 PM
Can you petition the court for the patient to become a ward of the state, giving them guardian status?

Brad
Title: Re: forced organ donor status
Post by: MillCreek on May 12, 2010, 06:23:36 PM
If the patient is already a client of the Department of Social and Health Services, then paperwork is signed making a DSHS caseworker the DPOA.  If the patient is not already a state client, there is no such paperwork, so you have to go through a court proceeding. The state can be the guardian of last resort.  In most places, there are attorneys or actual companies that work as guardians, and the state prefers you go that route if the ward has the money to pay for it.  In this case, the patient has a pension and some savings, so we will likely go the professional guardian route because that will be a lot quicker.   If the patient was destitute, he would end up on the state's dime.

In this particular situation, the patient is not in any danger and was being adequately cared for in a nursing home prior to his hospital admission.  He cannot go back to the original nursing home, which would have been the neatest solution, since he had already been admitted there by the DPOA.  The new nursing home, and I cannot fault them for this, since I would have given them the same advice, needs their own admission paperwork to be signed by someone with legal authority.

So from the state's point of view, the patient is not in danger, is in a safe place, and has some money.  There is no reason for them to get involved, since it is our problem.  It is not their concern that the hospital is losing lots of money.  This will all end up as a charity writeoff/uncompensated care. This is part of the cost-shifting that you hear about since people with good insurance pay somewhat more to offset the uncompensated care.  But when too much writeoffs occur, hospitals can go out of business.

A lot of these sort of situations don't have a lot of black and white answers.