Sectorgame

I agree that families should not be able to override a persons wishes, but purposefully withholding organs from non-donors just doesn't make much sense - even if you assume opters-out would accept them.

The fundamental basis for medicine is equal opportunities. Picking an arbitrary single reason to rule out donation, unless it's medical, goes against that principle.

It also means that you could possibly say a non-donor PhD winner is less important than a donor (non-opt out) convicted rapist; clearly the system for donor precedence can't be so black-and-white (plus, the idea sparks of two things - a rather petty vindictiveness towards those who don't donate for whatever reason, and it also reminds me a lot of the ethical dilemma of 'what if a donor stipulates only a white person can receive their organ').

Furthermore there are additional problems - what if a person was an opter-out in early life before changing their mind? What if they opt-out after receiving an organ? What if they are only opted-out due to family or religious pressures, and are 'forced' to realise their mistake by their own situation?

Also, if someone has never given blood, should they thus be barred from receiving blood in any operation or medical procedure? Perhaps a quota system would be sensible, in that case - you only get as many pints as you put in. After all, there's no moral reason for not giving blood and recieving it, is there? Those people should clearly die.

aldo wrote:The fundamental basis for medicine is equal opportunities. Picking an arbitrary single reason to rule out donation, unless it's medical, goes against that principle.

Except that while that's a nice principle it already doesn't hold true for transplant patients anyway. A sixty year old with a probable fifteen year life expectancy doesn't get the same consideration that a chronically ill 15 year old would get even if the 15 year old had a shorter ten year life expectancy.

The presumption is that the sixty year old has "lived his life" and therefore the 15 year old who hasn't should get the organ. How can that possibly be classified as a medical decision?

Now I may happen to agree that the 15 year old probably is more deserving of the organ (all other things being equal) for exactly that reason but I'm not going to try to delude myself into believing that this is anything other than society deciding that the life of a 15 year old IS more valuable than the life of a 60 year old.

It also means that you could possibly say a non-donor PhD winner is less important than a donor (non-opt out) convicted rapist;

Except that there probably aren't enough organs to save either of them. There's going to be a PhD who didn't opt out who needs the organ too.

clearly the system for donor precedence can't be so black-and-white

Of course it shouldn't be. But the selection criteria for transplants already include several non-medical considerations. I'm merely suggesting one more.

it also reminds me a lot of the ethical dilemma of 'what if a donor stipulates only a white person can receive their organ

Except that the selection is not done by an individual donor. It's done by the selection committee instead. Who as I've already pointed out are already making the choice based on non-medical factors.

Furthermore there are additional problems - what if a person was an opter-out in early life before changing their mind? What if they opt-out after receiving an organ? What if they are only opted-out due to family or religious pressures, and are 'forced' to realise their mistake by their own situation?

That's the can of worms I referred to right at the start. If you want to argue with me that judging based on who opted out has practical considerations then I'll agree. In fact I've already pointed that fact out several times.

However I'll point out that at least one of those cans is already open.

What if they are only opted-out due to family or religious pressures

If this is a consideration then how can you possibly accept that parents are allowed to opt their children out of having transplants due to their religious beliefs?

Are you going to take the attitude that the state should be allowed to step in for those cases? Are you going to start saying that anyone who brings pressure on an adult family member to not have a transplant should be charged with aiding a suicide?

Currently the state takes the opinion that if you were born into a family who do that then it's simply your bad luck. Why would this be any different? Besides pretty much all the religions that forbid organ donation also ban organ receipt anyway they're rather a moot point anyway.

Also, if someone has never given blood, should they thus be barred from receiving blood in any operation or medical procedure? Perhaps a quota system would be sensible, in that case - you only get as many pints as you put in. After all, there's no moral reason for not giving blood and recieving it, is there? Those people should clearly die.

Except that as far as I'm aware there isn't a critical need for blood which leads to a 50% mortality rate (as there is in the case of heart transplants). If there were then maybe more extreme measures would be needed to deal with it.

karajorma wrote:Except that while that's a nice principle it already doesn't hold true for transplant patients anyway. A sixty year old with a probable fifteen year life expectancy doesn't get the same consideration that a chronically ill 15 year old would get even if the 15 year old had a shorter ten year life expectancy.

The presumption is that the sixty year old has "lived his life" and therefore the 15 year old who hasn't should get the organ. How can that possibly be classified as a medical decision?

First you'll have to explain why the 60 year old has a longer post-op life expectancy.

Now I may happen to agree that the 15 year old probably is more deserving of the organ (all other things being equal) for exactly that reason but I'm not going to try to delude myself into believing that this is anything other than society deciding that the life of a 15 year old IS more valuable than the life of a 60 year old.

Correct me if I'm wrong, but in medical terms aren't younger bodies generally better equipped to heal than older ones? y'know, what with the whole aging thing. Or are you saying that a chronically ill 60 year old will, following a transplant, be more likely to survive than a similarly ill 15 year old?

Except that there probably aren't enough organs to save either of them. There's going to be a PhD who didn't opt out who needs the organ too.

So you're ducking the question?

Of course it shouldn't be. But the selection criteria for transplants already include several non-medical considerations. I'm merely suggesting one more.

Which non-medical selection criteria (that is, not alcoholism or smoking for example) is there which automatically rules out receipt of a donor organ?

Except that the selection is not done by an individual donor. It's done by the selection committee instead. Who as I've already pointed out are already making the choice based on non-medical factors.

Factors such as? Anything relating to general health and ability to recover is surely medical.

That's the can of worms I referred to right at the start. If you want to argue with me that judging based on who opted out has practical considerations then I'll agree. In fact I've already pointed that fact out several times.

However I'll point out that at least one of those cans is already open.

It's not just a consideration, it's a kybosh. The only way to make this sort of judgement is subjective, i.e. whether or not a judgement committee believes the persons' stated reasons for not opting out any more (or soforth) - effectively an interview for being allowed to live. That subjective, possibly easily biased, judgement would then override all medical or even factual factors.

If this is a consideration then how can you possibly accept that parents are allowed to opt their children out of having transplants due to their religious beliefs

Are you going to take the attitude that the state should be allowed to step in for those cases? Are you going to start saying that anyone who brings pressure on an adult family member to not have a transplant should be charged with aiding a suicide?

Currently the state takes the opinion that if you were born into a family who do that then it's simply your bad luck. Why would this be any different? Besides pretty much all the religions that forbid organ donation also ban organ receipt anyway they're rather a moot point anyway.

You've missed my point, I believe; if a parent pressures their child into opting out, then that automatically would bar them under your proposed system - regardless of whether the child wished to receive that organ or not; as presumably you don't want people to opt-back-in, receive and then opt-out again (unless you want to take organs away from those who receive then opt-out), then that person is bound by a parental decision that may have been made 10, 20, etc years ago. And as far as I know 'bad luck' isn't meant to be a good reason for someone dying, and what you're saying is that, even if a person fulfills all the criteria for heading the recipient list then they deserve to die regardless.

Except that as far as I'm aware there isn't a critical need for blood which leads to a 50% mortality rate (as there is in the case of heart transplants). If there were then maybe more extreme measures would be needed to deal with it.

There is a critical need for blood in all operations of any kind and of any mortality rate; approx 10% of people entering hospital in rich countries require blood (1m people UK), and there's a 7% shortfall in donations already.

I'm all for opt out. I used to be an organ donor when it was the result of ticking a box when I got my license, but since the government did away with that, I'm now officially not a donor, solely out of my own laziness (although I'm sure my family would ensure I got carved up should the situation arise).