Wednesday, June 17, 2009Make Everyone an Organ Donor
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America has one of the highest organ-donation rates in the world, yet the wait for a life-saving transplant remains tragically long. Patients in the queue of more than 100,000 can expect to wait up to six years, and sometimes longer, depending on the type of transplant. If the past decade is any indication, more than 7,000 people will die this year before cresting the list.
Desperation drives a black market for organs harvested from the world's most exploitable population--the poor. People in impoverished countries can make many times their salary through the sale of a kidney, yet the health complications that follow can permanently damage their ability to earn a steady income.
In 2007 the number of new U.S. donors fell for the first time in two decades, and it dropped again last year. It's time for states to recast their donor laws. In the U.S., donors are required to step forward and declare themselves. But over the past four decades, at least eight countries have flipped the system: all people will be donors upon death unless they remove themselves from the pool. The burden of communicating choice thus falls on those who object to donation, not those who support it--a policy that has boosted donation rates in places like Belgium, Austria, and Spain, whose donor rate is the highest in the world.
Implementing an opt-out system in the U.S. may seem invasive and vaguely Big Brother-ish. Yet in reality, an individual would retain full control over the fate of his or her cadaver; presumed consent would simply force an unsettling reflection on one's own mortality. In small doses, that can be downright healthy.
As critics point out, presumed consent wouldn't fully alleviate the organ shortage. But based on its effect elsewhere, it would certainly allow a greater number of patients to live longer and more comfortably. Presumed consent should be a foundation for complementary policies, which we could choose a la carte from other countries. As they do in Spain, policy makers could require highly candid education campaigns, cadres of empathetic donation counselors for grieving family members, and mandatory acquiescence to next-of-kin wishes. As in Singapore, they could provide incentives: donors get to jump ahead of non-donors on transplant waiting lists, and immediate kin receive health-care assistance for five years after a donation. Donors' status could still be denoted on driver's licenses (preferably by the little red hearts already in popular use).
At the very least, we should try to emulate the United Kingdom. A presumed-consent law failed to pass there last year, but the hoopla inspired nearly 1 million citizens to sign on as donors, swelling the register to a record high of 16.1 million names.
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Comments (5)
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We don't need an "opt-out" policy to get people to "force an unsettling reflection on one's own mortality"; we can have an "opt, period" policy instead. As an example, we could make it so that your drivers license doesn't become effective until you pick "Yes" or "No." It wouldn't matter which you pick as long as you pick. I think people would be a lot more comfortable with this policy than the alternative.
You want to know how to make sure every single person will become an organ donor? Allow their executors and family members to auction off those organs.
The value of the organs will naturally depend on the rarity of blood and tissue types and on the age of the donor (as it should), and EVERYONE will insist on their family member donating even if their parts are only of value to medical schools and pharmaceutical companies. People give up their weekends to make $300 in a garage sale. Women sell their eggs. You think they wouldn't ensure that their loved-ones have a continued legacy for the coin to be made offering their organs to the living?
Eventually, the only thing we will bury will be the bones of our family members which is what the Jews and Christians used to do.
We make sure the price paid to the supplier is $0, and then we are shocked when there is an under supply...
Beyond apathy, I imagine the other key reason people don't sign up as donors is b/c they are geneinely uncomfortable with the idea of being an organ donor. That's fine with me, its a free country.
But how many of those folks who hesitate to sign themselves up wouldn't hesitate to get in line to receive an organ donation the day their doctor told them they need a transplant.
Blunt solution to this - set a law that when you reach a certain age (18, 21, 25, whatever) you must make an irrevoable in-or-out decision. If you opt out, fine. But no organs for you in the future.
I think James' solution is a lot more workable than BWI's. I have a difficult time imagining that any policymaker would be hard-hearted enough to hew to this when someone is genuinely in need.