HN2new | past | comments | ask | show | jobs | submitlogin
New UK Law Mandates Organ Donation by Default Unless Explicit Opt-Out (2020) (organdonation.nhs.uk)
107 points by _red on April 24, 2021 | hide | past | favorite | 152 comments


New? Law came into effect on 20 May 2020 and received royal on 15 March 2019. Title of the post doesn't even reflect that of the link.

Want more info on the subject including a brief reason as to why visit (Spoiler: not enough donors) https://www.organdonation.nhs.uk/helping-you-to-decide/about...

The UK has been trying to push people more into being donors for a while. Back in 2011 (iirc) they added questions about your status as an organ donor to the driving license application. As the UK has about 75% of the adult population holding full licenses its was a good way of getting the question atleast asked to new drivers.

Also

> Will you automatically take my organs if I don't opt out?

> No. Your family would always be involved before donation takes place, so it is really important that you choose whether you want to be a donor and discuss what you want to happen with your family, so your decision is clear and they can have peace of mind knowing that your decision is being honoured.

EDIT: Also this is law in England. Wales has had a similar opt-out system in place since 2015 (Not checked Scotland or Northern Ireland)


I have been a registered organ donor (full body, even for research purposes) ever since I could legally do so, which is for almost twenty years now and registering for donation in every single country I have lived. However, not seeking consent is inexcusable, regardless of how noble the cause. Reading “80% of people in England support organ donation but only 38% have opted in. This means families are often left with a difficult decision when a loved one dies.” [1], it is clear that despite a massive amount of popular support the UK government fails to communicate effectively with its populace and instead of reflecting on its failures it now opts for a nuclear option. What about those without family? What about cases where family can not be contacted in due time? What about cases where the UK bureaucracy “accidentally” approves it? I am not a fan of slippery slope arguments, but here is a case where a good cause is hijacked and corrupted by a political body, leaving someone like me that considered donation to be a no-brainer with a bitter taste in my mouth wondering how best to protest as opting out clearly will not cut it given my moral inclinations.

[1]: https://www.gov.uk/government/news/opt-out-organ-donation-ma...


The biggest problem is people who would consent, but just never bothered filling in the form.

I think asking people this question when they apply for a passport would be a good middle ground, and/or maybe on the intake form for their GP, or other kinds of government interactions (voting registration might make sense in the UK specifically). People would still be able to opt-out of choosing at all, but this would catch the large group of people who just never bothered to register.


> I think asking people this question when they apply for a passport would be a good middle ground

This already happens. When you apply for a driving licence, you are asked whether you would like to be put on the donor registry.


The government has many ways of getting consent, as you said: driver's licenses, passports, tax, any other interaction with the state...or even mailing a separate form to each and everyone complete with a media campaign.

I am no fan of opt out since with the right opt-in they could get enough.


Must feel strange to have opted in many years ago and now it’s “just„ the default.

This rule has been decided by elected leaders after many discussions. As a citizen you opt in by default into many things that have been different in the older times. School, health care, the BBC, etc. some of which you even cannot opt out at all. Why should organ donation be treated differently?


No, it does not feel strange that it is the default, as I would love it if more people abided by the same moral code as myself which is why I contribute in a free exchange of ideas and advocate for people to volunteer both in terms of organ and blood donations – the latter I am sadly not allowed to do in the UK due to my type 1 diabetes.

It is however strange to me that rather than to communicate clearly with its populace, improve/innovate in terms of recruitment methods, and generally “educate” the populace, a government reaches for an option that I would consider morally dubious and potentially harmful to the overall opinion on organ donation further down the line whenever that inevitable case comes up when a donation is carried out without properly seeking consent. I say inevitable here, because out of the three countries (Sweden, Japan, and the UK) I have lived in long enough to form an opinion, the UK government is by far the worst and its institutions the most poorly managed.

As for “elected”, the UK has a very large expat community and many of us are well over the 12-month limit and are being “volunteered” as donors without being close to having the right to vote for the political body that enacted this legislation. Make of that what you will.


Yup, completely agree..

> it is clear that despite a massive amount of popular support the UK government fails to communicate effectively with its populace.

I have no idea where you get that opinion from... https://www.bbc.co.uk/news/uk-politics-56818750 (sarcasm tag, just in case :-p)


I completely agree.

I live in the UK, I’ve been a registered organ donor for as long as I can remember.

I’ve opted out.

I’m not a bag of parts that belongs to an all powerful state.


I think it's a bit much to punish someone in need because you're angry that your government made a bad policy choice.


He’s not punishing someone in need. Nobody has a right to someone else’s organs, however life-saving they may be. The fundamental idea of a ”donation“ is that it’s voluntary.


The Right to Health is an inalienable human right.

I suppose "organ donation" might be better phrased as "organ recovery" then?

You can't use it anymore, and it would go to waste... Hence it should be recovered. People might not have a right to have your own organs specifically, but it's society's duty to implement organ recovery.

Otherwise, we wouldn't be able to provide for everyone's human rights.


This thought process is why the idea of positive rights is incoherent.


The right to health is completely made up; bacteria, viruses and cancer don't honor this right and doctors and drug makers don't work for free, so this right and a few similar ones (right to Internet, for example) are just pulled out of someone's rear parts.

That being said, it cannot be used as an argument in a civilized discussion between adults.


So are all the other rights.

> Death: Yes. As practice, you have to start out learning to believe the little lies.

> Susan: So we can believe the big ones?

> Death: Yes. Justice, mercy, duty. That sort of thing.

> Susan: They're not the same at all!

> Death: You think so? Then take the universe and grind it down to the finest powder and sieve it through the finest sieve and THEN show me one atom of justice, one molecule of mercy. And yet... you try to act as if there is some ideal order in the world. As if there is some... some rightness in the universe by which it may be judged.

https://www.quotes.net/mquote/1016567


I think it's a bit much to voluntarily withhold lifesaving treatment for someone in need because you're angry that your government made a bad policy choice.


I respect your opinion but I don’t want my family to be pressurised with that view at the time of my death.

It’s one thing to ask if they will help someone in need and another to say “we’re doing this are you going to stop us?”

By opting out, when I was previously on the donor list, I can spare them that.

You might say it will be handled more tactfully but there’s historical precedent that it won’t be.

This is an unpopular opinion but I feel compelled to express it; I think this law is wrong.

There should have been more debate and finesse used in the drafting of it.


I don't know why my family should have a say either. I guess it's pressuring them in a way, but dying generally puts pressure on one's family regardless.

Cremated, buried, put out to sea on a flaming raft, whatever. Who cares if the corpse I left behind is short an eyeball, a couple tendons, and a liver?

More importantly, if those body parts can be used to save someone else's life, I don't believe they should even have the right to care. People who are still alive and need an organ to survive are more important than whatever squeamishness and perception of agency my family might have.

The concern that doctors could theoretically let people die more easily to get their organs is another matter entirely, but that's not the topic in this sub-thread.


Thank you that’s far more eloquent than I could have put it.


Punish who exactly?


Well put


Organ donation gets a lot of razzle dazzle press. I think we should put more effort into other things.

Rejection is horrifying and can be deadly. Donated organs can introduce deadly infections. If all goes well, you will be on anti rejection meds the rest of your life.

It's not the magic cure all with no downside that people often seem to imagine.


...what? Is there some media conspiracy pushing unnecessary organ transplants on people that I'm unaware of?

I don't think anyone gets a liver transplant because of an article in Goop. I imagine that in most cases, they do it because they're going to die without it.


It's really a lot more complicated than that.

But I think it's time for me to walk away from this discussion.


And they still have a great likelihood to die even after.


So, after a heart attack we should not try to do CPR on you because you have a great likelihood to die either way, do I get it right?

You might want to look into the definition of odds.


All of these things are vastly better than dying due to a failed organ... and it’s not like other choices are not seeked. Should we not extend the life of so many children, because in 10 years there may be a better option?


The primary issue that concerns me is that we plow a lot of resources into this option because it makes doctors heroes and grabs headlines. Meanwhile, less "sexy", less headline-grabbing options that would really be better for the patient may be getting overlooked and remaining underdeveloped because it won't grab headlines.


Any source on your claim? Because there is basically research into every illness, and usually organ transplant is chosen as a last option. But when an organ does fail, there is hardly any other choice left.

And organ “printing” is simply not there yet.


Considering how hard it is to obtain and transplant organs, I'm pretty sure doctors only do it when it's the last possible option. Medicine is incredibly data/statistics driven these days.


It’s not an easy thing to do and not an easy thing to say out loud but I _am_ angry about it and there’s not much else I can do.

Do we have agency over our own bodies or not?

How can I keep that agency and help someone under an opt-out system? That has been taken from me when better, workable opt-in solutions weren’t tried.

To take it to extremes, should the government be able to take “spare” kidneys from live donors?

Should criminals be forced to donate blood?

What about children that die in child birth, should they be harvested for organs too? ‘Cause the NHS were doing that at one time.[1]

Where does the line stop?

1. http://news.bbc.co.uk/1/hi/1136723.stm


> Do we have agency over our own bodies or not?

Right up until the point it's no longer your own body because you're dead, yes.

> To take it to extremes, should the government be able to take “spare” kidneys from live donors?

No, they're not dead.

> Should criminals be forced to donate blood?

No, but again, they're not dead.

> What about children that die in child birth should they be harvested for organs too?

The law only covers adults with the opt-out which would make this another no.

> Where does the line stop?

Pretty much exactly where the law says it does - "All adults in England will be considered as having agreed to donate their own organs when they die unless they record a decision not to donate (known as ‘opting out’) or are in one of the excluded groups."

[edit: Missed the A in "All"]


The line is pushed a bit every time. This time is there, but the history tells us it is not stopping and the next step is scary.


> Do we have agency over our own bodies or not?

No, and that's the point. When you're dead you cannot have agency over your body even if you had the right to.

I find it weird how people compare this to the government treating them like a "bag of parts", as if they were more than a rotting corpse at that point. If you have a religious belief or some other reason that makes you think otherwise then go ahead and opt out, I don't have an issue with that.

> To take it to extremes, should the government be able to take “spare” kidneys from live donors?

Who ever asked for that? If the time came where the UK government started acting like the CCP the law today wouldn't matter either way.


But this is a moral dilemma, where a slightly less ethical choice WILL dramatically increase another variable that is widely regarded as good.

And it’s not like it is forced, especially with the family being able to “stop” it even when it happens. The status quo was a different tradeoff.


> Do we have agency over our own bodies or not?

I believe the answer is somewhere in-between. We certainly don't have full agency over our own bodies. Can't take the drugs you want or need without asking permission, you're highly encouraged to stay healthy, vaccinations are mandatory, suicide is highly discouraged.

As always, it's a trade-off between the individual self and the society we live in.


> I’m not a bag of parts that belongs to an all powerful state.

Aside from the fact that this statement is wrong - the state can conscript you if there's a war, or imprison you - I'm wondering what actual objection you have to donating parts of your body after you are dead? Personally speaking once I'm dead, I'm not going to care in the slightest.


I have no objection to organ donation at all.

I think the idea that someone might see with my eyes after my death to be a beautiful one and I’ve been a lifelong card carrying organ donor.

I object to presumed consent.

A gift is not a gift if it’s not freely given.


Sounds a bit like you weren't an organ donor because it's the right thing but because it makes you feel good. And now that good feeling is taken away from you because everyone is an organ donor by default and you're not doing anything special anymore.


Does it? I think you’re twisting my words a bit there.

My aim was simply to answer the parent’s claim that I might have an issue with organ transplant and that’s not the case.

> because it’s the right thing

“What gets us into trouble is not what we don't know. It's what we know for sure that just ain't so”


80% of people in England support organ donation

This is nonsense, because this is the standard fallacy of any survey. You take a sample and extrapolate out to the general population. If your sample is not representative, then the statement is false.

In fact, I would go so far as to say that we should mandate a law whereby nobody can claim "% of X agree to Y" unless it is specifically stated "% of X surveyed out of a sample size of N agree to Y. Here's a link to the methodology and questions."

Organ donation is good and important, but default opt-in is a bad decision, and the reasoning listed for it is worse.


"NHSBT carries out biannual attitudinal surveys. The fourth wave in 2017, involved 1499 interviews carried out via online self-completion between the 10th and 21st of April 2017. In this wave, 81% of people supported organ donation in principle."

https://www.organdonation.nhs.uk/get-involved/news/hundreds-...

But alas, no methodology and questions on that page.


Precisely, this is a bullshit survey with dodgy results. Online self-completion? 1499 participants? If this survey was the basis of this change in law, to be default opt-in, then something very terrible has happened.


Seems rather accurate. Most people will assume "organ donor if you're 100% impossible to revive", if that is the case, might as well help someone else.


Good! organ donations save lives,restore vision to the blind, and help burn victims, and this lets people who don't have strong opinions on what happens to their body help other people, while still letting those who have strong opinions against organ donation opt out.


Just my personal (contraversial) opinion, but I believe that opting out of being a donor should also opt the person out of being a recipient. Include a 12 month waiting period for someone who has previously opted out, but now wants to opt back in to qualify as a recipient to reduce the ability to gain the system.


My slight adjustment to your plan (but probably still controversial):

Anyone can receive a donated organ. But those that do are permanently opted in to donate.

Well, I actually don't think that. People can legitimately change their views and philosophies. The "wedginess" of this rule would probably do more harm to society than the marginal increase in organ availability.


"We could very easily save your life with a transplant, but we won't because you did not choose to be an organ donor" is not something I think people in this country have the stomach for. This would be like if we didn't treat people who opt not to carry health insurance. In theory that prevents moral hazard, but in practice no society would be willing to let people with treatable ailments die.


The NHS has budget constraints so they are making this kind of decision all the time. It’s unlikely to be made by the doctor treating the patient anyway.


You don't say why you want to do this.

I think it's perfectly fine and respectable for someone who opts out of donation to decide for themselves, when the issue faces them, that they won't take a life saving organ.

That's very different from mandating and coercing organ donation in order to be eligible.

Right now, organ donations go to those with the greatest need. You are saying, well no it shouldn't go to people who aren't moral according to my philosophy.

I think you have to consider how that could go wrong, and who might be considered the wrong sorts of people, the sort of people who don't deserve to be treated.

Who might prominent political figures decide are immoral, abnormal, unproductive, unworthy, or unpatriotic?


IIRC this is how it works in Singapore.


Yes, let’s shame and punish people that think differently than "the good way", it will totally help the cause get more support.


There are long waiting lists for organ donors; why should I donate my organs to someone who won't return the favour? I'd rather donate them to someone who would.


But that's only fair.

As an analogy, it's like healthcare/insurance taxes - you pay them regularly in the hope that if you ever need it, they'll pay for you.

Why would you expect to receive an organ if you're not willing to offer yours?


It's not just that; it's punishing people who want to benefit from a system they refuse to "pay" into.


What if I off-shore my earnings to avoid paying tax; what if I vote Republican. Does consenting to organ donation make me a worthy person despite anything else you may disagree with?


Reciprocity is not some outlandish concept: If you're unwilling to help out, you don't get to join the mutual aid pact.


That’s irrelevant. If you just treat organ donation as an exchange system, an “organ-bank club” if you will, you don’t need to bring judgement into it.


Parent post was hinting at judgement though.


No shame, no punishment. It’s just an organ sharing club, join it or don’t join it.


It is also my view on the subject and the way it is in Portugal as well.

Here in Germany I stand in the minority where donation is opt-in, the result being that better not need an organ transplant over here, as it has one of the lowest contribution rates across Europe.


This Deutsche Welle (German Public Television) documentary on the German transplant waiting list is so sad: https://www.dw.com/en/donor-organ-recipients-second-chance-a...

One of the people in the interview is a medical student who does dialysis at night, and it negatively affects his studies and health.

I am a dual US|EU (Croatian) citizen. I also have lived with type 1 diabetes (autoimmune and insulin-dependent) for almost 30 years now. While I have been fortunate that my kidneys have been fine, if I were to need a kidney transplant, I would absolutely live in Croatia long-term (where I live currently) if I needed a donor kidney.

Croatia has an opt-out system, like Portugal.

Croatia has one of the highest kidney transplant rates in the developed world, and in Europe it competes with Spain and Portugal. You really do not have to wait that long for a kidney transplant in Croatia compared to other developed countries. Here is a good writeup on the Croatian transplant system and how it works: https://cdn.intechopen.com/pdfs/27728/InTech-Action_taken_to...


Like everything in similar kinds of scenarios, many strong opt-in advocates would probably change their mind when forced to be on the receiving end.

Anyway, all the best everything stays safe.


Thank you so much. I have always made myself an organ donor, on my drivers' license. Also, my father was an organ and tissue donor, after he died. It was what he would have wanted, so we did it, although it was hard. We have received a couple of thank you cards from anonymous recipients over the years. It is very sad, but it is always touching to receive such a letter.


I would have supported a law like this, back in Italy, although they don’t really need it (it’s already in the top-3 European countries for number of transplants). I am not very keen on it here in UK. That’s because the medical profession here stinks of massive classism, and there have been instances of abuses like https://en.m.wikipedia.org/wiki/Alder_Hey_organs_scandal and https://www.bbc.co.uk/news/uk-england-stoke-staffordshire-50... . The chances of doctors “hurrying up” families from working-class and minority backgrounds to pull the plug, for the purposes of organ harvesting, in my opinion are substantial. Already we have situations where minorities get substandard attention (likely one of the causes, for instance, of early-natal mortality in Birmingham being more than twice the national average); this risks exacerbating the problems.

Also, there are issues with forensics. Organ harvesting, from what I hear, is more likely to be followed by cremation than embalming, which makes it impossible to re-examine remains at a later date. Again, given the “tradition” of cover-ups that most nation-states carry, it seems like a dangerous slope.


Organ donation isn’t a hot issue where I’m from and I imagine that most people here will like such a policy, but I’m honestly surprised by the push back in this thread. Why? The honest question I want to ask is: do people think that they still own their bodies when they die?


The concern is, organs are most useful when the donor is still a little alive, which could affect the incentives in a hospital: You might be in a critical state and someone else really needs an organ from someone like you.

On the other hand if most people are donors by default there should be sufficient supply, easing this pressure.


I was actually referring to the pushback centering around the consent argument, but in any case:

> You might be in a critical state and someone else really needs an organ from someone like you.

How often does it actually happen that an organ recipient and a matching potential donor who is in critical condition are in the exact same hospital at the same time? Is the concern for skewing the incentives real? I’m not even sure where the incentive is in your example—it’s just trading off one life for another. The hospital still wouldn’t be avoiding the potential death of a patient either way.


> I’m not even sure where the incentive is in your example—it’s just trading off one life for another.

The issue is that the patient needing the organ might die before the potential donor.

Edit: this is under the assumption that the potential donor is very likely to die of their current condition.


...well, that's a rather paranoid bit of speculation that assumes that doctors are inherently unethical.


Sadly in the UK we’ve had a bunch of instances of malpractice where doctors came off as fundamentally unethical. Add to it that state bureaucracy can often feel cruel and heartless, and you can understand why people might be suspicious.


1) yes, I think you own your body when you die the same way you own your money: you can specify what should be done with it while you are alive

2) one rational argument for opting out is that if you are in a bad state, it might be rational for a doctor to let you die rather than save you, since your organs might be saving multiple people’s lives. I know I was a doctor and I had a 50 year old person in a car crash and I had 3 twentysomethings waiting for a heart liver and lungs I might want to hurry that 50 year old off this mortal coil. It would be the ethical thing to do. But if I was the 50 year old I wouldn’t like it.


About 2, I am fairly sure it is against every oath they take, and it may very well be malpractice as well. Also, with a default opt-in, the pool to get organs from dramatically increase.

And I’m not sure whether you meant that you were a doctor, or was it just a hypothetical, but usually car crash victims are not operated on by organ transplant specialists, so the doctor’s patients will not intersect, making your point purely theoretical.


Oath or no, if you could save 3 young people’s lives for one old person’s life, wouldn’t you do it? If I was a doctor I would at least want to, I don’t know whether it would be feasible.


As I said, you only “know” the old person dying in front of you, you are not simultaneously at a children hospital where 3 young people waits for a liver and two kidneys. Hell, not even the liver and kidney transplant happen at the same hospital. So this is indeed a purely hypothetical scenario.

And while it may seem like the trolley problem, it is not, because there is a huge indirection in whether those organs can be used at all, are required at this time and whether they will truly save someone else. So instead of the still morally questionable 1-3 trolley problem you instead have one where you can either direct the trolley on a track with one person in sight or another with noone on it. And at the distance, both tracks branch randomly and most of them go through 3 young person, and maybe slightly less kills them in the second case.


Well, if you're a doctor, you want to for a fee. Very few organ transplant surgeons work for free.


Please take one quick glance at your country's politicians, police or intelligence services. How many oaths did they take? The fact is oaths are just hollow ceremony.


If you want a more “rational” model of a doctor, why should he/she have a worse success rate by not saving one of his/her patients?

And while there are bad, even borderline evil doctors out there, I think statistically you are much more likely to find a morally corrupt politician than a doctor, especially in countries with public healthcare.


About 1) the situation is actually comparable with the way inheritance is handled.

Most people specify what to be done by issuing a will, but there is not unlimited freedom there. For example, in some countries it is difficult to completely disinherit someone. If there is no will, your property is split in some way among your relatives. The default option, if there are no heirs, is that the inheritance falls to the state.

After death your organs likely won't be able to benefit your relatives, unless they are currently in a life-threatening condition themselves. Dunno how long organs can be kept around, but I doubt that there is no expiry date after which they have to be tossed out. In that case, the organ would have gone to waste by sitting in a freezer.

Therefore, treating your dead body's organs similar to inheritance would make it moral to pursue the default option in most cases, which is donation to the health system. Still, there is the possibility to opt out, which is an extra effort similar to (but way less involved) than issuing a will.


> I think you own your body when you die the same way you own your money: you can specify what should be done with it while you are alive

You have the freedom to specify what exactly should be done with your stuff when you die. Whether those wishes will be legally enforced will depend heavily on what they say.

To test this thesis, go to a lawyer in your jurisdiction and ask them about whether it would be possible to split the proceeds of your estate in equal shares with every man in the Greater London area who wears brown shoes on a Thursday, and prepare for a short explanation of administratively workablity.

Then ask about whether you could posthumously fund some international terrorist organisations. Actually, maybe don't.


OK, so you can’t use your money in a way that’s infeasible to achieve or in a way that gives material support to terrorism. Is there a point you’re trying to make beyond that?


There's plenty more where those come from. Society rightly puts limits on what you can do with your property after you are dead. By analogy, there are legitimate limits on what you can ask your successors to do with your bodily remains - and it makes perfect sense to set sensible defaults.


I like the idea of opt-in by default for organ donations. However, I am curious about the results of changing the opt-out option of “you can opt-out but you cannot receive an organ donation if you choose to opt-out”-choice would fare in the real world.


There would have to be a really large number of opt-outs for that to matter. Unless the opt-outs actually cause still cause a problem after this change, why do it? Trying to punish dead people doesn't sound effective.


It’s not punishing dead people. It’s punishing people who benefit from organ donations but choose to not contribute their own organs i.e. those who receive organ donations from those who chose to donate their organs without themselves choosing to donate their own organs.

The default-to-being—an-organ-donor/presumed consent approach has proven benefits when it comes to outcomes in medical situations that require organ donors [0][1][2]. The thing that I personally dislike about defaults like these is that it allows people to move through their life ignorant of the good that they are able to do for others and the good that others are able to do for them.

In the case of an organ donation question on a driving license, I would personally like there to only be two options that are both not default: opt-in to being an organ donor and being able to receive organ donations, and opt-out to not being an organ donor and then be unable to receive donations. An answer to this question would be required (opt-in or opt-out), and not making a selection would the equivalent of submitting an incomplete driver’s license application such that the application would be rejected.

[0] https://en.wikipedia.org/wiki/Default_effect#Default_setting...

[1] https://sparq.stanford.edu/solutions/opt-out-policies-increa...

[2] https://www8.gsb.columbia.edu/sites/decisionsciences/files/f...


Unless we cross some significant number of opt-outs though and it starts to matter in organ availability statistics, what's the point of that punishment? If we have enough donors overall, I'd love my organs to go anywhere useful - regardless of who receives them. Let's not open the gates for more conditions in the future, because I'm sure some people would enjoy "donate my organs as long as there recipient is not X".


I guess a compromise could be the following: upon receiving an organ donation, the recipient is asked to consider donating their own organs once again.


My hope is that it would instill a sense of responsibility in some people. If you want to benefit from an organ donation if you ever need a transplant, then the responsible and fair thing to do is to donate into that system yourself when you die.


If we're concerned with getting consent, but also allegedly too many people are just forgetting to opt-in:

What if, before somebody gets their ID (or another process everyone goes through), we ask them "do you want to be an organ donor" and they have to say either say yes / no?


When I applied for my UK driving license I was able to opt in to the organ donation register then


Opt-out has been becoming more common throughout the world. Some countries only offer conditional opt-out.

In the U.S. 33% of organ donation come from motor vehicle accident. Reduced driving due to Covid put a dent on organ donation. Long term, as cars go more autonomous, vehicular related fatalities would decrease drastically.

The U.S will have to follow the same model.


There's a reason why some doctors call motorcycles "donor cycles".

https://en.m.wiktionary.org/wiki/donorcycle#:~:text=donorcyc....


Yep my volunteer paramedic Mum was rather upset when I started riding. She'd seen her share of traumatic decapitations, etc.


In the very long term, I hope we can just grow organs from stem cells. That way they'd also be a perfect genetic match for the patient, so no risk of rejection.


Implicit opt in is the way to structure decisions you want the user to take. This is of course not only used for good things like this but also "bad" things like checkboxes that say "share my data" and are already filled in.


Your organs are also your data. This could lead to a process where every dead person’s DNA is checked against outstanding criminal cases.


There's no DNA evidence found in the overwhelming majority of crimes. This would have almost no impact on unsolved cases. Life is not CSI.


Yes please. Why do you say that as if it's a bad thing?


Because humanities neurotic need to dissect, judge, survey and quantify everything is what is edging us ever so slightly into a dystopian world?


A world where most crimes are solved sounds good to me. Do you think we've passed the optimum point where enough crime is solved and we don't want any more because that would make it dystopian?


I’ve actually never thought of that. In most countries, does your next of kin own your corpse?


Why is it they have organ donation... But the hospital I'm guessing still charges for the harvesting, and surgery right?

They should then pay something to the organ donors family... Even if it's just twice what a decent funeral costs...

Wife's uncle had his eyes harvested nobody told her aunt and she had a horrible surprise at the funeral when he was highly disfigured...

She probably wouldn't have cared if she'd known... But I feel like there's a black market for organs...

Maybe more ppl would be okay with donation of they knew it'd help their family some.


A good cause aside, opting out of anything is a terrible practice that needs to be abolished. It’s shameful that we keep having to opt out of every facet of our lives.

Life is hard enough as it is, but let’s make it harder by forcing people to have to opt out of choices they never made!

Maybe it’s just the phrasing, but unless there is a proper shift away from a given default expectation, lots of people will be blind sided by this.


I think you've just described citizenship-by-birth anyway. Being born opts you into all sorts of crazy stuff.


I'm surprised this isn't a "sovereign citizen" argument: "I never opted into citizenship and taxes! My parents did that without consulting me!"


Is a slight psychological manipulation ethically wrong when it saves many many lives?


In the US, if you have a baby in the hospital, they take the placenta and sell it for the stem cells. We asked for the placenta and were told, “They took it to pathology, and really don’t like to give it back after that,” or something along those lines.

So organ harvesting without consent happens in the US too


I note with irony that that site doesn’t even let you opt out of “marketing” cookies.


Some people have organs no one in their right mind would want. For example: You have a genetic disorder.

So, I wonder how stuff like that factors in. That doesn't appear to be addressed.


If you don't trust doctors to choose safe organs you probably shouldn't trust them to cut you open and try to put the organ in you either.


I have a genetic disorder. That's why it occurs to me, though I edited it out because I get a lot of flak for "talking too much about myself" and then when I edit out stuff like that, I get replies like this one that seem to think it's some sort of ugly thing to say rather than genuine curiosity rooted in a smidgen of relevant information/experience.

I looked into signing up to be a bone marrow donor when my corporate employer was giving some kind of incentive. I don't qualify. Period.

You cannot tell by looking at me that my DNA is miscoded but it significantly impacts organ function, and not in a good way. My ID card doesn't state I have a genetic disorder.


Doctors test organs before using them. Obviously. Regardless of genetic disorders, the donor might have a disease that would kill the already-very-unhealthy-because-they-need-a-new-organ patient. They also test for compatibility with the patient. You can't just stick any organ in any person.

Genetic disorders among donora is not a legitimate concern here.


A quick google indicates they test for certain infections (in the US), not genetic disorders:

https://www.cdc.gov/transplantsafety/protecting-patient/scre...

It just so happens people with my condition receive a lot of organ transplants and the organs they receive then don't have the genetic defect. Not exactly a cure, but I'm pretty darn sure it would run the other way and if someone got one if my organs, they would have my genetic disorder in that organ. And they would likely not be happy campers.

So I doubt your statement is entirely accurate.

Edit: I will add that genetic testing takes time and organs aren't viable for transplant for very long. Transplant happens pretty quickly following death of the donor, so genetic testing is unlikely to enter the mix anytime soon, I think.


I guess you do have some medical info on your condition, don’t you? They do check that and will exclude you in this case.


https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1125622/

> On 7 February surgeon James Jaggers had almost completed the operation when he learnt that the organs came from a donor with type A blood, incompatible with Jesica's type O. The story became front page news. Jesica was kept on life support systems while a second transplant was sought—and, astonishingly, found. Despite the second transplant, Jesica died from irreversible brain damage on 22 February.

Quite the testing they did there.


Taking a single error and suggesting it's evidence of a wider problem is a fun game. Now compare how many transplants happen every day to how often this sort of mistake occurs.

Humans are fallible and mistakes happen. It's a tragedy of course, but it is not evidence of a widespread problem.


Indeed. The fact it made front page news suggests it’s a rare occurrence, compared to say, traffic accidents.


They’re supposed to. A good friend just died of hepatitis that came free with his liver, in the U.K. - and ironically, his father died of liver cancer brought on by hepatitis last year, that he was given with a blood transfusion in the 80’s.

The U.K. does not have a good track record here.

https://en.m.wikipedia.org/wiki/Contaminated_blood_scandal_i...



As I understand it, donor organs are carefully vetted for such things among others before they are made available for a patient - this information would presumably be on a person's medical history and therefore available for checking in advance of the transplant.


It doesn’t need to be addressed in this specific change because you could have already signed up to be a donor. They test when it’s used, not when (primary) permission is given.


I guess it depends on the nature of the disorder but if it is something that can cause problems for the recipients, it might be good to confirm with a doctor beforehand and opt-out, if advised. That indeed doesn't catch cases where a person doesn't know if they have a genetic disorder and their organs are used for transplant without testing for genetic disorders.


“Excluded groups”


Yes, I read that. It goes on to explain that:

Those excluded will be people under 18, those who lack the mental capacity to understand the new arrangements and take the necessary action; people who have lived in England for less than 12 months or who are not living here voluntarily and those who have nominated someone else to make the decision on their behalf.

It says nothing at all about "people with dread diseases that are genetic in origin that you wouldn't wish on your worst enemy."


I think I answered to another comment of yours, that presumably your condition is noted on your medical records. Which are definitely looked up before transplants.


Makes sense in the UK to donate, I suppose, since your treatment is free.

In the US, where it is fully possible that you will simply not receive an organ if you can't pay, I think it makes sense to also do the opposite and simply not offer an organ for transplant if it can't be paid for. I am interested in speaking to anyone who has had experience bypassing current "donation" laws.


Why can't we pay people to donate organs instead of begging or forcing them to, again?


It seems that it would increase the size of the black market significantly, create (more) underground slave rings, criminals would do the forcing and take the cash.

That, plus organ sales wouldn't stop at kidneys and the "trade your life for money to your family" thing doesn't sit well with most people, even if it's voluntary.


Why would there be a black market if there is a legal market? (Black markets develop when there are no legal markets.)

Kidneys and half-livers would all that would be legal to sell before death, but I'm talking about donations at death.


Human trafficking from poorer countries, kidnapping family and forcing the father/mother/siblings to sell their organs, for example.


This already happens.


1. Pay dead people? Why? How would that work?

2. Opt-out is not the same as forcing people

3. Dead people can't be forced to do anything, they are dead


1. Pay their estates, of course. (Which then gets used to pay for burial, enhance inheritance, offset death taxes, etc.)

2. I said "begging/forcing". Opt-out is forcing those who don't know, and begging those who do. Opt-in is begging. And you know, we've started with begging (not even opt-in), then added opt-in, now we're onto opt-out, which might make one wonder: what's the next step? The obvious answer is that if we continue on this path we won't even get to opt out (force).

3. Nonsense. The next of kin of a dead person gets to decide burial options, and much more. And there's no reason a living person couldn't have the right to decide what is to be done with their body after death.

Does the State own you, or do you own yourself? If the latter, you get to sell your dead body; if the former, you don't get to sell your dead body.


You'd be dead, what would you do with the money? Also, we don't charge people to receive them; organ donation is for the common good.


Have you never heard of "estates"? Do you really have no clue how we deal with death? What do you think happens to a person's assets when they die? Is their body not an assert? If you could sell your dead body, it would be an asset.


They'd go to the family.


If they want my organ, I’d ask them how much they want to pay me or my family for it. The medical industry gouges patients and derives exorbitant wealth from our “donations,” and there needs to be an equivalent exchange.

If my hospital bill for a single night stay is 50k, they can pay me 50k for my organ. I’m certain hospitals can pay far more than that, with the amount of insurance fraud they commit.


This is actually a pretty good point. Yes, a person truly in need, often in a life-or-death situation, will benefit from that organ, but the hospital and staff performing that transplant will also benefit financially (especially here in the US where health care bills are out of control).

Why shouldn't the estate of the deceased get rewarded for the deceased's generosity?

(Of course, I fully expect this added cost to just get passed on to the recipient, which isn't a great outcome.)


I would hope that legislation could protect patients from medical providers passing the costs on to them.

It seems to me that the medical profession is financially imbalanced with respect to the rest of society. In the US, they are propped up by mandatory health insurance requirements and are all but guaranteed income, whether it’s from private insurance companies, taxpayer dollars (a la Medicaid/Medicare), or some poor unfortunate soul’s lifelong medical debt payments.

As long as people are being born, medical problems will be a dime a dozen, and wealth earned by medical practitioners will scale with the size of the population.


The rules also work vice-versa. If you are in an accident and need an organ, would you prefer to bid/pay or would you prefer the donation to be under current rules where there is no payment to be made to the donor's side? Whatever approach is chosen, applies equally to when you are a donor or a recipient. In case of zero payment, both sides are balanced; in case of payment, it could be skewed - you may have to pay a lot more when you are a recipient vs. what you receive when you are a donor or vice versa. Unless, there is a law to cover payment/amount etc and even then, different states/countries can have different laws.


This sounds like a very good argument for socialised healthcare. Which, last time I checked, was something the UK has.


That 50k will just be charged to the recipient.


What would prevent a contractual agreement that states they could not do such a thing?


AFAIK, mandatory "donation" to government is called "confiscation".


How is opt-out the same as mandatory? Just opt out


Not going to jump in with arguments on this one. But just want to mention how positively horrified I am to see all the comments here cheering organ harvesting in a democracy.


If my dead body is useful to someone, then why should it rot somewhere? It’s not like I was cared for only to have my liver harvested, so it makes zero chance to compare it to deliberate killing of people.


Because morality should not be based on what "makes sense" or is an efficient use of things. The reason I used the term "organ harvesting" is the same reason people that talk about this "opt out" thing use the term "donation". But my overall feeling is that this is yet another thing that highlights and brings to the fore that the state pretty much owns us as essentially livestock to harvest things from.

At the very least, the default should be that your estate and/or your family takes ownership of your remains. Otherwise we're heading into territory where the state can say: "Why should you have a grave so your body can rot in there. It's not like we're going around killing you for your biological matter, so it's okay if we just take your body and decompose it into fertilizer to help rejuvenate the farm fields!" or "We've determined that you don't need 10% of the blood that you generate every day, so please make sure to go daily to your local "Blood donation centre" for your "voluntary donation""!

The way people are cheering this "donation" on is frankly very disturbing. Yes, I know it saves lives, but so would abolishing cars to stop car accidents and so would banning all knives and having people use feeding tubes instead!


That’s a huge hyperbole. Governments are not dictators. They are a democratically elected body that is given power by the people to enact laws. With proper separation of power (this is the most important!), this power can be revoked anytime.

They are absolutely not infallible of course, but they are the best formation we managed to come up with. So we have governments at the present time, and let’s say a power grab were to happen. Then does it really matter that we had such a law now? They can then do whatever they want with or without laws, so your fear is baseless. It is a good decision that will save lives and is basically without price.


When you are an organ donor in the UK, they still ask your family and follow their wishes. The family can override the default or even the wishes of the deceased if they really want.


You won't need them after you die, trust me. One (dead) person's organs can be totally life-changing for several other people but there are a shortage of donors because people forget to opt in. And if you would really prefer not to help sick people after you're dead, then you can still opt out.


Can a dead person own anything? Who’s rights are violated if an organ is taken from a dead body? I would be horrified if people were killed for their organs or organs were taken while they are alive.




Guidelines | FAQ | Lists | API | Security | Legal | Apply to YC | Contact

Search: