Serious Thread: Organ Donation

As someone who is generally knee-deep in economics stuff, I'm really interested in hearing from anyone who is opposed to opt-out systems, as the people I know/read are generally so uniformly in favor that I don't know if I've ever heard the opposite argued. I remember it featuring pretty prominently in Nudge but even that was a popularization what everyone in the field took for granted. I can't really comprehend the opposite side, with the exception of a few rather extreme religions that believe it affects the afterlife.

I think that for situations such as the alcoholic scenario, it would be one thing if we were evaluating this in a world where there existed an infinite supply of donated organs. But that is not the case: we have a fixed supply that is vastly exceeded by demand. So we are always making decisions about who gets to live via organ transplant and who does not, whether we're aware of it or not. i don't really see why a viability-based system (which is effectively what this is) is any less valid than first-come-first-serve, and in fact the opposite seems true to me. Organs should be going, broadly speaking, to those who will most benefit, which means that there should be a bias for the young, viable recipients, and those with dependents.

 

I don't follow what you're saying. Not because I think it's dumb, I just don't know what economics has to do with an "opt-out system" (I am obviously not knee-deep in it). Giving it a name like "opt-out system" is clever propaganda, by the way, whomever started that. Because, it makes it sound like anyone who doesn't support organ stealing is the one in the wrong or minority. You can have all my organs, but only because I told you you could. I see nothing wrong with anyone choosing not to be an organ donor because they have a religious objection to it (there are more than you think, and they're not fringe religions). The choice to be made is Organ Donor, not Opt-out.

That should be set by consultation and recommendation of the doctor and hospital, I think, not mandated by law. Isn't there a scoring and risk system? I don't think the organ always goes to the next one on the list, does it?

Side note: People that are healthy enough don't even "opt in" to give blood (I do) or get on the National Bone Marrow list (I am), why would they be comfortable being part of a forced "opt in" organ donation?

 

What I mean is that the idea that an opt-out system will produce at least as many and probably more organ donations (and thus produce a net benefit for society) has been accepted wisdom in behavioral economics for roughly twenty years now. Despite the theoretical support, however, it's less clear if this actually has any meaningful empirical effect; it's too hard to definitively disentangle cultural vs. legal differences for the most part.

The idea isn't really to shame anyone; the information isn't intended to be public. It's actually meant to deal with laziness and inertia: the vast majority of people have been found to have no opposition to organ donation, but merely don't bother checking the box at the DMV. A lot of people don't even know that the option is there. This merely changes what the "default" state is while still making it trivially easy to not donate if you so choose. Also, every nation I've heard of that uses this sort of system still recognizes that the family can contravene any organ donation status.

Every major religion that I am aware of, with the exception of Shinto, is either ambivalent or enthusiastically in favor of donation, albeit some of the less hierarchical ones like Islam are less uniform in this belief.

 

Ah, yes, that makes sense. I am surprised that it's only considered to possibly produce as many, and not definitely more. Weird.

And, all the more reason I hate something dubbed as an Opt-out System. What would the IRS and Social Security actually collect, if it wasn't automatically removed from most wage earner's paychecks? I assume I will need to Opt Out of having my driving speed transmitted automatically to the nearest police officer before long. (Which, of course, most people claim they want this privacy, and don't bother turning off the GPS on their phones - that they keep with them all the time.)

Every major religion that I am aware of, with the exception of Shinto, is either ambivalent or enthusiastically in favor of donation.[/quote]

You are correct, but I phrased that poorly. I should've written "people who claim to be religious" rather than "religions" - one person's interpretation over another. For instance, from what I have read, the Religion of Islam does not support terrorist activity based on most Muslim's reading of the Koran. However, it's practiced anyway. I know several people, who are otherwise seemingly reasonable, claim to be Christian, yet will not sign up to donate organs. I have heard "the dead in Christ shall rise" type comments. Christian is a pretty major religion, last I heard.

I think those people are idiots. But, even if misguided, I think they should be allowed to adhere to whatever religious practices they want without having to Opt out.

 

Alt-Focus: yes, a person's lifestyle should reflect if they get an organ. That way starstruck assholes won't waste precious organs on a hopeless case like Mickey Mantle, who recieved a liver "donation" less than 24 hours after applying for one. Then he died, fucking over somebody who actually may not have flushed their liver down the drain. If person is hard-wired at destroying themselves, why do they even deserve the time of day, much less an organ?

 

Just my opinion, man. But, in my opinion, if you "Opt In" to be an organ donor, that implies that you are making a choice to do something. And, that something is good and helps your fellow man. An Organ Donor. I am donating something that belongs to me, so someone else can get good use out of it, now that I don't need it. Calling it an "Opt Out Sytem" implies that under normal circumstances, others can have my organs, but I have to choose to stop that from happening. Not donating doesn't carry as much guilt or peer pressure as opting out. In my opinion.

And, I have heard the phrases "opt out" and "opt in" before, but this thread is the first I've heard of something that I always heard as Organ Donation being changed to an Opt Out System. Like the Sony discs that had the Extended Copy Protection rootkit built in, email lists, software installations, etc. - I shouldn't have to opt out of things that should be private to me. In my opinion.

 

Agree with Crown. A successful transplant requires a lifetime commitment to anti-rejection meds and a major lifestyle change...not only for the recipient but also for the family. If someone can't stop drinking or smoking or abusing drugs for six months, then why should they receive an organ? They aren't proving to anyone that they have the motivation or discipline to do what's required for a successful outcome.

 

That's true enough. I would rather, though, that groups (or people like you!) encourage others to be an organ donor, rather than it being mandated. I am an organ donor and think everyone should be, but not at the hands of another law.

 

Illinois and California have the same sort of law and this strikes me as a very agreeable middle ground.

 

Can of worms alert:

Do you guys think a person should have the right to sell one of their own kidneys?

 

I just got my license in Minnesota and there was still a form. It was awhile ago, but pretty sure it was the same way in Florida.

I'm for opt out once people are over 18. Funnily enough I've never heard of anyone opting out for religious reasons, but I have heard of people opting out because they were scared the doctors wanted the organs so fresh they were going to start cutting them up while they were still alive.

Alt Focus: I think there should be some consideration regarding the person's lifestyle and criminal background. However, labels like 'alcoholic' make me nervous. Have you guys looked at the medical/psychiatric definitions of alcoholism? You're either an alcoholic or you don't drink, pretty much. I'm sure decisions based on transplants generally apply to full blown alcoholics rather than the type of person who dominates this board, but I guess I just don't want Mormons getting all the organs since they won't touch any substance. Also, given the nature of many of the conditions requiring transplant, I'm not ok with someone having to quit for 6 months first. That's a pretty long window, especially considering how often diagnoses come after the condition is already really severe.

And by the way guys, we have done this thread before, but it's been a long time.

And for what Crown threw out there: Yeah, I'm ok with it. I'm not sure why we can't have this in the states, but you just fucking know idiots are going to start claiming the government is going to start robbing you of your organs without consent.

 

I'm pro opt - out but think it's politically untenable. I think a middle ground is - you aren't eligible for a donated organ unless you're a donor yourself. (The exception being people that aren't allowed to donate for health reasons. If you got a raw deal healthwise, good luck and godspeed. )

 

Yeah I can understand that. It's the having to prove you aren't drinking for 6 months when you don't have 6 months part that bothers me.

And I agree with AlmostGaunt. If you want to opt out you shouldn't be able to benefit from the system you don't want to assist.

 

My father in law offered Jägerette 100k for a kidney. Plus pay additional for all the work time she would miss.

She seriously considered it, and he was pressuring her in that paternal way where it feels like there is no way to say no.

But then she got two kidney infections in a month and was no longer allowed to donate.

Her hesitations were:
1. He was 69 years old. He was old and perhaps his life had run its course.
2. She has a chance of ending up with the same condition as him, and having one kidney would mean she would end up on dialysis way sooner should she end up sick like him. (Which reminds me, she needs to make her appointment to get them checked out)
3. What if he just spent years sitting around instead of using the second chance at life?

In 2011 he got a kidney from a dead guy. More on that in a bit.

Well, the money would have been nice, and it would have stayed in the family. It could have been considered compensation for missing work and complications that could arise.

But, the thing is we weren't desparate for money, and I can see people who are despirate for cash just jumping at the chance for fast cash without realizing the complications that can arise. Suddenly their medical bills are more than they were paid for the kidney.

Anyway, Jägerette is glad she didn't give a kidney because he has spent the past 4 years sitting at home all day dicking off on the internet. She would have risked her life and health to give him the opportunity to sit around behind the computer for years. Someone died and gave the most valuable gift they could, a second chance at life, and he has wasted it. Plus the medications have changed his brain function and made him an asshole. He screams at my mother in law daily, and the fact she is still there taking care of him is unbelieveable. (Stockholm syndrome?)

Honestly, Jägerette told me she kinda wish he had just taken the sentence life had dealt him to save her mom the pain she has dealt with.

So going back to him getting the kidney.

The organ game is big big big bucks to hospitals that do transplants. He had great insurance and the hospital was of course making money from all his monthly visits, but then he decided he would change hospitals as he would end up being higher on the list at another hospital (again, it is hard for a 69 year old to get a kidney).

Within two weeks of announcing to Stanford that he was changing hospitals, they managed to get him a kidney. Can't be a coincidence.

 

But that's part of the point of my previous post. People don't wake up with end stage organ failure needing a transplant. You were either born with a disease like cystic fibrosis or heart disease. Or you've developed COPD, heart failure, etc. It takes years to get to the point where you need a transplant. If you've been diagnosed with COPD and you continue to smoke a pack a day for the next 2 years, why should you receive a lung? People usually have longer than 6 months; usually they have been living with a progressive disease for years.

 

I know I'm beating a dead horse (let's get his organs!), but I still think you're referring to two different things. Having to decide to "opt out" and not doing something is NOT being a donor. The United Way consistently asks me for donations. They don't automatically get $100 from my bank account at Christmas, and I have to Opt Out for them to not get it, despite the fact that they do good work, and the people they help genuinely need it, and that helping them is a good thing to do.

In the be a donor to get a donation scenario: Children are automatically organ donors in the opt out system? But, in the current system, they can't get a transplant because they don't have a driver's license and the ability to mark they're a donor?