h2g2 The Hitchhiker's Guide to the Galaxy: Earth Edition

Me. I shall be making my way to the doctor's to pick a card up at my earliest convenience...

we've ticked all the donor or research boxes on as much as possible, and for the Gruesomes (while we are making their decisions for them)

What really makes me spitting mad and what needs to be addressed now is the ability of relatives to override a registered donor's decision. If any of mine did that on, say, religious grounds, I'd pretty much hope I could haunt them a lot.

There are two different issues here that are worth separating out.

One is whether there should be an opt-in or opt-out system. I don't really have a strong view on this - on the one hand, the more donors, the more organs, the more lives saved. On the other, issues around the rights of individuals to choose, and about respecting different cultures, beliefs, and world views. I suppose, on balance, I'd like to see more publicity and campaigns to encourage people to opt-in before thinking about moving to opt-out - at least in a UK context.

The second is whether or not it is reasonable for someone (or their family) not to want to be an organ donor. It's not just Maoris - some Islamic and Jewish groups also have objections, and people of other faiths and none might also have reasonable objections which have to be taken seriously in a liberal democracy. In some cultures, the means of burial and the body being buried whole is very important, both to the person who is dying and to his or her family and community.

The question of the alleged 'rights of the dead' has vexed me for some time now. If a person is dead and gone, in what sense do they have rights? If they are dead and in the afterlife, it seems unlikely to me (on most religious accounts of the afterlife) that they would be particularly bothered. But if the dead have no rights, why should wills be followed? What's the difference?

If we assume that the dead have no rights, the question of organ harvesting (rather than donation) comes down to a conflict between the rights of the bereaved family to conduct the death/mourning rituals that they see fit and the claims of other people to have a better quality of life, or to have their life saved.

It might be thought that this was straightforward - surely the 'good' of preserving/enhancing life outweighs the 'bad' of mere upset or inconvenience. But this means making being a 'good Samaritan' compulsory. Surely the 'good' of my holiday is outweighed by the good of giving to charity to save lives? Surely the 'good' of saving a life outweighs the pain and suffering I would undergo through being a live organ donor of bone marrow, or even a kidney?

Most people think that there are limits on what the law (and on what morality) requires us to do for others. Let's say that calling an ambulance when witnessing a serious accident is one such thing. Most people think that there are things that we are obliged to do, and there are things that are morally good which we are, nevertheless, not obliged to do - these are known as 'supererogatory' actions.

I am a registered organ donor, and I would encourage others to do the same. But making it compulsory, or heaping scorn, shame or derision on those who do not wish to donate, is setting a very dangerous precedent about what is morally required of us.

Thought-provoking stuff as usual, Otto. I'll have time to give a proper reply tomorrow...

I don't think anyone is talking about heaping shame, scorn or derision on anyone. Every time this comes up, newspapers or comentators interview people on the street or check statistics and usually come up with a remark that more people would donate if they didn't have to go through the rigamarole of getting a card and signing it

People who have objections, by their nature, would probably be more likely to go to the trouble of opting out whereas my impression is that not all people who would opt in do so.

I agree that it should be made easy to opt in/out e.g. a tick box when registering with a doctor. My feeling is that one should have to make a decision yes/no, but no preference registered taken to be yes.

That would perhaps eliminate the necessity to seek consent from shocked relatives at a time when they may not be able to make a rational choice. Transplants may be costly (don't forget the anti-rejection drugs involved) but restoring someone to active life may mean them being able to pay taxes, care for their families etc.

Does anyone know if those who have some cultural/religious reason for refusing would also refuse to accept a transplant?

Don't Jehovah's Witnesses refuse transplants, blood transfusions etc?

How would folks feel about people who deliberately opt out being banned from receiving transplants?

Is there not a bit on a UK driving licence application form to opt-in these days? (Been that long since I applied for a licence, I can't remember!)

That would cover most of the adult population and you may as well tick one extra box.

I don't know about banned, but given a choice of two equally suitable recipients, they'd miss out.
Generally isn't the patient in most physical need at the top of the waiting list, but subject to compatibility with the available organ. It would be a shame to waste an organ if the only suitable recipient were a 'non-donor'. After all, it would perhaps encourage all their friends & relatives to opt-in.

>>How would folks feel about people who deliberately opt out being banned from receiving transplants?<<

Reluctant as I am to have scorn poured upon me, I'll confess that I have no wish to donate organs or receive them if any of mine pack in. It seems like cannibalism to me and even though I would sympathise with any starving person who resorted to cannibalism, it's always been frowned upon in most cultures. In any case, I don't expect the sort of people who would object to organ donation would want to receive one either.

>>How would folks feel about people who deliberately opt out being banned from receiving transplants?"

I wouldn't ban them, just put them at the back of the queue.
If someone has religious or other claimed moral or cultural objections to giving organs, they presumably have similar objections to receiving them, unless they are a hypocrite, so non-hypocrites with what they feel are valid religious/moral/cultural objections would have nothing to complain about.

If someone has other objections, whether a psychological revulsion against thinking about giving organs, a fear they might end up giving organs to someone undeserving, or whatever, then those objections still end up in the way of other people benefitting from their organs, so it's only fair that they should end up getting in the way of benefit flowing in the other direction.

With relative's objections, whether a system is opt-in or opt-out, and whether a person wishes to donate their organs or not, they should be allowed, when living, to specify which (if any) relatives should be consulted. If they specify that some or all relatives should have no say, that should be absolutely respected however vocal the relatives may be.

While we're on this, I have an organ donor card, which stays in my drawer. Does this matter, or should I be carrying it with my in my wallet? I know I'm on the database. Am I right to assume that, should I die, this information would be available?

Kea, RE: culture. Very often it seems a catch-all meaning not much at all. What is a cultural reason and why does it matter? Culture is shared experience. In the case of very personal organ donation, it is only important if it leads to the donal making that cultural reason into a personal reason.

Basically what I'm saying is that I don't think 'the people have been doing for years, accompanied by a cereinoal ' is any better of a reason than 'I don't really feel like ' in this context.

apologies for poor spelling there.

Tibley Bobley >>Reluctant as I am to have scorn poured upon me<<

I don't think anyone here is going to pour scorn, in fact quite the reverse since you're just about the first person to stick their head above the parapet and explain why you're uncomfortable with organ donation.

Have you made sure your nearest and dearest know about this, should the worst happen?

>>How would folks feel about people who deliberately opt out being banned from receiving transplants?"<<

They would have to be banned. The original donor has already given consent for his organ to be used. If the recipient then dies, but refuses consent for the same organ to be taken, he is going against the wishes of the original "owner". Wouldn't work.

That's at least two people just in this little group who would be willing donors but currently aren't. I should include myself too, since I have only recently got hold of a card. For most of my life (the bit when the organs would've been in good working order) I was not registered.

Multiply that up and you see the value of the opt-out system.

Sho>>Have you made sure your nearest and dearest know about this, should the worst happen?<<

Thanks Sho. I think they know and understand how I feel. The subject doesn't come up all that often. It did came up at work a couple of years ago when someone was taken ill with a sudden kidney problem that quickly got very serious. He asked his brother for a kidney and his brother obliged (I guess most people couldn't say no under those circumstances). The new kidney packed up quite quickly after the transplant unfortunately. It was discussed quite a lot in the office at the time. We all felt for both the brothers and I didn't mention the fact that I find the idea repellent because I didn't want to upset anyone and also, I realised that if one of my brothers asked for a kidney or some other giblet from me, I couldn't refuse. But then I know and love my brothers.

I'm registered but haven't got the card anymore. Its annoying that although I've registered and made my feelings clear to my relatives if they chose to ignore them they could prevent my organs being donated.

I'm also not a donor but I want to be.

I think I've registered several times as there have been tick boxes on various forms, but if I don't carry the card (no idea where it's got to), is the database easy to check?
Does anyone know?

Here's a couple of [possibly a bit suspect] links giving info on the stances of various religious groups on organ donation:

http://www.transplant.netcare.co.za/index.asp?LinkID=15&ContentID=15#ISLAM
http://www.medbroadcast.com/channel_health_features_details.asp?health_feature_id=198&article_id=640&channel_id=1012&relation_id=6981

The second link says:

"Laws in Judaism and Islam, for instance, prohibit desecration of the human body. But both religions note that prohibition is trumped when it comes to saving a life." Despite what their respective dusty tomes say, on balance both Islam and Judaism support donation.



Otto: >But this means making being a 'good Samaritan' compulsory.<

No it doesn't. Making a will isn't compulsory, just a very good idea as you get older, if you're not keen on the vagaries of Intestacy Law. Similarly, if organ donation was the default option, those who weren't keen on it could simply make their feelings known. Telling their next of kin about it would help too - they could just say "No, she didn't want that, sorry." So, as long as an objector either ticked the 'no' box or made their opinions known to nearest and dearest, their rights wouldn't be infringed at all.