Comment by DougWebb | Hacker News Reader

Comment by DougWebb | Hacker News Reader

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My ex-wife is still recovering from her second liver transplant. The first one was when she was 20, due to a genetic disease that causes sudden liver failure around that age. That time, she went from ER to transplant to recovery in just a few days, because of how quickly she became sick enough to move to the top of the list.

They never told her that liver transplants are pretty much always temporary, at least with the immuno-suppressant drugs that were available most of the past 20ish years. Even with drugs, most people's bodies are constantly attacking the foreign liver and damaging it beyond its ability to repair itself. 20 years is a pretty good run; hers lasted 22.

This time around, she was in the hospital for two months (seemed much longer) while they tried to keep her alive. She went through all the symptoms you mentioned. Towards the end she suffered full-on dementia from the toxins in her brain. After two months of suffering, she lost her will to live, and told me and her family that she was giving up. I was sure she'd be gone by the end of the week, but that night the miracle happened; a compatible liver was available and she was at the top of the list. The next day, after a very long surgery (working around 22 years of scar tissue from the first transplant) she got a healthy new liver.

She remained in the hospital two more months, mostly in rehab, while her brain returned to normal (mostly) and she learned to walk again. It took months after going home for her to be strong enough to fully care for herself.

Unfortunately, the decades of drugs and months of liver failure pushed her kidneys past their limit. She's not on dialysis yet, but most likely she will need a transplant before the year is up. It's just a matter of time, and she's trying to find a living donor. If she can find one, she can get the transplant before she gets too sick again, which will make recovery much easier.

Organ transplants are absolute miracles of modern medicine, but we need artificial organs. Whether they're completely mechanical, natural organs grown artificially, or custom gene-spliced organs to prevent rejection, we need them. There aren't enough organs available now to meet the need, and the patients who get them have to go through hell first. And the ones who don't, don't survive at all.

> we need artificial organs

Or a way to farm organs in the lab.

If self driving cars succeed in massively reducing accident deaths (yay!) an unintended consequence will be huge shortfalls in donatable organs.

All the more reason to make organ donation opt out or mandatory.

You know, at some point negative tradeoffs kick in when you try to go do far with this idea of "making everyone do the right and honorable thing, all the time." Such as, for example, the very, very negative implications of the idea that "society" (really, the government) outright owns your internal organs.

Let's stick to education and (why hasn't been tried?) financial incentives, please.

Explain why making organ donation after death an opt-out process would have any negative tradeoffs, let alone a net negative effect.

Someone who appear brain dead at first glance, their family might be pressured to turn off life support to take out the organs, to give to another person in the same hospital.

If that first glance was mistaken and the person was in a coma that could recover months from now, then basically a man was killed for his organs.

It is highly unlikely that the recipient is in the same hospital. The ER team who oversees the brain-dead person is not the same team who handles the organ transplantation. The docs who treat the patient with a failed liver aren't the people who decide where the organ(from the deceased donor) goes. This is a myth that needs to die. Doctors don't 'let someone die' because they are an organ donor. There's a complex system in place to regulate the distribution of organs.

edit: I am a liver transplant recipient.

Opt-out. Problem solved. If you are that worried about it, you can opt out. Most folks won't care.

This is a utilitarian-ish argument. I would consider the following questions:

- Who owns your organs before death?

- Who owns your organs after death?

- I assume you are opting-out from a government mechanism for organ donation. What is the origin of the government's power to claim your dead organs unless you opt-out?

1. You do

2. No one does

3. The origin for the claim is that you accept to give your organs, and it is that way by default in a lot of countries because most people either don't care or actively want to save lives. If you don't want to give them for whatever reason, you can always opt out

I would also like to point out that this whole point seems like debating for the pleasure of rhetoric : there is no specific downside to having organ donation opt out by default, as a lot of countries do, for example France since 76. And if you don't agree with organ donation, just opt out. There is, however, a huge upside : saving a lot of lives.

Actually the person above specifically suggested it could also be mandatory, as this were an equally palatable option.

So it was mostly that suggestion that I was responding to. As to the negative tradeoffs in that option -- I think they're pretty obvious.

(Hint: we'd have to in effect force members of certain religious to at least formally disavow that aspect of their religion, for one).

As to opt-out, while of course different, it's still in the same (troublesome) territory as the 'mandatory' option -- definitely a major insult to people with strong personal or religious convictions about the issue. At the end of the day, it's inseparable from the idea that your body is, on a certain level, state property.

Which, aside from being repugnant to many people, is also in conflict with the emerging social consensus that, by and large, one's dominion over one's physical body is absolute and inviolable† -- which just so happens to form the legal and philosophical bedrock behind the idea that one should be free to choose to terminate a pregnancy; as well as (in the case of terminal illness, at least), the manner and timing one's own death; and of course, the manner in which one's body is disposed;

The same should naturally hold for the disposition of one's organs after death. We would never think of passing a law making, say, chemical dissolution the default disposal method for your body after death, unless you "opt-out" and choose some other method -- even though this is touted to have many environmental benefits. Nor would we think to propose that, by default, your body be served up for whatever experimental purposes the local university might have in mind (unless you "opt-out", that is). It'd just be way to repugnant to many people, and open up too many cans of worms ethically and legally.

So the organ donation issue is basically right in the same territory.

† Aside from proscriptions against controlled substances, of course. But that's just one of the many schizophrenic negative tradeoffs of that particular policy.

But don't financial incentives lead to thieves stealing your organs?

Not if you structure them properly.

Where I live (Austria), it's opt-out already. I didn't find concrete numbers, but I read that Austria is therefore among the top transplant nations.

We may have a way to farm organs literally and soon.

https://www.technologyreview.com/s/603857/crispr-may-speed-p...

It was already ten years ago that some scientists figured out how to grow a 'mini liver' in a bioreactor. They've developed the technology a lot further since then, but it still looks to be 15-20 years out for full commercialization. The CRISPR solution may do wonders for people waiting desperately on organ lists in the meantime.

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