Organ donations in the US are soaring amid the worsening opioid crisis | Hacker News Reader

Organ donations in the US are soaring amid the worsening opioid crisis

verdict.co.uk

59 pointsprkralex50 comments

The headline is shocking, but 1,000 deaths leading to organ donations spread across the entire united states over a year is relatively small.

It's interesting that drug deaths can so easily lead us into a moral panic in a way that obesity deaths do not.

Obesity? Let's not forget the primary source of donor organs: participants in car wrecks. No moral panic there, either.

According to the CDC accidents are the fourth leading cause of death. I looked but couldn't find a source to cross reference which causes disqualify a organ donor.

https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm

It's not merely about death. You need to die young and healthy for your organs to be worth anything. That's why car crashes are a particularly useful source.

You don't want to transplant from someone that died from cancer or AIDS etc. You want healthy organs and they tend to come from accidents.

There's often healthy organs and tissue left that can still be used for donation, even in some cases of cancer. Dutch source: https://www.transplantatiestichting.nl/donor-worden/wie-kan-...

Organ transplant recipients are already at vastly increased risks for dying of cancer. If the only other option is death then sure take risks, but it's not a good idea.

https://www.medscape.com/viewarticle/856854

Often the only other option is death.

We've repeatedly intervened to make cars and roadways safer, crack down on drunk driving, and the like, so I'm not sure the idea that nobody cares about driving deaths is right.

I'm not sure what it's like in other countries, but in the Netherlands, patients have to die in a hospital to be eligible for an organ transplant (not for tissue transplants), so I don't think car accidents are a major source.

Is organ donation in the Netherlands also opt-in?

Interestingly, we're at a transition point at the moment. A law was passed last year that changes it to opt-out. However, it still has to come into effect. Additionally, they're currently in the process of abolishing a law that allows citizens to initiate referendums, but it is currently looking like a referendum about the law changing it to opt-out is still going to make it in time to be held before it is abolished. In other words, the change to opt-out might still be put on hold before it comes into effect.

That is interesting... I'm asking because it seems to me like the supply of organs, which is already strained in the US (well, maybe less now, but usually), would be too low under the system you're describing.

It's usually too low in an opt-out system as well, just less so than in an opt-in system :) But yeah, it's pretty much without a doubt that an opt-out system leads to more donors. The debate is mostly about whether that's worth the restricting people's self-determination, and to what extent an opt-out system would be restricting it in the first place.

No, but interestingly enough, there are people who freak out that self-driving cars will thin out the organ supply:

http://www.slate.com/articles/technology/future_tense/2016/1...

(To avoid a rehash of the Facebook flamewar I already had about this: Yes, you can be correct on the facts, but still promote a flawed narrative; that's what's happening here.)

Motorcycles are called "donorcycles" in ERs for good reason.

Moral panic from obesity would be highly irrational. ~30% (74% when counting obese including overweight) of USA adults was obese in 2007.[0]

This would be equivalent to admitting, society wide, that we ourselves are generally too fat.

Drug (ab)users are much more rare, and feel as 'the other' in a sensational narrative. easy to see as outrageous, gross or hateful; good for a moral shock effect

[0] https://en.m.wikipedia.org/wiki/Obesity_in_the_United_States

That’s 74% overweight, not obese.

Thank you! I badly misread the title of that graph. Edited my faulty percentage.

[1] https://en.m.wikipedia.org/wiki/File:USObesityRate1960-2004....

I think there does to tend to be a moral tinge to coverage of it, though.

> It's interesting that drug deaths can so easily lead us into a moral panic in a way that obesity deaths do not.

Because the obese likely are net contributors[0][1]. They work for their most productive period, and often die "young" which just so happens to be right before they enter retirement.

If you look at total cost over a lifetime a "healthy" person is far more expensive than an obese one because so much of the healthcare cost is back-loaded into older ages (drug costs, hip replacements, alzheimer's, additional cancers, heart surgeries, etc).

And while the last few years of an obese individual's life is expensive too, we're talking about tens of years of similar level care for a "healthy" older person.

Not to mention that most pension systems are substantially under-funded for current life expectancy. The obesity epidemic might save the pension system from complete collapse.

None of these are moral arguments. I'm not going to defend obesity. But it is worth considering that if the "epidemic" continues the results likely won't worsen healthcare or pensions, but may in fact reduce total costs.

[0] https://www.nytimes.com/2008/02/05/health/05iht-obese.1.9748...

[1] https://www.forbes.com/sites/timworstall/2012/03/22/alcohol-...

> Because the obese likely are net contributors

While you did plenty to explain the economics of obesity in our health care system, you did not do enough to tie the economics of obesity back to morality. Sure obesity is probably a net contributor, but is that important when deciding what is moral? My gut says no, but I haven't formed an educated opinion on the matter.

I don't think it makes any sense to talk about obesity as "moral" or "immoral."

I'd argue, in spite of the name a "moral panic" isn't specifically about morals. That's why I didn't focus on the moral angle.

Moral panics are obscure "bads" that a large number of people suddenly take interest in. Like violent video games or swine flu. Swine flu for example isn't immoral (or moral) it simply just is, but it still presented a moral panic when people were panicking about it.

Obesity could become a moral panic but it hasn't yet because experts often squash the issue with facts, at least when applied to a larger society (nobody is arguing it is good for an individual or for family members of an individual, we're talking society scale).

I've always thought the same thing about smokers. Other than the obnoxious second-hand smoke, why would we want to discourage people from smoking? Typically they will live long enough to pay decades of taxes and then die from lung cancer around retirement. Win-win.

Ancidotal, but the only time I hear people complain about smoking is when they are upset about second hand smoke - I don't see people complaining about vaping nearly as much (and even then it's usually just "they look stupid", not "they are being stupid for vaping"), even though there are some similar health risks (not as many, but inhailing steam will never be good for you, espically if it contains nicotine).

Second hand smoke is espically evil because it's very common for young children to be inhailing it while their parents are smoking.

> ... inhailing steam will never be good for you ...

Guess I'll have to stay out of the sauna, then?

Like everything else in life, moderation is key. Hot air in a sauna every once in a while is not going to be a problem (assuming you're otherwise healthy). Concentrated hot steam multiple times a day for months at a time could cause health problems.

"Vaping" is somewhat a misnomer. The vapor is really tiny atomized droplets, and is not hot at all. Maybe warm, but far below anything that could cause heat damage to tissues.

Yes, there is a tiny amount of actual vaporized (as in, a gas) liquid, the stuff that Leidenfrosts the rest of it off the hot coil.

That all being said, your main point still stands. We don't know what the long term effects are of inhaling these droplets of propylene glycol, glycerol, nicotine, and flavor compounds.

stay in dry saunas instead?

Obesity is so astonishingly bad that it's insane everyone just glosses over it. All homicides, suicides, and drug overdoses in the US combined have nothing on obesity.[1][2]

Somehow, there's no getting people to understand the scope of it. They'd rather attack the healthcare system and its costs, which are easily explained by use[3], than do some serious national soul searching on obesity.

[1] https://imgur.com/a/YV2wBe8 - data from an article I was writing.

[2] https://www.cdc.gov/media/releases/2017/p1003-vs-cancer-obes...

> Cancers Associated with Overweight and Obesity Make up 40 percent of Cancers Diagnosed in the United States

etc.

[3] https://randomcriticalanalysis.wordpress.com/2016/09/25/high...

It might be because most interventions have dismal success rates.

I would be thrilled for some regulatory interventions. We can start with getting added sugar out of just about every product. Changing the rhetoric about caffeine would be nice too. Everyone talks about it as if it is a given that we use it, when in reality they are reliant on it. We really let the big companies run over us in terms of what we eat.

Changing the food on supermarket shelves could help but I meant "intervention" in the sense of things you can do with someone who is already obese -- few seem to be very successful in keeping weight off.

You could get surprisingly far on obesity simply by removing agricultural subsidies. If corn & soybeans cost their actual market price, we wouldn't be putting high-fructose corn syrup and partially hydrogenated soybean oil into every single processed food made. No additional regulations needed, no additional taxes, and most of the impact comes out of Monsanto's bottom line rather than individual farmers - just let the damn free market do its job and stop with a massive corporate welfare program.

Then again, good luck. The farm lobby is strong, the ag-tech lobby is even stronger, and removing handouts to America's heartland has proven politically unpopular in the past.

I'm not sure a policy leading to higher food prices or offshoring of food production capacity would be that popular.

Lower taxes is always a good sell, though, as is reducing handouts and eliminating corporate give-aways.

obesity ruins useful organs to use in transplants

How many people do you know who died in their mid-twenties of obesity? Of these, how many spent their last years engaged in behavior that alienated them from their friends and family, or turned to crime, because of their obesity? Do you see a lot of discarded needles from diabetes testing kits in the park? The two things aren't comparable.

Genuine question: have you ever lived or spent time in non-coastal USA? The amount of obesity is shocking. All across the country, you'll find body shapes you did not think were possible.

I am a lifelong suburbanite and the suburbs have lots more obese people than the cities. But let's say I'd be shocked if I visited San Antonio. I'm not seeing how that's a refutation of what I said.

As someone who apparently has visited those areas, can you answer emodenroket's questions for us?

FTA:

>In the first study to link organ donation to drug abuse, researchers found that organs donated by overdose victims jumped from 59 in the year 2000 to 1,029 by 2016.

>This is almost as many as the 1,356 organs donated as a result of deaths from car crashes, the biggest source of organ donations.

Comparing organ donation from deaths, it's not very small at all.

In Massachusetts, we used to have to reach out to hospitals across the country, including the big California hospitals, to try to expedite heart transplants for some of our patients with unfavorable blood types.

It is really heartbreaking in a different way that we do not have to do that anymore.

Pretty sad. If we removed safety belts from cars the donor numbers would soar even more...

I'm not making a particular argument for this specific circumstance.

But I do believe in asking, when a "bad" situation refuses to change for the better, "Who's benefiting?"

To go a bit paranoid: We have apparently confirmed reporting of condemned prisoners' organs in China being "donated." "Donated", in quotes, because it seems to be unclear who controls the decision and whether it has created a demand driving an increase in "supply".

Leaving organs out of the mix, there seem to be a fair number of people who think "it's their own fault" and the these deaths in the U.S. are simply ridding society of problems. Whether or not they'll say that, and to whom...

Drug crime law enforcement disproportionately impacts people and communities of color.

We also continue to have racial and socio-economic prejudice. And exploitation. So, who's benefiting from that?

And lately in the news, the prescription opioid manufacturers.

So, amidst this crisis, by all means, ask who is harmed, and how, and how to fix that. But don't forget to ask, who's benefiting.

And how far are they willing to take that?

Organ donation is a paradox in so many ways[1]. We seriously need to find replacement technologies.

[1]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1350269/

My mother got a organ donation from a not-very-close family friend whose daughter OD'ed. It was a very odd time for our family because we were excited for my mother and her health but sad for the family who lost a child.

What a horrific headline.

An advertising agency targeted 18-30 year old males who mix alcohol and red bull with organ donation commercials. It was wildly successful. Maybe more than this.

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