Spain leads the world in organ donation. What’s stopping other countries?
mosaicscience.com
mosaicscience.com
Spain is at the top of the ranking because the medical staff have a huge economic incentive to convince donors/family (2k euros) and conduct transplants (e.g. from 10K euros to 15K euros for a liver transplant). The Spanish model has been criticized for many years for being a shady procedure controlled by even a shadier organization that is barely regulated by the government. When the success of the transplant is taken into account Spain loses a lot of places. Spain is at the bottom of Europe in terms of blood donation. The Spanish Model is definitely not one to be imitated.
https://elpais.com/elpais/2018/06/22/opinion/1529691789_6524...
"It has maintained its position as the clear leader for the past 26 years."I realize those are both very controversial, so I wonder why we don't have a monetary incentive.
i.e. We will pay $1000 for every organ of yours we take to a person you nominate.
There is another factor and is cause of death and age which directly is tied to doner suitability as well as if there is infrastructure to support organ donation across the nation and other process related issues.
I would strongly suspect that Spain managed to solve the infrastructure and process related problems rather than it simply being a cultural factor or that Spain has somewhat more non-toxicity, cancer/congenital or massive trauma deaths of otherwise healthy people between the age of and 20-45.
> Spain managed to solve the infrastructure and process related problems
That's correct, the Organizacion Nacional de Transplantes is the main culprit.
You can read about it here: http://www.newsweek.com/2015/02/20/spain-has-become-world-le...
> Dr Matesanz rejects the idea of a Spanish miracle or a unique store of generosity in the hearts of his compatriots: “We have asked the same question in various surveys over the years and every time 56% or 57% say they would donate their organs after dying; roughly the EU average.” On the role of Spain’s transplant law, which presumes consent unless otherwise stated, Matesanz is also dismissive, pointing out that families always have the final say and that the only country in the world to enforce such a rule is Singapore. “Spain has not been a leader in surgery or research; we have hardly chalked up any firsts in transplant operations. What we have brought to this area is organisation. Following a philosophy that states that donors do not simply fall from the heavens, we have provided organisation and professionalisation.”
The same law is being applied in France, you have to be registered as not a donor in a national database. But, as the doctor said, the problem is with the available organisation, not the laws that are applied.
For example is familial consent is required and the answer is usually yes even in Spain AFAIK.
But that doesn’t mean they are all equal the time that it takes to contact a family and get consent plays a critical role so is who contacts them as in a professional that can explain to them the process and increase the likelihood of consent being given to some busy administrator asking them that as btw....
Also are all hospitals equipped for organ harvesting? Do they have free surgeons and free surgical staff and rooms for that? Can all hospitals handle transport and distribution of organs? How fast is donor decision can be made after harvesting?
These are all critical factors for organ donation in cases that do not involve a vegetable state patient where organ donation can be planned.
I don’t know about the UK but I have knowledge of another opt-out system in a different country and in the case if the family couldn’t be contacted in time for the organs to be harvested the reason for why not would be recorded as the same as the family refused and that is “consent was not given”.
So to me the % difference can be just that Spain is quicker at contacting the family and is more prepared for organ harvesting and distribution for ad-hoc cases in which time is critical.
- no heartbeat - no breath - their body temperature falls to ambient temperature - blood pools on lower half of body - onset of decomposition - etc
When organs are removed from a person for donation, none of those conditions apply. In order to accommodate this fact the concept of brain death was created. But really brain death is an example of taking a word representing an ancient and well understood concept, death, and applying it to something completely new.
Really it's a form of deception. I don't think it's a malicious deception but when the doctor comes in and says your loved one is brain dead that person is not dead in the ways understood by a typical person.
I'm in favor of organ donation in general but until the medical community has some very frank discussions about the medical definitions of death I'm opposed to any form of mandatory or opt-out organ donation.
He once said that this team of expert transplant specialists who flew in are just waiting and waiting because this one person's heart would just keep starting back up on its own, so he had to be exceptionally careful to pronounce him actually dead.
They actually spend more time trying to revive a donor and doing everything they possibly can because of misconceptions like what you said above. She is quite certain that if anything, being a donor actually increases the likelihood of you being revived by medical staff, who would much rather revive you than have to deal with people telling them they didn't try hard enough.
Is there any kind of (independent) check for this? In my country (Germany) there has been collusion to get ones patients on the top of the recipient list. I wouldn't be surprised of there were similar collusions for the donor side.
I've also heard that recovery procedures differ from organ prevention procedures (at least you don't want to apply medication which potentially damage organs for a potential donor). How does one get assurances that the latter are not applied prematurely if you are a donor?
Maybe the place should start handing out bonuses for each successful patient revival, that'd really get those ethics kicking.
If you ask a lay person from any human culture very probably the most significant part of the definition would be "non-reversibility".
That works for brain death too.
How is the decision to opt out made?
You need to either:
1) Register your wishes with the National Board of Health and Welfare
2) Fill in a donor card and carry it in your wallet
3) Notify next of kin/will etc
Upon your death you need to be pronounced dead twice with at least 2 hours apart, sometimes after a brain scan.
The low participation is indeed true, but according to a 2010 poll, 83% Swedes were positive to organ donation, but very few register as such.
Edit: Actually the participation doesn't seem that low [1].
[1] https://ec.europa.eu/health/sites/health/files/blood_tissues...
On the Swedish system, in Swedish:
https://www.socialstyrelsen.se/donationsregistret
http://www.socialstyrelsen.se/pressrum/nyhetsarkiv/sverigeha...
http://icelandreview.com/news/2018/06/07/all-icelanders-are-...
The fact that no money is involved is a critical part of this system. It also is the fact that no money is involved in RECEIVING an organ.
This makes the system purely altruistic a removes the kind of questions of "how much should an organ cost", "could I accelerate the process paying more for an organ?", "could I sell my organs, or the organs for my just deceased relative for more money?" "Is this enough money for selling my organs?"
Eliminating the money from the equation makes this simple. You don't win or lose anything for donating. If you don't want to, is cool. But if you want to, is totally selfless. Which strangely, makes more people be cool with the default and donate more. Because the only thing involved is feeling generous and helping others, unless you have some sort of religious feeling or fear. But, again, nothing to earn.
Personally, I wouldn’t go about the issue by shaming nations that don’t belief in the practice. I would instead go about it by having a campaign of information on the life saving benefits of helping others. Undoubtedly someone will tell me that these campaigns exists, but I’d say they don’t do a good enough job yet.
Reminds me of the grandmother in Uri Orlev's book, who insisted on burning every fingernail clipping, as otherwise their souls would be stuck on Earth seeking for them after death.
In the end, nobody old enough to make that decision dies with what they came with - the body changes too much over the years. But then again, we allow everyone to destroy their organs with drugs, dangerous sports, sitting for most of the day, etc. It would be hypocritical to deny others the equivalent choice.
As long as it is opt in you won't get much success, because there is no benefit and people are lazy by nature, which is normal.
I don't think paying organs donors should be a thing, so maybe have a priority list for organs where donors get higher? Seems fair: you promised to help society, and in exchange society promise to help you first instead of the selfish non participants.
See, not as simple as it sounds.
If there are no boundaries or rule structures, then the incentives often (always?) bleed into some involved party not having a choice, or a Hobson's choice.
Someone having to choose between selling a kidney or starving is terrible. But the solution shouldn't be to deny the first option - that just leaves starving. It should be to give them a third option.
That said, obviously "no rules" would still be dangerous, but no legal sale is done without any rules.
There's little reason for anyone to submit to organ harvesting to eat. The idea that our society is just enough for individuals to face that choice is kind of laughable.
Of course the best thing is to make artificial organs work, but that's not something most potential organ donors have much influence over.
If in the XXI century we have not eliminated those dilemmas is that we are doing something wrong.
Also, it seems that you would be creating an incentive to make people hungry.
Also some kidneys can be problematic I passed on one where the donor might have been HIV+ - I had gone on the list prior to needing diyalsis so it wasn't like I needed one immediately.
The second most important factor is good organization and infrastructure. That's Spain's and now also Croatia's strength. You really need to be able to transport the organ fast and cool to the next hospital where the organ is needed. And you need to have the recipient on call also, who should not have eaten something in the last 6 hours.
Iran is currently the only country with a legal organ market. It also happens to be the only country with no shortages or wait lists. Both facts were true in India and The Philippines until the sale of organs was prohibited in those countries in 1994 and 2008 respectively.
https://www.tabletmag.com/jewish-news-and-politics/164976/is...
So yes, I for one am not interested at all by donating my organs (here it is an opt out). I'd rather be dissected, as I learned a lot on (in my case animal) cadavers.
Or think about this on the extreme end: I think many people would choose a time to die peacefully rather than sit in a semi-vegetable state in a hospital bed for the rest of their life.
Maybe in some cases, but as an overall statement it seems seriously misinformed. Not all cancers or their treatments are the same. My mom had breast cancer surgery followed by chemotherapy and it certainly didn't age her or make her body frail.
As for the first or last on the waiting list, that's a cool soundbyte, but that doesn't matter at all. It is still the case that most transplanteable organs are thrown away.
Now granted, that's not 100% true in all cases. If you're on dialysis and need a kidney, that might happen. But a true necessary organ, like a lung or a heart, beginning of the list, end of the list, doesn't matter. Even then, compatibility is an enormous restriction.
And of course, there's the counterargument everybody's silent about : if you're an organ donor, doctors will not make the same efforts to keep you alive. The decision to donate organs cannot be made postmortem, but must be done before the patient dies (at least 15 minutes or they won't even attempt transplant, ideally hours). Granted, if you're braindead for 2 months, not an issue.
If however you come in after a car accident with heavy internal bleeding, a doctor has a choice : you're, say, 80% likely to die, but in 30 minutes or so, not immediately. But if they extract your heart now, they can prolong the life of someone else by ~5 years with odds of some 50% or so (can be higher, can be lower).
At that point, a doctor will make the decision to throw away the 20% and ... well kill you.
But it gets worse : they won't use sedation (and though it's likely you're unconscious, it's not certain, certainly the level is uncertain (because there is more states between awake and coma than you'd think, some of those states involve paralysis, or you may be conscious but have severe nerve damage), as that would significantly reduce the odds of a successful transplant.
Now I'd hope they'd at least inject an overdose of morphine once the organ's out (because the patient at that point will, of course, die, no need for suffering).
Sadly, if accurately informed, I believe nobody would volunteer to be an organ donor.
And yes, the Spain thing is true in the worst possible case: doctors get paid, thousands of euros, for every time they declare a patient beyond rescue and go for organ harvesting instead. So not only is there a terrible incentive in the first place (the same as elsewhere, organs available for harvesting save lives of course), there's an even worse incentive in Spain's case.
Also, some people don't even have the choice. Does it affect happiness ?
No but most other people have religious or similar reasons.
I don't see many people not donating organs because they simply don't care. So congratz I guess.
My immunosuppressive treatments is a walk in the park compared to the 6 months I was on dialysis. I got married and had a kid after my transplant, none of which I even considered while I was on dialysis.
Which is to say, you are horribly misinformed. :). I hope you will read more about organ donation before making the decision to not opt in.
Also idk your personal reasons for need of a transplant but common reasons for acute renal failure are diabetes melleitus, vascular disease, and immunological diseases. Many in each category have a genetic component. I wouldn't dare to pass such risk to offspring but to each his own I guess.
To grossly sum it up, we end up putting new kidneys in people who fucked up their own because they got diabetes (ok, a small share is congenital, which also sucks a lot). I don't feel like sustaining that and I don't feel guilty the slightest.
Your choice if you don't want to sign up for organ donation, and I respect your choice. Everyone should make their choices about their bodies. However, your choices are coming from horrible misinformation.
Also what is misinformed? Are you living without treatment? Do you indeed carry any risk for offspring or are you in the slight share of patients who got acute renal failure thanks to some bacterial infection? Since you didn't address it and the odds are not in favor, I don't have much doubt on the answer. I don't think much is factually wrong, rather that you're displeased with my conclusions : not worth enabling.
For context, I was in my 30s when I had the transplant. If I was 70+, then perhaps I might pass.
I hope you are never in the position of being on a waiting list for an organ donation, but it is much easier to dismiss an abstract idea of saving some unspecified life versus facing short term uncertainty about your own continued life.
I hope anyone reading this thread considers signing up to be an organ donor. There is very few free lunches, but organ transplant is one of them.
Also, this line from the parent post requires a response:
> I don't think we have such a shortage of people that we have to save every and each one no matter the cost.
Organ donations are huge net positives for society. In a world with no organ transplants, the renal failure patients would be spending an average of 5 years longer on dialysis, which ties up hospitals, patients and caregivers mush longer than a transplant operation plus+ immunosuppressive treatments do.