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.
- 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.
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.
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.
http://icelandreview.com/news/2018/06/07/all-icelanders-are-...
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...