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Medicine

France Begins Opt-Out Organ Donation (theoutline.com) 445

Laura June, reporting for The Outline: France began to use a new opt-out system of organ donation on Jan. 1, making it one of a large number of European nations that now use a "presumed consent" system. This means that any adult who dies will now donate their organs by default, regardless of their survivors' wishes, unless they have signed a refusal registry in advance. The new law gets around what has historically been a stumbling block for organ donation: the surviving families of the deceased. A survey in France previously showed that while up to 80 percent of the population was in favor of donating their own organs, about 40 percent of families refuse when pressed to make the choice.
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France Begins Opt-Out Organ Donation

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  • by Anonymous Coward

    Click here to opt out.

  • by Opportunist ( 166417 ) on Monday January 02, 2017 @04:09PM (#53593531)

    Sure I'm for donations, they might save my life!

    But I'd want to receive, not give!

    • by jedidiah ( 1196 )

      ...assuming you don't get organs from a guy like me. You don't always want to receive. Sometimes you have no idea where it's been.

      • That's a downside of declining traffic casualties. Traffic is one of the sources of healthy and young donors.

        • I think I remember reading an article recently fretting about this. They were worried specificaly about the automated cars "driving" down organ availability by drastically cutting down on traffic fatalities.
    • by WarJolt ( 990309 )

      I've heard a testimony a docs that was a little bit shocked at how they treat potential organ donors. The fact is in an ER you don't necessarily get the opportunity to have a 2nd opinion about you being pronounced legally dead.

      • by ShanghaiBill ( 739463 ) on Monday January 02, 2017 @05:13PM (#53593873)

        The fact is in an ER you don't necessarily get the opportunity to have a 2nd opinion about you being pronounced legally dead.

        If you are that far gone, you are likely better off dead anyway. It is a common scene in movies for the hero to flat-line, be revived with CPR and/or defib, and then be running, jumping and doing gymnastics a few minutes later. That is BS. Most people given CPR/defib don't survive or only survive for a few miserable hours or days, and even those that last longer usually have a very poor quality of life. They often are confined to bed or a wheelchair and often suffer brain damage.

        People that work in ERs, or once worked there, are the most likely to ask for "Do Not Resuscitate" or DNR orders when they are hospitalized.

        • by fahrbot-bot ( 874524 ) on Monday January 02, 2017 @06:33PM (#53594283)

          People that work in ERs, or once worked there, are the most likely to ask for "Do Not Resuscitate" or DNR orders when they are hospitalized.

          When my wife Sue [tumblr.com] was diagnosed with fatal brain tumor the day before Thanksgiving 2005, she completed a health-care proxy (living will) stating that no extraordinary measures should be used and a DNR. When her brain stem was damaged six weeks later, she fell into a coma and I had the fun task of re-asserting her DNR. She died a week later on Jan 13, 2006. Sue was a teacher so, instead of donating her organs, she donated her body to science. She was only 61 (I was then 42) and in excellent health (other than the brain tumor) and most donors are much older and in poorer health, so the Virginia Anatomical Program was very happy to have her (so to speak).

          I have also completed a living will and healthcare proxy form and registered them with the U.S. Living Will Registry [uslivingwillregistry.com] specifying no extraordinary measures and registered with the Virginia State Anatomical Program [virginia.gov] to have my body donated to science.

    • by ChromeAeonium ( 1026952 ) on Monday January 02, 2017 @04:25PM (#53593621)

      I think they should be tied together. Unless you have some sort actual medical reason as to why you should not be an organ donor (HIV infection, ect.) opting out should put you on the bottom of the donation list should you need it. If you contribute to the system, you get priority if you need the system. Otherwise, you go to the back of the line. Don't expect to receive if you're not willing to give.

      I just don't get the mentality of people who refuse organ donation. If you're dead, you're dead, why take other people with you? It's one last act of good that could save lives and, seeing as how you're never going to use them again, costs you absolutely nothing. How big of a prick do you have to be to look at that proposition and reject it?

      • by mysidia ( 191772 ) on Monday January 02, 2017 @04:36PM (#53593673)

        I just don't get the mentality of people who refuse organ donation. If you're dead, you're dead, why take other people with you?

        The concern is not "If you're dead". The concern is, If i'm in critical condition, the hospital that knows I'm a potential organ donor
        may treat me differently in a manner that makes me less likely to survive, Or they may prematurely declare me dead out of concern for
        the organs they could get from me to save someone else..... perhaps someone they deem "More worthy" of being saved.

        • by Anonymous Coward on Monday January 02, 2017 @04:41PM (#53593711)

          Which is an issue that an opt out system mitigates nicely. The more donors there are, the less likelihood of unethical behavior.

        • Ok, that's very scary, but is there any evidence that that really happens? Are there any medical professionals here?

        • by AmiMoJo ( 196126 )

          If you are that paranoid why not just opt out?

        • Good point, I forgot to apply Hanlon's razor to the situation. I should have said prick or conspiracist with unreasonable fears. If there were any evidence whatsoever that organ donors die at a higher rate in emergency situation (are emergency medical staff even aware of your status in those situations?), it would be huge medical ethics news. Somehow I doubt that is the case.

        • Re: (Score:3, Insightful)

          This exactly. I am all for organ donation, but the problem is that it is a statistically proven fact that organ donors don't get worked on as long as non-donors with the exact same injury, especially those involved in violence, such as car accidents, gun shots and other traumatic injury. I used to be an organ donor on my drivers license, now I am not on my license. I have told my family that if I am really dead and the opportunity to donate is there, I would like them to do it, but I want the doctors foc

          • by AmiMoJo ( 196126 ) <mojo@nOspAm.world3.net> on Monday January 02, 2017 @06:48PM (#53594345) Homepage Journal

            Do you have a link to that data? A quick Google turned up nothing.

            Personally I'm more concerned with being kept alive too long. The last thing I want is to live in pain or unable to move.

            • by LeftCoastThinker ( 4697521 ) on Tuesday January 03, 2017 @02:06AM (#53595925)

              I couldn't find the original journal article, but this WSJ article lays it out pretty clearly. The tests they use are from the 1960s and among other things, not checking for higher brain function with an EEG is a real problem for me.

              http://www.wsj.com/articles/SB... [wsj.com]

              An excerpt: " In a 1999 article in the peer-reviewed journal Anesthesiology, Gail A. Van Norman, a professor of anesthesiology at the University of Washington, reported a case in which a 30-year-old patient with severe head trauma began breathing spontaneously after being declared brain dead. The physicians said that, because there was no chance of recovery, he could still be considered dead. The harvest proceeded over the objections of the anesthesiologist, who saw the donor move, and then react to the scalpel with hypertension."

              Those of you looking to avoid pain may not like it if you can feel yourself being slowly dissected...

          • I will join the chorus too: Citation needed.

          • You assume that "getting worked on for longer" correlates with a higher probability of recovery. That's simply not the case. Health care workers are the ones most likely to have DNR's and living will's stating "no extraordinary measures" as they know that Standard procedure is to extend the life of the patient no matter how hopeless the chances of recovery or how painful those procedures and the extra time they are giving you is. Organ donor or not, I would rather go then live a few more hours in excruciati
        • There is a man on the runoff railway track and a family of 5 on the main track. A speeding train is heading toward the family of 5, which could be diverted if you pull a lever, though you will kill the man by himself on the runoff track.
          What do you do?

          There is a man in ICU. If you "declare him dead" his liver, heart, lungs, kidney(s), and other internal organs will save the lives of at least 5 people.
          What do you do?

      • Re: (Score:3, Insightful)

        by ooloorie ( 4394035 )

        I think they should be tied together.

        That's a useless suggestion: people who need organ donations are generally not suitable to donate, and they know it long ahead of time.

        I just don't get the mentality of people who refuse organ donation. If you're dead, you're dead, why take other people with you?

        Well, one reason is a concern that doctors and hospitals might be less interested in saving you if that means potentially damaging donatable organs. There are many other reasons as well.

        How big of a prick do you

        • by ilctoh ( 620875 )

          Well, one reason is a concern that doctors and hospitals might be less interested in saving you if that means potentially damaging donatable organs

          While I'm sure this is a concern for some people, I'm questioning whether its a realistic concern. I have some experience in the health care field (as a paramedic), and infrequently but regularly find myself working on people close-to-death, where organ procurement is a concern. I can't say that I've ever witnessed, or even heard, of any inkling of an idea that we wouldn't put forth our full efforts to save the patient in front of us in favor of potentially harvesting organs. I'm also not sure that there

          • While I'm sure this is a concern for some people, I'm questioning whether its a realistic concern.

            The book "Death to Dust" [amazon.com] (by an MD, and which is fascinating, BTW) examines this point in detail.

            He comments that there is no certain method to certify being dead. Absent massive bodily damage we can't determine true death with any certainty.

            There are many cases where the patient has no perceptible breathing or heart rhythm, but wakes up at a later time - in some cases living years longer.

            The book refers to a study of Civil War coffins which were moved to a different cemetery, where they studied the buried

            • by ilctoh ( 620875 )

              There are many cases where the patient has no perceptible breathing or heart rhythm, but wakes up at a later time - in some cases living years longer.

              Many cases? There's a small handful of anomalies whose stories get retold because they are so bizarre... but that's just statistical noise compared to the billions of humans who have died, and stayed that way.

              Death is something that happens with a great deal of regularity, there's actually quite a bit of research done to correlate various medical interventions with survival rates... Obviously assessment techniques and record keeping have both improved considerably since the Civil War days. I don't thin

        • That's a useless suggestion: people who need organ donations are generally not suitable to donate...

          Err, if you have a bad heart, why must it follow that you have bad kidneys, corneas, skin, liver, etc?

          ...and they know it long ahead of time.

          Even if true (do most of them know prior to the age of 18?), this seems irrelevant. The idea that you are pushed below organ donors on the recipient list if you've opted out of organ donation in the past X months (to prevent people from simply switching the moment they learn they need a transplant) is entirely sensible and entirely fair. Whether or not your condition is detectable far in advance and how lo

          • by AmiMoJo ( 196126 )

            It will never fly, because some people will claim religious discrimination as their beliefs force them to opt out. Others will complain that some people who are on the list are destroying their organs with alcohol and lifestyle choices.

            • It will never fly, because some people will claim religious discrimination as their beliefs force them to opt out.

              It's pretty doubtful a religious discrimination case would win out in a first amendment battle, given the red letter law there, nor is the case one that's sympathetic enough to garner much support from lawmakers or the public ("So you're saying it's ok for us to defile our bodies to save your life, but not the other way around?")

              Others will complain that some people who are on the list are destroying their organs with alcohol and lifestyle choices.

              It's not the economics of each individual transaction that matters; it's the big picture. People will most likely make the decision early in their lives and then forget about it. Th

        • That's a useless suggestion: people who need organ donations are generally not suitable to donate, and they know it long ahead of time.

          Except in cases of injury, or where only one organ is the problem.

          Well, one reason is a concern that doctors and hospitals might be less interested in saving you if that means potentially damaging donatable organs. There are many other reasons as well.

          Considering that, far as I can tell anyway, virtually every medical organization on earth denies that happens, that seems an extremely unlikely and unreasonable concern. I would not be surprised if there were isolated incidents, but by that logic you should wear body armor in case someone stabs or shoots you. I think its much more reasonable to trust the opinions of major medical organizations than put stock in baseless fears pulled out the

          • I think its much more reasonable to trust the opinions of major medical organizations than put stock in baseless fears pulled out the usual place.

            You mean the same "major medical organizations" whose errors may be the 3rd leading cause of death in the U.S. [cnn.com], amounting to roughly 250,000 deaths per year?

            Don't get me wrong: I agree with you to the extent that I think it's probably MUCH more likely that doctors are making errors rather than deliberately killing people or letting people die. But given how few actual errors are admitted by doctors, it's hard to put the word "trust" and "major medical organizations" in the same sentence. (And yeah, I ge

      • How can I be sure that the doctor would do everything that he can in order to save my life (including using drugs etc that might damage my organs in the long term or make them unsuitable for donation but would help me right now) when there is a child etc waiting for a transplant and my organs are compatible? I do not say that doctors would do this intentionally, but there may be some slight nudge in the "right" direction.

        As far as I understand, once you are completely dead (heart stopped, body at room tempe

      • by AmiMoJo ( 196126 )

        I can see the logic in preferring people who donate, but if you go down that route you have to start thinking about people who smoke and destroy their lungs, or drink and wreck their liver, or get a sports injury that writes off a kidney...

        • by quenda ( 644621 )

          I can see the logic in preferring people who donate, but if you go down that route you have to start thinking about people who smoke and destroy their lungs, or drink and wreck their liver

          We already do. Alcoholics don't get new livers. Smokers are pushed way down the list of transplant recipients for anything. You want a new kidney? Then stop smoking and lose weight if obese. We do not hold patients responsible for past sins, but we do for current ones.
          So by analogy, you would not consider how long someone had been on the organ donor list, just if they are on it at the time they find out they want to be a recipient.

    • by hey! ( 33014 )

      Technically you don't give anything when organs are harvested from your corpse. Even calling it "your" corpse is begging the question.

    • Which provides the perfect solution, not registered for at least 12 months as an organ donor at the point you need an organ, then no organ for you. Heavy advertising as you bring in the scheme and a 12 month grace for those reaching 18 to register. Also change law so revlatives can't over ride your wishes.

    • I am happy to surrender my organs after death provided the person is willing to accept my brain as well.
    • It's not necessarily NIMBY, it's just going with the default. When this was introduced in other countries, organ-donorship went from large-majority-don't to large-majority-do, with no change in people's attitudes. People just went with whatever was the default, so you may as well make the default option the better one.
  • by tgibson ( 131396 ) on Monday January 02, 2017 @04:16PM (#53593571) Homepage

    The assumption is that only vital organs needed to help a living, sick person survive are harvested. But is that the case? Does the system define which organs may be harvested and for what purpose? Can one's entire body be donated for the purpose of research or training? Is the system truly altruistic or are there people profiting from the practice? Who decided what the rules are?

    • by mysidia ( 191772 )

      But is that the case?

      No.... donated body parts, if they cannot be used to save somebody's life will likely be used for Scientific research, or educational purposes instead.

      Can one's entire body be donated for the purpose of research or training?

      Yes. Schools that graduate people as medical Doctors use Human kadavers for the purpose of teaching physiology and teaching surgeons.

      Historically, these are expensive and hard for them to obtain. There may be research uses as well.

      I don't know what the new Fre

    • Maybe you only want to donate to save a life, but donating one's body for research or training potentially helps more people people survive in the long run. Of course, the latter path means your organs will die, if that's something you actually care about. (But hey, maybe they'll find a way to make your cell line immortal.)

      Of course people profit from the practice. Did you think the doctors were working for free? There's no problem with profit as long as the dividends are proportionate to the skills, risk,

      • Actually, it turns out that the difference between a cadaver's anatomy and a live person's anatomy is sufficient that most doctors actually get their anatomy training on the job--as in, when they get to see inside live people. The best anatomy texts we have are from imaging of live people, followed by a project that worked using donated bodies of people who died under circumstances that meant their body could be frozen at the point of death (or close enough) and then sliced (I think the images are online s

    • No one 'profits' from it, at least not direct monetary profit. Yes, some body make make money off of medical inventions developed using research done using these organs, but that is about it.

      Organ donation is very difficult, very expensive, and heavily regulated in all western countries. Hence the medical tourism to non-western countries.

      This will definitely save a lot of lives. In the US the wait for kidney donation (keep in mind that you can donate one of your two kidneys with minimal health issues) i

    • Is the system truly altruistic or are there people profiting from the practice?

      Something tells me when I'm dead I won't care.

  • by johannesg ( 664142 ) on Monday January 02, 2017 @04:20PM (#53593589)

    If you die while on a visit to France, will the family receive a stripped body?

  • Presumed consent (Score:2, Informative)

    by jdavidb ( 449077 )

    This gets very, very tricky. I don't think presumed consent in this particular area bothers me per se, but I can imagine a lot of other issues where presumed consent would scare the living daylights out of me. Sounds like a very slippery slope.

    • I don't think presumed consent in this particular area bothers me per se, but I can imagine a lot of other issues where presumed consent would scare the living daylights out of me. Sounds like a very slippery slope.

      I agree. While I too think it's somewhat silly to be concerned about ownership of body parts after death, this effectively causes ownership of the corpse (or at least parts of it) to pass to the state, unless you opt out. So while your property, finances, etc. pass to your family members by default, your own body comes under control of the state by default (who cedes it to medical professionals, it seems).

      Death rituals are important to many people, especially loved ones who have to go through mourning.

      • By the way -- I am aware that some other countries have adopted this system already and haven't apparently seen such abuses or problems. I'm just posing some thoughts about where things COULD lead when we start changing basic assumptions like this.
        • by Jack9 ( 11421 )

          Most importantly (IMO) is that, statistically, nobody thinks about organ donation too much in the US except when looking at their Driver's License every couple years. The public thinks long and hard about comas and other altered states and has plenty of time to do so. The slippery slope can't practically apply when comparing events that have orders of magnitude difference, in time between deliberation and consequence.

      • by jdavidb ( 449077 )

        But what this law is effectively doing is removing ownership of the deceased person from the family and passing it to the state.

        Exactly! And while I'm sure we all know some people who have terrible families, I think the state is all too happy to play on fears of individual families making the "wrong" decision and to present itself as the enlightened benevolent decision maker who should have the right to decide.

        Just to throw out some "slippery slope" possibilities -- could the government also decide that you are "opt-in" to a DNR order by default?

        That is the specific slippery slope scenario I have in mind. And I've actually worried about that since the late 1980s.

    • This gets very, very tricky. I don't think presumed consent in this particular area bothers me per se, but I can imagine a lot of other issues where presumed consent would scare the living daylights out of me. Sounds like a very slippery slope.

      I don't know...limiting implied consent to dead people feels like a pretty good firewall to me. Where do you imagine we could end up sliding to? (Talking about implied consent only, not other issues like doctors possibly being less than enthusiastic to save someone.)

  • Wonder how long before some crimes will no longer carry the death penalty but organ donation penalty? No one was really executed just all of their organs donated, too bad they could not live without kidneys, liver, and both lungs. But hey they were not executed, meanwhile since they are suffering a major life ending trauma lets just grab that heart, too.

  • How do the doctors know that the, uhm, donor, doesn't have a condition that will make the organ bad news for the recipient?

    • A check of medical records, and standard blood tests for all the testable diseases that might be transmitted. You can't be absolutely sure - it's always possible the donor picked up HIV on a one-night-stand a month ago and didn't tell anyone, and isn't yet carrying enough virus to show on the test. But you can get the risk down to an acceptable level: That is, the risk of dying from disease via donation is less than the risk of dying through not having an organ.

  • ... what kind of sauce I'd like my organs served with?

  • huge organ (Score:4, Funny)

    by PopeRatzo ( 965947 ) on Monday January 02, 2017 @05:33PM (#53593975) Journal

    You want my organ, come and get it.

    https://lh3.googleusercontent.... [googleusercontent.com]

  • by Anonymous Coward

    I am actually amazed by the comments here.
    I live in Austria and we have had opt out for a veeery long time and it is no issue at all.
    We only use the nickname "organ donors" for motorbikers as a joke.

    You can still choose not to donate and can communicate that intent in various ways(also informally).
    Examples:
    * register in a government database that is restricted to only this opt outs
    * carry a signed piece of paper that says something like "i dont want to donate my organs"
    * your family "testifies" that you wis

  • by Damouze ( 766305 ) on Monday January 02, 2017 @06:30PM (#53594269)

    Especially the right to the integrity of one's body.

    Death has now become a taxable event and one's organs are the fee.

    • by SuricouRaven ( 1897204 ) on Monday January 02, 2017 @07:48PM (#53594591)

      You can't call organs a fee when they have zero value to the donor, on account of the donor being dead. It's just taking from them something that they no longer have any use for, and giving it to someone who has a very dire need.

      If you have the ability to save the life of one person, possibly more, and you refuse to do so for no other reason than sentimental attachment or superstition, then you bear responsibility for the consequences of this inaction. So I am entirely wiling to see any number of corpses mangled in order to benefit those still alive. At the end of the day, they are just bags of spare parts.

      • You can't call organs a fee when they have zero value to the donor, on account of the donor being dead. It's just taking from them something that they no longer have any use for, and giving it to someone who has a very dire need and has the money to pay for it.

        I unticked the "donor" box on my DL renewal a long time ago after I realized that organs only go to wealthy people.

  • Not harvesting (Score:3, Insightful)

    by netean ( 549800 ) <email.iainalexander@com> on Monday January 02, 2017 @07:58PM (#53594627) Homepage

    Any discussion about this topic should NOT talk about organ "Harvesting". It is NOT harvesting, it's recycling and reusing something that you no longer have any need of.

  • by asifyoucare ( 302582 ) on Monday January 02, 2017 @08:09PM (#53594661)
    They'll have to prise my Wurlitzer from my cold dead fingers. Oh wait ...
  • by WaffleMonster ( 969671 ) on Monday January 02, 2017 @08:29PM (#53594739)

    I'll happily become an organ donor as soon as there is process in place to deny hospitals any and all financial incentive arising from harvesting organs. Until then call me a conspiracy theorist until your blue in the face betting against human nature or thinking doctors are goddamn saints having your best interests at heart.

    Look at all the people addicted to prescription drugs in recent history. What changed? Who the heck do you think keeps prescribing all of this shit? Receptionists? Why are all the pharma sales reps always young chicks that just happen to be as hot as hell? How is this even an industry let alone a multi-billion dollar one to begin with? How does this serve the best interests of the patient? Numerous studies indicating widespread instances hospitals pressuring doctors to be profitable by forcing them to cut corners to cover for unsafe staffing levels to ordering tests or procedures they believe to be unnecessary or redundant to profit based discharge and admitting criteria. You would be hard pressed to find a hospital anywhere in the US where those involved in providing care would not admit to being forced to act in ways that go against their training to accommodate pressures of their job. Ask anyone you know who works in the field. A doctor a nurse...anyone and see what the they tell you or just lookup the stats showing 100k hospital deaths/year due to preventable errors. Hospitals are not run as bastions of humanity helping others they are businesses looking for profit the same as any other commercial enterprise.

    I deal with enough assholes in my own family who openly root for death of relatives so they can cash in on inheritance. People are inherently scum. The only way to keep them in line is not to incentivize them to do scummy things. Organ donation is too big a carrot... one that can easily be addressed by structures to prevent people from devolving into scum.

    I don't know of anyone who refuses to donate because they care what happens to their organs or some religious/philosophical bullshit... everyone I've spoken to refuse because they are human and they know enough about human behavior to fear being looked at as a profit center rather than a patient... You can strongly disagree and say I'm and everyone who thinks like me is full of shit...but you'll never change my mind nor will you be able to explain why structurally such a conflict of interest even needs to exist in the first place. If it is really about helping people this should be a no-brainer and everyone should be on board with structurally doing what is necessary to make it a reality. The little that does exist such as NOTA has effectively been bypassed/ignored with impunity.

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