A Fresh Debate?

The BMA wants a fresh debate on organ donation.

Society should have a fresh debate on organ donation, says a new report by the British Medical Association.

The number of organ donations has increased sharply in recent years but still lags a long way behind the number of people waiting for a transplant.

My response to which, is; so what? This is likely to always be the case. For someone to have an organ, another needs to die. Clearly, they are not doing so in convenient numbers in a manner that makes harvesting a viable proposition. Perhaps more of us should pop our clogs…

The BMA says new types of donors may need to be considered, like brain dead patients kept alive on ventilators.

This seems reasonable at first glance. Providing, of course, those brain dead people made their wishes known before they became brain dead –  or, in the absence of that, the consent of their next of kin is sought and obtained. The crucial matter here is informed consent.

Of course, this being the BMA, informed consent is not what they are after:

And it calls for an opt-out donation system, where people are presumed to have agreed to donate their organs.

Indeed. This has the aroma of asking the same question over and over until, weary of the constant hectoring, we finally give up and provide the “right” answer.

Yet, presumed consent –  which is no consent at all –  does not necessarily mean more organs being available as people still have to die and they still have to do it in a manner that means harvesting is viable and not all countries that have it have radically increased donation rates.

The interesting thing here is that donation rates have increased anyway, without instigating an opt-out system. So what’s the problem?

But that will still be some way off the target of 50% by 2013 set by the Organ Donation Taskforce.

The answer to this is not to set targets. Targets tend to have unfortunate side effects whether it is GPs twisting their booking systems to meet them or as I saw in my own industry, death by audit of people who didn’t need auditing but were convenient to hit those all important targets. This added no value to the system whatsoever. All too frequently targets don’t. So, don’t have a target for organ donation. Treat it as what it is; a gift freely given and be grateful for it. However many or few you get.

The BMA points out that, even if that figure were to be achieved, people on transplant waiting lists would still be dying because of a shortage of donated organs.

Dr Vivienne Nathanson, one of the authors of the report, says as a society we need to decide if this is a situation that we will tolerate or whether we should look at new methods of encouraging donation.

Yes, we should tolerate it. The existence of transplant surgery does not provide a requirement to carry it out. It is not an automatic right to life. And given that the alternative is the state making decisions on our behalf, the current arrangement is preferable.

“There could also be legislative options like the possibility to electively ventilate someone – not to benefit their own health but to make them a better donor.”

That has to be one of the most sinister statements I’ve read in a long time. It is one that sends a chill down my spine and gives us an insight into the darkness at the heart of the medical profession that sees us as a collection of spare parts.

But the report says other options could include “mandated choice”, where all adults are forced decide whether they want to become an organ donor…

Fine, do that. My answer will be “no”. At the moment you will have to ask, but it is “yes”. Force me to make a choice on your terms and it will be one you would prefer not to have.

13 Comments

  1. Whenever someone calls for a “debate”, it’s a sure sign that actually a debate is the last thing they want, and in fact they want to impose their preferred solution.

    • Exactly what I was going to say.

      They’re only interested in debating how to implement what they want.

      I’ve carried a donor card for 10+ years, but if they bring in presumed consent then I’ll opt-out in a heartbeat.

  2. But there are heartening signs that not all doctors are on board with this, and some can indeed see the writing on the wall for their profession:

    …the report admits that some intensive care doctors oppose the practice, “questioning whether frustration over the falling number of DBD [donation after brain death] donors has resulted in ‘interventions that could jeopardise professional and public confidence in all forms of donation’ and arguing that such practices are ‘at the very edge of acceptability'”.

  3. “Society” is a thing, an abstract and so cannot donate organs or decide or tolerate – only people can do these things.

    As medical technology improves and the population life expectancy increases, organ transplant will become more required and viable.

    As life expectancy increases, and we find better ways of protecting ourselves from harm, the number of dead bodies available from which to harvest organs for transplant will decrease relatively.

    Taking the two together the gap between supply and demand is bound to grow – even doctors should be able to understand that, but maybe I am giving too much credit to a profession whose members, from personal experience, are not actually that bright and entirely self-absorbed.

    The solution is the steady development in stem cell research and other areas which allows organs to be grown in vitro. Perhaps this would be a more worthy area into which to sink the trillions of taxpayer and private money than the climate change scam.

  4. “There could also be legislative options like the possibility to electively ventilate someone – not to benefit their own health but to make them a better donor.”

    Christ! It’s like something out of a horror movie.

  5. What about criminals? Burglary……….suspended sentence if you donate 0ne kidney. You don’t think this could get out of hand do you? You don’t think that a crim would end up broken up for spares entirely? Well. it might happen to patients judged brain dead and kep on ventilators for organ harvesting. You don’t think that might get out of hand, do you?

  6. Apparently, the artificial ventilation of patients who had been earmarked as suitable for tissue donation was going on for several months at a hospital in the West Country, until someone pointed out that such procedures are currently illegal.

    The idea of terminally ill patients being medically treated to maximise their tissue yield, gives rise to a number of disturbing questions. Such as would that impact their end-of-life palliative care? Also I can imagine dying patients being carted off to hospital instead of being allowed to die at home in their own bed.

    Personally, I am giving the vultures no advance permission to harvest any bits of me, they will have to ask my family, and their permission would of course be contingent on ensuring that any of my loved ones in need of a transplant would get first refusal. To hell with the men in white coats and their “policies” and “protocols”.

  7. Said it before, but as someone waiting for a transplant, I agree wholeheartedly with you LR.

    As for the twaddle abour people dying on the waiting list, yep, they are but plenty of them are dying of other conditions that getting a transplant will do nothing to cure. Even where a transplant would make a difference, as you say
    they don’t have a right to life. (You know what, lots of people not on the waiting lists are also dying….)

    The other reason why there is a shortage is that it’s not a case of ‘here’s a transplant, now you’re sorted’. The most successful type of organ transplant is the kidney, and the average kidney transplant lasts…. 8 years. Yes, some are still going after 30 years, but for most patients you’re looking at multiple ops. Of course, as the technology has been around an increasingly long time, not only is there the inflow of completely new patients to cope with but the number of patients coming back for a second, third or fourth transplant is also rising, adding to the list. Personally, I’m now waiting for my third kidney transplant.

  8. +
    It is noticeable that one of the authors of this report, Dr. Vivienne Nathanson, has also spoken against tobacco and alcohol consumption. Zealots like her are infesting all aspects of our life and we will get no rest until they are put into a position where they can have no further influence on anything but their own existence.

  9. “There could also be legislative options like the possibility to electively ventilate someone – not to benefit their own health but to make them a better donor.”

    But presumably they would die of horror at the mention of “the death penalty”.

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