Opt-In vs Opt-Out for Donors

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**whembly**

http://awesome.good.is/transparency/web/1205/the-impatient-list/flash.html
I light of me ruffling some feathers recently... I'd thought I post something dear to me.

I'm a kidney donor to a non-biological recipient who had renal failure in her early twenties. Now, she's doing great... got married, had kidz, you know...life.

Are you familiar with the Opt-In vs Opt-Out for Donors?

In US: you have to Opt-In to be placed on a donor's list, such as the back of your driver's license, living will, etc.

In Europe(?): you have to Opt-Out of the donor's list.

Questions for Dakkanuts:
1) Would you be okay with changing this to "Opt-Out" (if currently Opt-In)?

2) How do you feel about incentive programs to donate, such as:
a) some or all govt school loans absolved
b) tax rebate
c) if incarcerated for non-violent crime, reduce sentance (or maybe include violent offenders... who knows?)
d) free WarHammer box every year

e) what about selling your organ to the highest bidder (needs a process in place so that the poor aren't taken advantage)

3) If anyone has questions about my experience, please ask... but, be forewarned, it may be in the TMI category

.

**d-usa**

I think opt-out would be great. Way to many people die each year while waiting on transplants, and way to many viable donor organs end up pumped full of chemicals in a concrete vault.

I don't like any of the incentives though mainly because it seems like it has too much potential to be abused.

Non-violent criminals can get a reduced sentence? Why make pot legal then, it would reduce your potential donor pool!

Tax rebates? I can already hear the cries of "Obama is raising taxes so his Organ donor panels can take our kidneys!".

The idea of incentives just gives me feelings of a poor lower class donating their organs to a privileged upper class, to be honest with you.

But opt-out would be a good thing for me. My advanced directives make it clear I am a donor, my license is checked, and I am registered with the organ donation folks (which means that I already gave written consent to donation).

**whembly**

d-usa wrote:
I think opt-out would be great. Way to many people die each year while waiting on transplants, and way to many viable donor organs end up pumped full of chemicals in a concrete vault.

Right on!

I don't like any of the incentives though mainly because it seems like it has too much potential to be abused.

Fair enough... it's a subject that the transplant folks always struggle with.

Non-violent criminals can get a reduced sentence? Why make pot legal then, it would reduce your potential donor pool!

FWIW, I'd make it legal and regulate it like a vice (ala alchohol). But, yeah... I'd entertain this idea as the donor would "pay his/her debt to society" for the crime. I just wouldn't know how to administer this reduction.

Tax rebates? I can already hear the cries of "Obama is raising taxes so his Organ donor panels can take our kidneys!".

Okay... that's hilarious.

The idea of incentives just gives me feelings of a poor lower class donating their organs to a privileged upper class, to be honest with you.

Yeah, I definately understand. But, most living donors don't have the incentive (nor could take off work) to do this. Maybe expand the same Act that gave Moms recovery time after deliver her child? Moms get 3 months... I don't see it a stretch to include organ donations for that.

But opt-out would be a good thing for me. My advanced directives make it clear I am a donor, my license is checked, and I am registered with the organ donation folks (which means that I already gave written consent to donation).

Awesome dude... Opt-out I think would definately be the way to go.

**Ensis Ferrae**

whembly wrote:

Yeah, I definately understand. But, most living donors don't have the incentive (nor could take off work) to do this. Maybe expand the same Act that gave Moms recovery time after deliver her child? Moms get 3 months... I don't see it a stretch to include organ donations for that.

In what area of the US do mom's get three months off after giving birth??? Seriously. My wife, who is also in the military with me gets 6 weeks, plus a post-partem "profile" (for those who know, know what that is), and this is according to my sister-in-law (an ER nurse near the west coast) thinks that that is absolutely epic, as she got 4 weeks paid, plus she used her two weeks unpaid leave.

**Melissia**

I'm fine with opt out, myself. If your religion thinks you shouldn't donate for some reason, opt-out.

**whembly**

Ensis Ferrae wrote:
whembly wrote:

Yeah, I definately understand. But, most living donors don't have the incentive (nor could take off work) to do this. Maybe expand the same Act that gave Moms recovery time after deliver her child? Moms get 3 months... I don't see it a stretch to include organ donations for that.

In what area of the US do mom's get three months off after giving birth??? Seriously. My wife, who is also in the military with me gets 6 weeks, plus a post-partem "profile" (for those who know, know what that is), and this is according to my sister-in-law (an ER nurse near the west coast) thinks that that is absolutely epic, as she got 4 weeks paid, plus she used her two weeks unpaid leave.

http://www.dol.gov/whd/fmla/
The FMLA act. Your job is guaranteed for 3 months after a birth. It being "paid" is determined by your workplace/state.

**d-usa**

You are allowed 3 months off from work, but your job doesn't have to pay you for it. If you have vacation or sick leave you are covered, but other than that it depends on you being able to afford not to work for 3 months.

Automatically Appended Next Post:
@Whembly: What if the ACA made it mandatory for insurance companies to cover 100% of organ donation surgeries?

**sebster**

I know a lot of people who would be happy to have their organs used for any old purpose when they die, but who never get around to stating that properly. On the other hand, I don't know of a single person who has a strong belief about preserving their organs who wouldn't immediately sign a form to opt out. So I'm pretty strongly for opt out systems.

But I don't like the idea of giving incentives to give up organs. That just seems fraught with trouble.

**whembly**

d-usa wrote:
You are allowed 3 months off from work, but your job doesn't have to pay you for it. If you have vacation or sick leave you are covered, but other than that it depends on you being able to afford not to work for 3 months.

Automatically Appended Next Post:
@Whembly: What if the ACA made it mandatory for insurance companies to cover 100% of organ donation surgeries?

Um... then I'd shut up.
:ducks and runs:

**Lynata**

d-usa wrote:The idea of incentives just gives me feelings of a poor lower class donating their organs to a privileged upper class, to be honest with you.

Even if you don't get anything out of it, there's a history of rich people just paying a sum to corrupt doctors to get a higher place on the priority list. I think stuff like that just comes with the current model of economics and, like any sort of corruption, is pretty much impossible to eliminate entirely.

So, why no incentives? I'm not sure what sort of fraud or abuse this is supposed to favour when it's your body and you make the decision if you want to donate or not. If you're talking about the docs stealing your organs, or even letting you die just so they can harvest you (it happened), this has absolutely nothing to do with incentives for the donor.

That being said, I would actually support a system where only voluntary donors qualify for receiving organs as well, unless there's a surplus or someone is not allowed to donate due to a medical condition. The same could actually apply do blood donations as well, now that I think about it. With the waiting lists being as long as they are and stuff like this being in high demand, I don't see why egoists who only want to take but not give should get anything. Give and take, people!

**d-usa**

You know it would seem like organ donation would be covered anyway, but I guess since you are not "sick" when you donate then I would not be surprised if it is not covered.

I would think that maybe even the insurance company of the guy that gets the organ could cover it, but I don't know if they do. With end-stage renal disease you usually get on Medicare to pay for dialysis anyway, so there might not be a cost saving incentive for insurance companies to provide the service.

I'll have to look through my benefit package to see what my insurance covers.

**whembly**

There's a study that I simply cannot find right now...

But the gist is... its cheaper to pay for most transplants (I think bone marrow/heart is different, not sure) and the subsequent followup/meds than to pay for treating the end stage disease.

I

Automatically Appended Next Post:

Lynata wrote:
d-usa wrote:The idea of incentives just gives me feelings of a poor lower class donating their organs to a privileged upper class, to be honest with you.
Even if you don't get anything out of it, there's a history of rich people just paying a sum to corrupt doctors to get a higher place on the priority list. I think stuff like that just comes with the current model of economics and, like any sort of corruption, is pretty much impossible to eliminate entirely.

-snip-

That's the argument I hear too... if corruption is still going to exist, then why not have the incentives?

**d-usa**

Lynata wrote:
d-usa wrote:The idea of incentives just gives me feelings of a poor lower class donating their organs to a privileged upper class, to be honest with you.
Even if you don't get anything out of it, there's a history of rich people just paying a sum to corrupt doctors to get a higher place on the priority list. I think stuff like that just comes with the current model of economics and, like any sort of corruption, is pretty much impossible to eliminate entirely.

So, why no incentives? I'm not sure what sort of fraud or abuse this is supposed to favour when it's your body and you make the decision if you want to donate or not. If you're talking about the docs stealing your organs, or even letting you die just so they can harvest you (it happened), this has absolutely nothing to do with incentives for the donor.

That being said, I would actually support a system where only voluntary donors qualify for receiving organs as well, unless there's a surplus or someone is not allowed to donate due to a medical condition. The same could actually apply do blood donations as well, now that I think about it. With the waiting lists being as long as they are and stuff like this being in high demand, I don't see why egoists who only want to take but not give should get anything. Give and take, people!

I think Steve Jobs benefited from being rich if I remember right. I think he was on multible waiting lists because he had the ability to be at many hospitals within a certain time frame due to owning a private jet. This could be one of those Internet legends though.

**motyak**

sebster wrote:
I know a lot of people who would be happy to have their organs used for any old purpose when they die, but who never get around to stating that properly. On the other hand, I don't know of a single person who has a strong belief about preserving their organs who wouldn't immediately sign a form to opt out. So I'm pretty strongly for opt out systems.

I agree. Opt-out would be best.

On a side note, which do we even have here?

**d-usa**

whembly wrote:
There's a study that I simply cannot find right now...

But the gist is... its cheaper to pay for most transplants (I think bone marrow/heart is different, not sure) and the subsequent followup/meds than to pay for treating the end stage disease.

Which is why I was thinking about ESRD in particular. If that diagnosis makes you an automatic Medicare patient, then the insurance company would not have an incentive to pay for a transplant and post-op treatment.

**Mr Nobody**

Opt-out, I wonder how many cases there are of people not being donors just because they didn't bother saying yes or no.

**Goliath**

I don't know about the rest of Europe, but in the UK it is opt in, and I believe you can't do it till you're 16, much like blood donation.

**Medium of Death**

Goliath wrote:
I don't know about the rest of Europe, but in the UK it is opt in, and I believe you can't do it till you're 16, much like blood donation.

This, you get a card IIRC. I haven't done it yet, I really should but it's not something that you think about.

http://www.organdonation.nhs.uk:8001/ukt/newsroom/statements_and_stances/statements/opt_in_or_out.asp

An interesting snippit from that link.

Experience in other countries
Large disparities in organ donation rates exist throughout the world, despite the laws governing organ donation.

Some European countries with opt-out systems have higher donation rates than the UK. However there is no clear evidence that opt-out is the sole factor. The fact that Sweden has an opt-out law does not seem to influence the donation rate per million of population, which is lower than that of the UK, which does not. Within almost all countries, large local variations exist in donation rates, despite a common legislative background.

Opt-out systems can be "hard", as in Austria, where the views of close relatives are not taken into account, or "soft", as in Spain, where relatives' views are sought.

Different cultural attitudes to the disposal of bodies, greater provision of intensive care beds, more pro-active donation programmes and the numbers of road deaths, each play their part. However, the single most important factor so far identified is ensuring that the relatives of potential organ donors are always approached, and approached by someone specifically trained for the purpose, as happens in Spain.

In fact, while Spain is recognised as having a higher number of donors than the UK, it is acknowledged by the director of national transplant organisation in Spain himself that the increase in organ donation during the 1990s could not be attributed to a change in legislation which had remained the same since 1979. The improvements in donor rates in Spain followed the implementation of a comprehensive national procurement system.

**Happygrunt**

I would be hesitant to have a cash incentive for organs, as I see that leading to increased crime of the organ-stealing variation.

**Howard A Treesong**

I think it should be opt-out and there's no need for incentives, just change the law please. Many people seem not to care either way, if it's opt-in they never got out of their way to get on the list, if it was opt-out they wouldn't bother to be removed. But with opt-out, there would be more opportunities for people on the donor list.

If you feel that bad about giving someone else a chance at life from your organs then you can opt out. I really don't see why people would opt out, it seems like a final act of selfishness. Is it really so important that your organs are buried or incinerated with you?

I also don't think your relatives should be allowed to prevent your organs being taken, that seems to clearly dismiss the wishes of the deceased donor.

**d-usa**

Howard A Treesong wrote:
I think it should be opt-out and there's no need for incentives, just change the law please. Many people seem not to care either way, if it's opt-in they never got out of their way to get on the list, if it was opt-out they wouldn't bother to be removed. But with opt-out, there would be more opportunities for people on the donor list.

If you feel that bad about giving someone else a chance at life from your organs then you can opt out. I really don't see why people would opt out, it seems like a final act of selfishness. Is it really so important that your organs are buried or incinerated with you?

I also don't think your relatives should be allowed to prevent your organs being taken, that seems to clearly dismiss the wishes of the deceased donor.

There are always the religious reasons, which would be covered by the option to op-out.

I don't know about the UK, but in the US there are still sizable segments of the population that just don't trust hospitals and who think that being an organ donor means the doctors won't try as hard to save your life and just say "he's a goner, cut him up and take his stuff".

**Goliath**

Medium of Death wrote:
Goliath wrote:
I don't know about the rest of Europe, but in the UK it is opt in, and I believe you can't do it till you're 16, much like blood donation.

This, you get a card IIRC. I haven't done it yet, I really should but it's not something that you think about.

I did it as part of getting my provisional driving license.

**Melissia**

There's still people who think that that scene from Monty Python's The Meaning of Life is accurate.

**AlmightyWalrus**

Goliath wrote:
I don't know about the rest of Europe, but in the UK it is opt in, and I believe you can't do it till you're 16, much like blood donation.

Same in Sweden, except as far as I understand you can opt in anytime you feel like it.

(I'd urge everyone to opt in BTW, it saves lives!)

**Palindrome**

1. Opt out is a greta idea which would significantly increase the number of available donors thereby saving lots of lives.

2. Incentives are a bad idea.

Automatically Appended Next Post:

Ensis Ferrae wrote:

In what area of the US do mom's get three months off after giving birth??? Seriously. My wife, who is also in the military with me gets 6 weeks, plus a post-partem "profile" (for those who know, know what that is), and this is according to my sister-in-law (an ER nurse near the west coast) thinks that that is absolutely epic, as she got 4 weeks paid, plus she used her two weeks unpaid leave.

She is in the wrong army. She would get 6 months in the British army and a further 6 months at half pay if she so chose.

**streamdragon**

Opt-in.

Before I explain let me be clear that I am an organ donor and have been since I got my driver's license. I used to donate blood every 56 like clockwork, until the madcow outbreak when they disallowed anyone who lived in the UK past 1980 from donating. I think everyone should do both, donating blood as often as possible.

That said, I still think it should be Opt-In instead of opt-out. The simple fact is that my body is just that: mine. Being born did not give the US or state government any claim to my corpse or to my pieces. This is not something that is really part of their purvue nor should I be required to opt out to basically lay claim to my body. I chose to opt-in and give them that claim; it should not be automatic.

As to incentives, I admit a little hesitation at the idea. I absolutely think it should be put out there as an option and really should be a more championed cause. As it is, the most you see really is a yes/no box on your driver's license form. It would also cause issues re: those who are unable to donate, to offer incentives to those who can.

As I said though, I am an organ donor and strongly encourage everyone to be one also. One of these days when I have some time I want to get on the bone marrow registry as a donor, though I admit the process does make me cringe and hesitate a bit. Still with the many lives I know that cancer has touched, it is simply time to put on the big boy pants...

**Palindrome**

streamdragon wrote:

That said, I still think it should be Opt-In instead of opt-out. The simple fact is that my body is just that: mine. Being born did not give the US or state government any claim to my corpse or to my pieces.

Its not the 'state' its your fellow citizens. Various parts of my dad went into 8 different people, massively increasing their quality of life/longevity and he certainly had no use for them anymore. I have been an organ donor for years and I am more than happy to be used for spare parts.

**Lordhat**

Palindrome wrote:
streamdragon wrote:

That said, I still think it should be Opt-In instead of opt-out. The simple fact is that my body is just that: mine. Being born did not give the US or state government any claim to my corpse or to my pieces.

Its not the 'state' its your fellow citizens. Various parts of my dad went into 8 different people, massively increasing their quality of life/longevity and he certainly had no use for them anymore. I have been an organ donor for years and I am more than happy to be used for spare parts.

The point is still the same, and one with which I agree. Opt-in.

**Palindrome**

Lordhat wrote:

The point is still the same, and one with which I agree. Opt-in.

How is it the same? If you don't want to be a donor, opt out. Its as simple as that.

**streamdragon**

Palindrome wrote:
streamdragon wrote:

That said, I still think it should be Opt-In instead of opt-out. The simple fact is that my body is just that: mine. Being born did not give the US or state government any claim to my corpse or to my pieces.

Its not the 'state' its your fellow citizens. Various parts of my dad went into 8 different people, massively increasing their quality of life/longevity and he certainly had no use for them anymore. I have been an organ donor for years and I am more than happy to be used for spare parts.

My fellow citizens have no more claim to my body than the state does. I do not exist to serve them, in life or death.

Again, I am an organ donor. I think eveeyone should choose to be an organ donor. But it remains that:mine a choice.