Saturday, September 03, 2005

Presumed consent: supply-side economics of the moribund kind

I've mentioned both the need to increase in the number of people agreeing to be organ & tissue donors and the distrust many in this country have of doctors and our system (some for valid reasons and some not) on this blog many times. Well intentioned organ donation advocates are yet again bandying about an idea that is likely to exacerbate both problems.

Presumed consent turns organ & tissue donation into a national opt-out system - it's a "do not call" list that will cause more disruption than the infuriating unsolicited calls currently exempted by regulations. The way it works: if you become eligible to donate & haven't legally registered dissent, you're a donor.
"The driving factor behind presumed consent is the fact that the waiting list continues to rise at a rapid rate," said Richard Darling, a Palm Desert dentist and three-time liver transplant recipient who is active in transplantation issues. "As we get close to 100,000 people awaiting donation, that's going to open people's eyes."
In much of Europe, physicians will refrain from harvesting when family members object. Whether that will be the case in the US if presumed consent is permitted is up in the air; one of the problems transplant teams run into is family member objections thwarting donation when the decedant-to-be's desire to donate as indicated by an organ donor card/organ donor sticker on an ID.

In addition to family member over-rides, presumed consent is likely to engender a fear that plug-pulling will occur prematurely (or next of kin will be pressured to pull the plug earlier and/or possibly intentionally provided a worse prognosis to encourage withdrawal of life support for certain classes of individuals). This increases the probability of a heightened politicalization of medicine in communities that already have a less than healthy mistrust of those working in our healthcare system that could spur more succesful drives to get people to register their dissent than organ donor drives have in recruiting consenting donors. The end result will be that those already disproportionately affected by the dearth of suitable organs (people of color) may find themselves matchless in their moment of need.

There are other avenues that should be considered in the search for organ/tissue donors
Other potential solutions include expanding the criteria under which organs are considered suitable for donation, such as organs from donors who are elderly, obese or have some illness. Organs now are usually taken from healthy, young donors who are brain dead but on life support.

Yet another option is to obtain organs from donors whose hearts have stopped but whose organs could still be healthy enough to use if removed quickly. Currently, only organs from brain-dead donors are removed to preserve the quality of the organs and increase the chances of a successful transplant.
Proponents of presumed consent point to the fact that it has been found to have a "large and positive effect on donation in other countries" (the article does not state whether the "positive effect" was purely an increase in the # of donations and therefor transplants or if the positive effect was an emotionally impactful nationwide positive experience by the donors' next of kin).

As loathe as I am to agree with anyone at the Discovery Institute (which, I'm sure, has it's own religious/anti-scientific agenda in advocating against presumed consent), the idea is more likely to backfire here as this country is significantly more heterogenous than the European nations in which presumed consent has been implemented.
"If people ever come to believe that the issue of getting the organ becomes more important than the patient and the family, I worry it will undercut what is already a pretty thin trust of the whole process," [Discovery Institute Sr. fellow Wesley J.] Smith said. "I think we're much better off continuing to educate people and taking steps to ensure that organ procurement will remain ethical.
The time to consider the various ways to give the gift of life is when the decision can be made and discussed with family/friends in a non-emergent setting (if you check the link, you'll see the multiple painless opportunities you have to be a living donor as well).

tags: ; ; ; ; ; ;

Sphere: Related Content

No comments: