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Mandatory organ donation

by Ted Rall

Last week America’s news media obsessed over the shooting deaths of 12 people in Washington. The usual arguments over gun control seem irrelevant since there isn’t much that could have been done to prevent those particular killings. It was a navy base.

Even in England, members of the military have access to automatic weapons. And even if we were inclined to start locking people up for hearing voices or feeling strange vibrations, we can’t build enough mental asylums to hold all of them.

On the other hand, it is estimated that 18 people die every day due to a national shortage of organ donations. This crisis can be solved.

Don’t worry: This is not one of those pieces calling for you to consider signing the donor section on the back of your driver’s license. My solution is more radical: When you die, the government should take your organs.

The transplant shortage is acute. Some patients are so desperate that they travel on ethically dubious “medical tourism” junkets to China, which implants organs from executed prisoners.

Others accept D-grade organs. Patients at the University of Maryland recently accepted kidneys that had recently been operated upon for benign or malignant tumors. Better bad kidneys than none at all.

The waiting list system is widely viewed as arbitrary and unfair. In June 2013 a federal judge made news by issuing an order suspending rules that effectively blocked children under the age of 12 from receiving organs from adult donors. Several children who might have died without the procedure benefited.

Unfortunately the court’s ruling probably killed a similar number of adult patients. Like cash, life is a zero-sum game.

It is widely believed that celebrities and wealthy people, most notably Billy Martin in 1995 and Steve Jobs in 2009, are able to cut the line, moving themselves up the waiting list. Technically this isn’t true. But practically it is. A major factor determining whether you will receive a new organ is whether you can afford the $500,000-plus cost of the procedure and its maintenance, or whether your insurance coverage is sufficiently expensive to cover it.

Rich people can pay, poor people can’t. “There’s a huge triage involved in getting in,” Arthur Caplan, chair of the department of medical ethics at the University of Pennsylvania, told CNN. “If you’re a homeless alcoholic sleeping on the streets of L.A., and you’re going toe to toe with Steve Jobs, you’re going to lose.”

Where resources are scarce, politics get ugly. In 2012 the University of California at San Francisco kidney exchange was accused of denying a kidney to a man because of his status as an undocumented immigrant. A petition campaign changed U.C. officials’ minds.

This being America and anything more progressive than the collected works of Ronald Reagan being off the table, the mainstream media turns to free-market solutions: paying prospective donors, either while they are alive or after they die, for their kidneys, livers and other body parts that could be used to enhance or save someone’s life.

In 2010, The Wall Street Journal published an essay urging that we adopt Iran’s approach, which guarantees a year of health care and a cash payment to donors.

A June 2013 Slate piece by Sally Satel, “How to Fix the Organ Transplant Shortage,” called for “providing in-kind rewards — such as a down payment on a house, a contribution to a retirement fund, or lifetime health insurance” to donors.

These merchantilist suggestions have gotten traction. A 2012 poll found that 55 percent of Americans now believe that selling your organs ought to be legal.

Maybe they’re right. But it’s easy to imagine how the commodification of body parts could corrupt an already flawed system. Do we want to live in a nation where the jobless resort to auctioning off pieces of themselves?

There’s not much we can do to reduce demand for organs. So let’s focus on the supply side of the equation.

Efforts to guilt Americans into donating voluntarily are failing those 18 Americans a day. But not every healthy person who refuses to sign a donor card is heartless. I know because I’m one of them. I refuse to endorse a system that rewards the rich at the expense of the poor. If the system were more transparent, and treated everyone equally, there’d be more donors. But the system being what it is, that won’t happen.

Which brings us to the government’s role. I don’t understand why organ donation isn’t mandatory. Why isn’t every corpse harvested for all of its usable organs?

It isn’t a property rights issue. You don’t own your corpse. Neither does your family. If it did, they could leave your body to rot in the backyard. Laws dictate how to properly dispose of a dead person.

There have been baby steps toward mandatory donation. In 2010 a New York assemblyman introduced a “presumed consent” bill that would have automatically enrolled all New Yorkers as organ donors unless they opted out (analogous to the federal “do not call” list for people who don’t want to get telephone solicitations). Two dozen other nations have similar laws. The bill failed.

If the government can save 18 people a day by harvesting every available organ, why doesn’t it pass a law making it so?

The blogger Stewart Lindsey expresses the most passionate, coherent and logical argument I can find against mandatory organ donation: “If I OPT to donate my liver, kidneys, heart or any other worthwhile organ at the time of my death, I will make that decision known. Don’t we have enough intrusion from the government into our personal lives already?

“If they can dictate whether or not you should be an organ donor, how much longer before they will be making the choices of where you can live, where you can work, go to church or school, who you can marry, what stores you can shop in and ultimately, how long should you be allowed to live, before your organs are no longer a viable option for harvesting!”

As a student of history, I am sympathetic to slippery slope arguments. And as I wrote above, I despise the way that the current health care system prioritizes wealthy Americans over the less fortunate. But when you boil it down, Lindsey’s argument is purely emotional. It’s my liver, and you can pry it out of my cold, dead carcass … or not.

Whether your body is harvested for organs, eaten by cannibals or minced to fertilize topsoil, you will never know the difference. Anyway, no major American religion teaches that what happens to your corpse affects your destiny in the hereafter.

Between our smart phones and amazing technology that allows our government to spy on our every digital moment, citizens of the United States of America feel that they live in an incredibly modern society. But not in our hearts, not in our souls, and certainly not in our brains.

About 2.5 million Americans die every year. Most are burned or planted in the ground, completely wasted. Vast numbers of them rot away, their bodies containing potentially lifesaving organs, left intact — or embalmed — for only one reason: Politicians are too cowardly to challenge the ancient idea that there is something sacred in a hunk of flesh.

Ted Rall’s website is tedrall.com. Go there to join the Ted Rall Subscription Service and receive all of Ted’s cartoons and columns by e-mail. © 2013 Ted Rall

  • Jaycasey

    Organ donation is clearly a voluntary matter. It should be actively promoted – but never mandatory.

    • Archie

      It wouldn’t be donation unless it was voluntary. It would be organ harvesting, or something, right?

    • Willahelm Christóforos Baillif

      In an ideal world it would be a voluntary matter. But people are dying from lack of donations; it is not an ideal world.

      An alternative is what Wales has done: you opt ‘out’ of organ donation, rather than opt ‘in’.

    • James

      The author is not promoting “mandatory” donation, but “presumed consent.”
      Some relevant facts:
      1. In our country today, this decision is not made by the state, NOR is it made by the deceased. State law in nearly every US state dictates that the next of kin gets to make the decision about donation. Fully 50% of the time, a person who intended to donate their organs after death does not get to because their family decides “it’s just too much to decide right now.” With presumed consent, the next of kin would be responsible for opting out of donation, rather than opting in. That is a totally different decision to ask of a grieving person, and one that is more likely to lead to a decision that complies with the deceased’s original intent.
      2. Viable organs often aren’t harvested because the ICU doctor who cares for a patient at the time they are declared “brain dead” (note: only those who die of brain death, approximately 1% of the population, not those who die of cardiac death, the other 99%, may donate) neglects to call the local organ procurement organization (OPO), which is the entity responsible for delivering critical information to the United Network for Organ Sharing (UNOS), which identifies the first person on the list to receive any organs. If that call isn’t made, then the organ isn’t harvested, no matter the donor’s intent. With presumed consent, all hospitals would be forced to institute a policy of calling the OPO after every brain death.
      3. With a population approaching 320 million, average age span of 80, and assuming 1% die of brain death, then 110 people die every day who could be donors. You could set the “presumed consent” laws such that it is very, very easy to opt out, and still you could save the lives of all 18 people who would have otherwise died that day for lack of an organ transplant.
      In summary, a “presumed consent” law would not deny anyone their freedom. On the contrary, it would ask people to affirmatively assert their decision regarding the use of their bodies after death. A good presumed consent law would comply precisely with those instructions. Unfortunately, our current “opt in” laws allow for far too many mistakes and mishandled decisions, such that most potential donors are denied the opportunity to exercise their individual liberty.

      • Dan Li

        Which is odd, since he seems to be forwarding the suggestion of mandatory over presumed consent. He refers to the fact that nobody owns their own corpse, and that he suggests it be “mandatory” to donate.

    • carolyn gallaher

      The problem is Ted, that you are not dead when
      the organs are harvested. Organs can only be retrieved from a patient that is
      being kept alive by life support until all the organs are brutally cut out.
      Yes, I for one want to die naturally, not brutally as legal modern day human
      sacrifice like the Mayan Priest did. Yes I am sure that they were stupidly
      convinced as you are, that we need to sacrifice another human so that we can
      appease the sun god to let us live a little longer on this earth. To kill
      someone so that you can live a little longer on this earth is the most selfish
      act on this earth. To lie and deceive people, telling them that their loved is
      brain dead when they have known since the first operation that the patient was
      not dead, but a live. Because only a live person can change his heart rate.
      Only a live person can perspire. Only alive person can move their limbs. Only
      a live person can tightened their tummy. This is why the onlookers have to be
      consoled that the person was really dead, and that they did not in fact just
      kill a person. A person like Zach Dunlap who was literally minutes from being
      dissected alive, but is now alive, almost 100 per cent, and is very happy. Good
      is not good when the benefactor is evil.

      To kill someone so you can have their organs, so
      your private company can prosper is evil. To kill someone for their organs so
      you can live a little longer is evil. To kill the young and innocent is evil so
      that the senior citizens can have a little longer life on this earth is
      evil.

      Sincerely yours,

      Carolyn

  • CHEMST

    I guess what matters here is our relationship to the State. If we are but its slaves it may take our parts when we pass for the better good. If we are a free people with a a government with limited power then we should be free to choose what will happen to our bodies after we die. Many have religious beliefs that would be annihilated with the author’s plan but then again, the better good, as judged by the State, should override our religious rights in the eyes of the Progressive Totalitarians of our day.

  • j011254

    A civilization is known for how it treats its dead. If you want mandatory organ donation implemented, what you are saying is the individual no longer matters and therefore can be disposed of at the will and whim of some government bureaucrat. At the prime age for donation? Don’t have any diseases? Good, its time to dispose of you so we can get your organs. You object? So what, we’re the government and we’re not here to help. And by the way, its false to conflate a “do not call” list with a “mandatory organ donor” list. Under the one, you prevent calls wanting you to buy something. Under the other, your dying and we are going to rob you of the things that make up you. Not the same thing at all. Your argument would be more powerful if you had voluntarily donated your organs despite the flawed system.

    • Willahelm Christóforos Baillif

      “Your argument would be more powerful if you had voluntarily donated your organs despite the flawed system.”

      I have volunteered my organs, and I make the same argument he does. Is it more powerful now?

  • aed939

    A small refundable tax credit would be reasonable.

  • Joe Jenson

    There is no legal ownership of a dead body possible, since it is not considered to be property. This implies that the state has no right use the body for organ harvesting, the exception being voluntary donation. I’m going to wager that getting this basic principal of law changed to “save 18 people a day” is going to be a political non-starter.

  • haroldheck

    so long as nobody makes a profit from my organs, then i don’t see why not. however, since somebody–somewhere–is making hundreds of thousands of dollars from my death, then my wife should be able to “sell” my organs for a price. take ALL profit out of medicine and organ transplants, or give the grieving families a “cut.”

  • Afshin Nejat

    It turns out that what is “yours” when you are alive has value even after you die. That value cannot be ignored while alive because it turns out it is the SAME value when you are alive as when you are dead. The difference is that when you are alive people are supposed to respect your right to what is yours. Why does it matter after you die? BECAUSE: When you are alive, the only thing that keeps people from owning things of yours merely because you died is that your WILL when you are alive matters, EVEN INTO DEATH. That matters BECAUSE: If in death my will in life no longer matters, then it becomes a rather unfortunate “solution” to the problem for others who want to get at what is mine to simply CHANGE THAT LITTLE DETAIL.

    There are far too many people, as you say, who might WANT WHAT IS MINE, in the case of great wealth, for me to want simply being dead all the permission they may need to get at that wealth. There are too damned many people with TOO GREAT A LOVE OF WHAT IS NOT THEIRS, who would be motivated to pay whatever the cost to “facilitate” the expeditious re-appropriation of some of one’s belongings by speeding up one’s DEATH. That is why RICH PEOPLE have such intricate wills many times, and their WILL is often all that stands between predatorial others and their wealth, because often there are clauses of many sorts to prevent anyone getting a value from hastening or in any way increasing the chances of an early death, to say nothing of trying to get away with murder.

    NOW, when it comes to ORGANS, these are very specialized possessions, and if nothing else ones most personal physical possessions, and are a component of the greatest asset of all according to the popular folklore: ONE’s HEALTH. There is absolutely NO REASON that a person’s WILL in life should not be followed to the letter IN DEATH for other forms of property, to say nothing of this most intimate and personal form. Now when it comes to how much OTHERS need the property of a person, that is simply NOT the problem of that person, and their NEED has NO MERIT. Only the will of the owner in life, including their wishes as to the disposition of their possessions IN DEATH.

    It is easy to see that many other possessions of people can be desperately needed by someone out there, such as cash, cars, clothing, houses, etc etc. Why not extend this generosity with things that don’t belong to you to these others items then? Why not make dispossession of all things mandatory? Because someone’s body needs an organ and the right organ is so rare and this person is so poor? Then why don’t you face the lager issue, such as how much human wealth is tied up into falsified economic systems which are really just forms of slavery in order to WASTE TIME ON PURPOSE because the technology exists to remove most of these “jobs” and to give each person a piece of land, a homestead, all tools and items needed for self-sufficiency, and nearly PERFECT HEALTH, but all industries in existence today are backwards and detrimental ON PURPOSE to turn man into a wretched animal that must snarl and beg and steal in order to exist without being in total suffering? Why not face THIS issue instead of rearing your moron head and suggesting FURTHER indignities on an already wretched lot.

    IDIOT.

  • Maj. William Martin

    To even consider this is morally wrong. let alone ones having to take anti-rejection drugs For Life. To do what? Extend your life a few more years and saddle your family with debt?

    This is why its important to take care of ones health.
    Perhaps the US could have harvested organs from the 10,000,000 people this military and proxy dictators has killed since the Korean war?

  • csmagor

    It should be in by default or opt out. In 20 years we probably won’t need donated organs, but until then we do.

    Also, Jaycasey and jo11254 – seriously? While donor availability is improving just about everywhere else, here in Japan there is a severe shortage of donors – people die every day as a result.

    People want to take all of their working parts with them when their meat goes off to be incinerated.

    Compulsory is a little harsh, but opt-out is cool – it gives the ignorant and small-minded an escape hatch… just so long as they aren’t too lazy to tick “no.”

  • Me Piper

    The weak point for me is Rall’s assertion that “It isn’t a property rights issue. You don’t own your corpse.” On the contrary, that’s exactly the point. We DO own our own bodies, in life and in death. My claim to ownership of my body, dead and alive, trumps anyone’s claims on me. I do not consider death disqualifying because I do not equate the expiration of life with the expiration of human rights and the due process of law. Wills recognize that principle, and I think we can expand on it. Since the dead cannot defend themselves it is fitting for the law to do it for them and recognize ownership rights. One’s body is part of one’s physical postmortem estate. In many ways the living will benefit from the precedent of the conservation of government’s reach into private life.

    The claim that nothing matters to individuals after death and so what’s the difference anyway? misses the point. It does matter to thoughtful souls.

    It sounds silly, as well as selfish and callous towards those who die every day desperate for an organ transplant. What of their suffering? Sorry, but everyone
    dies. Get used to it. I am the very definition of compassion, but our allotment of time is an immutable act of God. People now are so intoxicated with their own egotism that they can’t sanction the idea of dying without advantage, disappearing into the smoke after a display of great noise and fire. Suddenly the decision to donate organs appears to harbor a bit of selfishness in the guise of altruism.

  • Andy Sutton

    Is this guy serious?? Mandatory donation will do little more than introduce a raft of diseases into transplanted patients. There is a rather complicated screening system in place for ‘voluntary’ donors and it works quite well. I supervised such an operation for a time back in the 1990s. The writer needs to face up to the fact that sometimes life isn’t fair and people live and people die. The cost side of the equation is a big issue though and we’ve done NOTHING to fix that. His number of $500K is probably well on the low side. A liver transplant in 1995 cost about that much.

  • John

    You are wrong. The state has no right to anybody’s organs when he/she dies. The worms, or vultures, or the fire can eat them because that is their right by nature. If others wish to give their organs so be it. American society should learn to give first before demanding a person’s body parts in death. If you don’t, you will be like others who sell them, and how Jesus will judge that, and he one day will, I think, will be negative indeed, and in the extreme.

  • Jon Ripley

    Haven’t you ever seen the horror movie “Coma”. The potential for misuse is so great that it boggle the mind.

  • adaminoregon

    Sorry nope. I’m taking it all with me when I go. Everyone dies. There is no getting around it. Sorry you drank yourself to death, or smoked until you died. Of course there are some that need organs due to accidents, but guess what, there are too many people here. I will refuse to get anyone else’s parts in me as well.

  • Italics Mine

    This is just an extension of the same philosophy that claims every one and every thing belongs to government.
    And contingent with the usual custom, the big shots will be exempt from having their precious cadaver mutilated because they’re too important to be so disrespected.

  • Ishihara Hideaki

    I oppose the very idea of organ transplant itself because it is unethical. Making it obligatory is out of the question.

    Think cool-headedly of its future ramifications. Should it take hold and spread, possibly we would eventually
    always have in our society millions of people, including patients themselves who need transplant and those who love them, “wishing for someone’s death”. Imagine any society where millions of people are wishing for someone’s
    death while not even hating them. It is just not human.

    Some may object that just waiting and seeing when someone is suffering and dying is more inhuman, but just a couple
    of decades ago, when the convenient concept of brain death combined with the technology of organ transplant was not available, people humbly accepted their fate. Are those millenniums before the current snake-oil technology to be called inhuman?

  • abinico

    This is one of the most disgusting concepts one could think of – what is really disgusting is that organ transplants are virtually never needed and alternatives are available. This is the allopathic medical industry at its worse.

  • carolyn gallaher

    The problem is Ted, that you are not dead when
    the organs are harvested. Organs can only be retrieved from a patient that is
    being kept alive by life support until all the organs are brutally cut out.
    Yes, I for one want to die naturally, not brutally as legal modern day human
    sacrifice like the Mayan Priest did. Yes I am sure that they were stupidly
    convinced as you are, that we need to sacrifice another human so that we can
    appease the sun god to let us live a little longer on this earth. To kill
    someone so that you can live a little longer on this earth is the most selfish
    act on this earth. To lie and deceive people, telling them that their loved is
    brain dead when they have known since the first operation that the patient was
    not dead, but a live. Because only a live person can change his heart rate.
    Only a live person can perspire. Only alive person can move their limbs. Only
    a live person can tightened their tummy. This is why the onlookers have to be
    consoled that the person was really dead, and that they did not in fact just
    kill a person. A person like Zach Dunlap who was literally minutes from being
    dissected alive, but is now alive, almost 100 per cent, and is very happy. Good
    is not good when the benefactor is evil.

    To kill someone so you can have their organs, so
    your private company can prosper is evil. To kill someone for their organs so
    you can live a little longer is evil. To kill the young and innocent is evil so
    that the senior citizens can have a little longer life on this earth is
    evil.
    Sucker, your are not dead when the organs are brutally cut out of you.
    Hey stupid, I know first hand what organ donation is all about. My daughter was given up on within two hours, while she was breathing, coughing, alive. She lived for six days, she is recorded on medical report to be feeling pain, withdrawing, contracting, breathing and coughing. The medical team did nothing, they stood by and watch my daughter starve, suffer in pain, she only died because her blood volume was below critical levels for six days that eventually caused cardiac arrest. Don’t you ever insult my intelligence by telling me that the medical community will do all they can for the brain injured, because if they did, they would all be alive today.

    Sincerely yours,

    Carolyn