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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.

    • 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.

  • 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.

  • 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?