New Opt Out Organ Donation System comes into effect today

I'd be more inclined to agree if this legislation change were causing the number of donors to shift by an order but it's a rather modest increase and, compared to, for example, blood product manufacture, rather small economically.

A journey of a thousand dollars starts with a single cent.

But the whole area of organ donation has for too long been held back by the inability of private capital to monetise it. Not what I believe, of course. But how it will be sold.

I'd be more inclined to agree if this legislation change were causing the number of donors to shift by an order but it's a rather modest increase and, compared to, for example, blood product manufacture, rather small economically. A tragic number of people already die each year while waiting for an organ, NHSBT are already doing most of the work tracking those individuals. My experience with recipients is limited but those I do know who have received organs took several 'turns' of being prepared for surgery only to have it called off due to factors that made the potential donor unsuitable. I don't see this as a system ripe for corporate exploitation.

Balance of probabilities, someone will have.

Can you please give one example of an existing private consultancy that does this at the moment?

Not really. Far better you read what I wrote. No use citing laws that can be changed on a whim. Or simply ignored, which appears to be the current vogue (I guess it's cheaper).

I stand by my point, and you are free to agree or not. But the whole area of organ donation has for too long been held back by the inability of private capital to monetise it. Not what I believe, of course. But how it will be sold.

Balance of probabilities, someone will have.

Can you please give one example of an existing private consultancy that does this at the moment?

www.theguardian.com/society/2009/jul/31/private-organ-transplants-face-ban

Someone, somewhere has already registered a "consultancy" to "help" the NHS deal with the deluge of donors they are going to see.

Do you have a citation for this?

Balance of probabilities, someone will have.

We crashed through the looking glass decades ago. There's no longer even a pretence that government is run for anyones benefit other than the 1% (who have recently seen a 17% uptick in their fortunes) of society that really matter.

So: totally unnecessary (albeit engineered) shift in donor legislation ? Can only mean one thing. Boris and the Big Boys (who will speak with American accents) have found a way to skim more money away from the UK taxpayer and into the deserving coffers of MegaCorp Inc.

Or did I imagine surrogacy agencies that do the same thing ?

I tend to get more cynical the hotter it gets. 25C at the moment. Wait till it gets to 30.

I still have some questions about the Carina Melchior case. She was "brain dead" and they were preparing to harvest her organs when she woke up! If that can happen once, it can happen again.

I think human death is generally determined by convention rather than specific science. And it's been a problem since whenever.

Maybe it's another area for non binary activism ?

where did this "absence if information" crock come from ?

The previous gap between those on the organ donor register and those who, when surveyed, responded positively about donating their organs in the event of their death.

ScrimpshawTheSecond, I understand your point but I'm afraid I disagree. I understand that, to someone who does not wish to donate, the idea of it potentially happening is horrifying or, at least, upsetting but, equally, I find the idea of whatever parts of me prove useful being wasted to be upsetting. I believe that the approximate number of people on the register, prior to opt out, was around 60% but the number who responded positively to surveys was close to 85%. In other words, opt in potentially failed to represent the wishes of more people than opt out would if all who didn't want to donate were entirely ignored.

Someone, somewhere has already registered a "consultancy" to "help" the NHS deal with the deluge of donors they are going to see.

Do you have a citation for this?

As those (potential) donors will (very nearly) all be dying in NHS hospitals, where there already exists an excellent information sharing system, I fail to see how an external consultancy would have a role (though it would in pluralistic systems).

Also, as there are so many people involved in ICU care (where most of these decisions are made), it would be extremely to run an illegal and unethical organ racket.

I know rogue nurses and doctors exist, but not in the numbers required to be on shift together in the right place at the right time with enough frequency to make it worthwhile

I still have some questions about the Carina Melchior case. She was "brain dead" and they were preparing to harvest her organs when she woke up! If that can happen once, it can happen again.

I don't trust the state with choices that could profit them, but need my death for that to happen. If the state own my dead body, will they withdraw anything that is keeping 'their' dead body frustratingly alive??

There's also the unfailing ability of cronyism to manage to make money out of organs, given half a chance. Just look at surrogacy.

Someone mentioned "balance of probabilities" upthread. Here's a "balance of probabilities" assertion for you. Someone, somewhere has already registered a "consultancy" to "help" the NHS deal with the deluge of donors they are going to see. You could easily get away with charging £10,000 for a heart (liver too, probably). Obviously you could never pay the estate of the deceased. That would be as immoral as paying a woman to have a baby. But there will be expense that can be invented to make sure the Right People get their snouts in the trough.

might equally be tempted not to 'waste so much time' on a selfish' individual who opted out
For me, I couldn't give a shit, I've lived my life and I've gotta die of something. If that something is a hcp who doesn't care then so be it. Hcps however probably shouldnt be in a job when they dont care about outcomes. Shades of dr shipman there.

why is it less significant of an issue if someone wishes to be a donor but is not able to donate

I think because it's far more intrusive and wrong to use someone's body parts without their consent than it is to not use them, despite having consent. Taking concrete, definitive action clearly requires consent - the witholding of action does not require quite the same consent. I'm not phrasing this very well, but it seems quite clear to me.

I would say that it's a form of consent quite distinct from one which applies to the living. Simply put, something has to be done with a body so, in the absence of information (and with none likely forthcoming from the deceased) choices are made on the balance of probabilities,

where did this "absence if information" crock come from ?

Either we have an organ donation register. Or we don't.

WTF have people been doing all these years signing donor cards ? Playing liver lotto ?

I can only speak for myself. But when I first got my driving license - aged 17 - I immediately signed the donor consent form that came with it. And at every opportunity I have repeated signed up to donate whatever bits of me they can find working when I croak it.

I cannot describe how cross I would be in heaven if I looked down, and saw my - literally last and dying - wish ignored.

I don't trust the state with choices that could profit them, but need my death for that to happen.
If the state own my dead body, will they withdraw anything that is keeping 'their' dead body frustratingly alive??

The other aspect of this is when someone looks like a potential organ donor, certain steps need to be taken around their death for the organs to be suitable. Institutions and regulations are all too likely to push for certain outcomes, because it is all abstract.

Isn't this also an issue with socialised medicine? If the public is paying for healthcare, rather than the individual, aren't choices that prioritise healthcare workers and equipment towards those more likely to recover likely to be made? At an individual level, it seems like a healthcare professional who supposedly might let a potential donor die to save others might equally be tempted not to 'waste so much time' on a 'selfish' individual who opted out.

A much simpler system would have been to simply ignore them, rather than make a seismic shift in the notion of consent (which will be leveraged further in years to come).

I would say that it's a form of consent quite distinct from one which applies to the living. Simply put, something has to be done with a body so, in the absence of information (and with none likely forthcoming from the deceased) choices are made on the balance of probabilities, hence why the Public Health (Control of Disease) Act 1984 prescribes either burial or cremation (as opposed to, for example, a sky burial or the undisturbed period for Buddhists that
ScrimpshawTheSecondmentioned).

Given that every survey has shown that the vast majority of adults are happy to donate their organs, why is it more important to safeguard the wishes of those who do not wish to donate than those who do? In other words, why is it less significant of an issue if someone wishes to be a donor but is not able to donate due to limited information?

Unfortunately, I don't think it's safe to rely on that assumption. It wouldn't be the consent is required from men, but not women.

There's no need to assume, you can read the act here:
www.legislation.gov.uk/ukpga/1990/37/schedule/3
Pertinently, consent given must be for a specified period and can be withdrawn.

Yes, indeed, Goosefoot. Some Buddhists wish the body to be undisturbed for a period of three days to allow the full process of dying/death to unfold.

While some people presumably are quite happy to share that utilitarian approach, I do think it's vital that we don't presume everybody does so.

Thanks for the link, Professor. Interesting subject!

I think many people are not aware that the harvested person is not dead at the time the organs are removed. The person is anaesthetised during the process just in case they are aware. This means that if you donate your relative's organs then you don't get to sit with them as they die, they are taken away and operated to death.

Yes, I think maybe people don't realise this.

Nor do they realise that "brain death" is a particular idea of what death is. Are you dead when a certain amount of brain activity stops? What counts as "you" anyway? This si not just an aside - in some countries organ transplant is rare because people do not see a divide between brain/body the same way many westerners do. That's not wrong, it's a different way to conceptualise the person.

There is often a similar take in religions where they require the body to be buried intact (Orthodox Christians or Jews for example.)

The other aspect of this is when someone looks like a potential organ donor, certain steps need to be taken around their death for the organs to be suitable. Institutions and regulations are all too likely to push for certain outcomes, because it is all abstract. It's not even the individual doctors necessarily, it's the system that pushes towards particular outcomes.

It's very easy for this to become a matter of deciding that certain people (like the ones someone thinks are brain dead) no longer count and should be sacrificed to the more worthy people, that is the ones not as close to the end of their lives. A utilitarian view of lives and people is pretty horrific and it needs to be guarded against by systemic measures - like an opt in system.

In general we are moving more and more in much of the west to a utilitarian approach to valuing life, so I would not even say it's an abstract or theoretical issue at this point in time - I think it's quite possible things will go farther in that direction if it's not prevented.

‘ For example at the moment, with a highly infectious disease, issues of consent must be involved? People's wishes are being over-ridden, I imagine, in terms of funerals, etc. So in this case, the state has some power (I presume) to step in‘

Yes, it’s an explicit part of the coronavirus emergency law, subject to same reviews and sunset. I don’t think they have had to use any of the provisions about dealing with bodies in a timely and safe manner. Had the planned expansion of mortuary arrangements not have been sufficient, then I expect we would have seen some/all of them activated

I haven't opted out but have sent feedback.

Such stupidity needs to be addressed

It raises questions for me, then! I have no idea about legalities of property and bodies.

Have fun: pubmed.ncbi.nlm.nih.gov/15040359/

It's a very niche area. If there's no property in a body, then it can't be stolen - not can removing bits of it be considered stealing. Hence the outrage when it emerged that certain hospitals had been playing collector cards with bits of bodies that had been through their care. Especially childrens remains. Who remembers Alder Hey ?

There are some very good scientific reasons (some impinging on the focus of this forum) why the law might need updating. However with tiresome predictability this isn't really the best way to go about it.

When it comes to stories about the potential of tissue samples from human beings, the Henrietta Lacks case - albeit US - is a fascinating and depressing story centering on her race and sex making her (and her family) fourth class citizens.

www.theguardian.com/science/2004/oct/18/medicineandhealth.lifeandhealth

According to this 2004 article on the Diane Blood case, the law now forbids storing of a man's sperm without his written permission, so I assume the same applies to ova.

As I understand it, the recent laws passed about the state response to Covid19 have some slightly alarming aspects wrt things like burials/cremation, autopsy etc. Frankly, I do not have any confidence in laws made hastily and without thorough scrutiny, or based on emotion-led arguments. I'm genuinely concerned about the Covid19 laws and the shift to presumed consent.

And has been said, the argument of 'our government would never use these laws badly' is possibly the most stunningly naive statement I can think of.

The coronavirus thing is more to do with public safety rather than ownership of the body.