AIBU to think that it is immoral to have financial incentives to harvest peoples' organs on the NHS?

[ZhenThereWereTwo]

AIBU to think that to give hospitals financial incentives for numbers of organs donated leaves a lot of scope for corruption, especially when dealing with elderly, vulnerable, disabled or people with learning difficulty. Alder Hay and many other stories show us that medical professionals do not always act with integrity or to the Hippocratic oath.

Article here.

Evidence portfolio from NHS here.

Whatever you think about the proposals, I would encourage you to add your voice by filling in the survey here.

It is likely that they will not have many people doing the survey from non-medical backgrounds as it is not widely advertised, but it is your way of giving your opinion on the proposals.

My MIL was in intensive care with only 20% chance of survival, they told us she would not wake up again as she was on life support and in a coma with little brain activity.

Well she did wake up and she was no vegetable. Would they have harvested her organs under these new proposals, I think so.

Organs are harvested when technically you are still alive.

Some hospitals give the donor an anaesthetic and some don?t, there is medical research that shows brain stem dead people respond to pain stimuli.

The government has no right to lay claim to my organs unless I opt to give them. This automatic donation unless you opt out infringes my human rights to decide what happens to my body once I am no longer conscious in a U.K. hospital.

To be quite frank these proposals scare me. I will be telling everyone I know to be very careful about organ donation, because there are many documented cases of people waking up from comas, strokes and even some waking up in the morgue.

So unless it is your intention to occasionally kill and harvest people that could have survived, against their wishes in some cases, you need to think about these proposals. I think organ donation is important, but not at the expense of our human rights. A sick person doesn't have more rights to my organs than I have rights to choose whether to donate or not.

Ive never thought about organ donation before, how do you register?

You can join here

www.organdonation.nhs.uk/ukt/how_to_become_a_donor/registration/consent.asp

If you do decide to join, I would like to say thank you

No need to say thanks, I'm not going to need them when I'm dead am I?

Not only you won't need them, but you would be giving the gift of life to at least 1 person

As a registered donor I would prefer for my organs to be taken whilst still on life support so that they have the best chance of being successfully transplanted.

I am mentioning PVS, because if we go by the survey questions they are talking about increasing the numbers and chances of successful transplants. Therefore the best way to ensure successful transplant would be to keep a patient with PVS on life support whilst their organs are 'retrieved'.

Given that the relationship between clinical findings and consciousness isn?t clear cut when deciding on a diagnosis of PVS or that of a partially or minimally conscious state this is a grey area Source. Because the vegetative state persists, we call it PVS. Unfortunately, at present we really don?t have a better system.

There isn?t a clear relationship between the responsiveness to pain and the existence of consciousness. It is something that we have to infer. Because we don?t have access to what the patient is thinking (or not thinking) it is really hard to tell whether they are conscious or not.

One of the previous posters on this thread mentioned that her BIL was allowed to die with life support off for 30 minutes then life support was reattached. This will not give the best outcome for organ donation.

Some people with non-survivable injuries to the brain never become brain dead because they retain some minor brain stem function. If such individuals made the decision to be donors or their families are interested, organ donation may be an option.

Truog RD, Robinson WM. Role of brain death and the dead-donor rule in the ethics of organ transplantation. Crit Care Med2003;31:2391?6.

Kerridge IH, Saul P, Lowe M, et al. Death, dying and donation: organ transplantation and the diagnosis of death. J Med Ethics2000;28:89?94.

Woodcock TE. New act regulating human organ transplantation could facilitate organ donation. BMJ2002;324:1099.

All argue for a change to the 'dead donor rule' and propose that the ethics of organ donation be based on the ethical principles and respect for persons rather than on brain death. They propose that sometimes the harm of dying is sufficiently small that patients should be allowed to voluntarily accept that harm if it makes organ donation possible.

This is one suggestion from the medical profession being floated at the moment. With an opt-out system then you would not be voluntarily accepting that if you failed to opt out, couldn't opt-out for whatever reason or didn't opt out because you did not have the full information to make an informed decision.

Someone also mentioned upthread about the lack of record keeping of registered organ donors. Who is to say that the record keeping of people opting out under the opt-out system would be any better? In that hypothetical situation then you might find that someone became a donor when in fact they did not consent.

Rewarding trusts financially for each organ they provide (as opposed to simply meeting their costs) is ethically questionable in the light of increasing privatisation (e.g. www.guardian.co.uk/business/2011/nov/13/circle-health-social-enterprise-hedge-fund-manager).

It may discourage people from opting in or encourage them to opt out and make it harder to obtain families' consent.

A hospital with a higher than average mortality rate for certain procedures should not be given more money as a result - this is a perverse incentive.

ZhenThereWereTwo

I've just read all the links you posted for Dr's mistakes. Onl the first one stated the tests used to establish brain death - but the writer says the patient was intubated throughout, but that they tested for a gag reflex - the two cannot be true. He also states that God resurected his siter's brain cells - so I'm a bit .

None of the others were actually declared brain dead. One took her mother home in a coma, another sent the patient to a nurologist to establish brain activity - the nurologist sent the patient for an EEG that showed the patient was not brain dead.

Did you actually read any of these articles?

Patients are often unreliable when talking about their own condition. Journalists are also unreliable. They frequently do not understand that a procedure is not an operation, and that just because someone cuts into another's skin they are not a surgeon.

Hassan and Munford's paper is the only one I would rely on, and agan, the patient was not diagnosed as brain dead, they thought it might be brain death, they sought an expert opinion and then found out it was not brain death, ie it was not diagnosed.