The organ transplant list is one of
the most depressing places to be in a hospital. The patient waits while their
health slowly deteriorates, hoping for a miracle. One of the main shortcomings
of the transplant list is the lack of available donors. A surplus of patients
with a dearth of available organs creates many compromising positions, both for
the patients and doctors, who must decide on the recipient of the donor, a life
or death decision in many cases. The system of organ donation, where patients can
opt into donating their organs, is lacking because it relies simply on altruism
rather than some more substantive motivation.
A proposed solution to low supply
of donors was instituted as a law in Israel in 2010 and will take effect in this
year. The plan is to incentivize signing up as organ donors by giving priority
on the transplant list to those who sign organ donor cards. In addition, the
law gives compensation to live donors of organs. This more active incentive,
along with a healthy ad campaign, has lead to a sharp increase in signups both
for live organ donors and organ donor cards.
Opponents of this law argue that it
can be a form of religious discrimination, as many Orthodox Jews will decline
to fill out donor cards out of religious objection to the “desecration of the
body”. I would counter that people who fundamentally disagree with the
desecration of their own body should not be able to benefit from the
desecration of another’s. Others argue
that a medical decision should not be able to be influences by nonmedical
factors, and that such a law is fundamentally unethical. The law, however, does
not offer undue discrimination against certain groups. The law only applies
when comparing patients with identical medical needs, and a tiebreaker that
encourages greater overall happiness in the increased availability of organs
seems like as good a tiebreaker as any.
REFERENCES:
http://well.blogs.nytimes.com/2012/02/16/in-israel-a-new-approach-to-organ-donation/?ref=health
4 comments:
This new law is indeed very interesting and raises a lot of ethical questions. I agree with you on the point that it doesn’t necessarily entail religious discrimination because patients who are opposed to “desecrating” their bodies shouldn’t prolong their lives at the expense of desecrating another’s. But I think there still remain some questions regarding discrimination in a different sense, namely that the law disadvantages patients on the waiting list whose organs are not (or will not be, after brain-death,) in harvestable conditions. For instance, if the patient has a disease that affects all of their organs, or if their “health slowly deteriorates,” as you mentioned, while they’re on the waitlist, making their organs sub-standard for donation, then they wouldn’t be able to donate even if they have altruistic inclinations. Patients who are willing to donate but whose conditions simply don’t allow them to, therefore, wouldn’t be able to get priority to a transplant, as they’re hindered by an obstacle that is really not their fault.
A related issue to this law that we could consider is on the question of consent. If a patient is in need of a transplant, they’re likely to harbor very strong fears since they’re hanging on to life every minute. Under these conditions, can we really say that their agreement to donate an organ comes from their genuine, unmitigated consent? Or are we getting dangerously close to having someone give “consent” under duress? Essentially, this system obliges patients to earn their treatment when those in equal need of treatment deserve it to the same extent. The (debatable) fact that more organs could potentially result in more “happiness” in the society shouldn’t be a justification to force patients to resort to gaining an advantage by using a non-medical, arbitrary tiebreaker.
And on the note of arbitrariness, the priority assignment in the system goes as follows: a patient who signs their own donor card gets double the priority than that of a patient whose first-degree relative signs a card, and a patient whose first-degree relative (alive or passed away) has already donated an organ get a priority 1.5 times that of a patient who signs a donor card. I find this assignment quite arbitrary because it seems that a key tie-breaker here is how generous one’s relatives are or have been. Patients don’t choose the people they are related to. If their relatives are not the most altruistic people, or if they can’t donate for medical reasons, then, again, patients are being punished based on factors that are not in their control.
All that being said, I still think the new law in Israel is an interesting incentive. It certainly has a lot of complex ethical issues that it has to address, so it’s worth keeping an eye out for what kind of results it would yield when it does come into effect later this year.
http://www.hods.org/pdf/Lancet%20-%20December%2017,%202009.pdf
Wow. This new law is very interesting. Let me start off with a couple of questions that popped up while I was reading the article.
Can people opt out of their organ donation cards after they have signed up? And particularly, after they have received a transplant? This was the most interesting situation I could think of when reading. If people could do so, this would be highly problematic.
As for the actual law, I think that it is a good idea that is stirring up the stagnant state of organ donation. Since both the United States’ opt-in approach and Spain and Austria’s opt-out approaches are lacking, I say that this new law is a bold new step that at least attempts to solve organ shortage and ultimately saves lives. I think Israel should be applauded for being the first country in the world to brave an incentive based sign-up, especially since it recently was ranked at the bottom of organ donation of Western countries.
Lastly, for the family benefits issue of card sign ups, I think that this is fair. It encourages the social awareness of donating organs through the family unit. After all, people are born naturally into social situations they cannot control (e.g. a female child born in China, where at one point male children were predominantly preferred). Furthermore, family members can actually do something by encouraging each other to sign up.
As for now, the overwhelming response (a 60% up in transplants this year) to this new law is a sign that we are moving forward. I am curious to see what will happen when the law takes full effect on April 1st.
Excellent comments by Buyan and Jeff. Vibrantionz will need to get more into the details if this is kept as a part of R4. Right now, it is mostly orienting of the NY Times article. But fascinating topic.
It seems to me that certain parts of this new policy are ethical where as other parts of this policy have some serious flaws. Concerns over informed consent I believe are not valid because donating organs does not actually harm the donor because the organ donation would occur after death. The worry that informed consent is coerced is irrelevant here because where as in experimental trials research participants need protection from potential harm in this case organ transplantation would not harm a person because the procedure is post-mortem. Furthermore let us not forget that the units we are using to determine the success of this policy is number of human lives saved, which seems like a good justification for the use of coercion. Where as many human experiments have the potential to save lives and we must evaluate the potential risks versus the potential benefits, in this case the benefits and risks are fairly well known. Therefore we do not need to employ the same cautions that we would use in an experiment because this new proposed solution is not a human experiment so much as an experimental policy. The policy is also not discriminatory towards religious groups because any religious person who takes offense at the procedure should not be allowed to participate because their participation would show a lack of respect for others. If you believe that someone’s agreeing to donate organs is sinful then it is both disrespectful and hypocritical to accept their organs.
On the other hand there are some serious flaws with the family-incentivizing plan because it is not fair to determine whether someone lives or dies based on the decisions of other people who happen to be related. The state does not judge people for having good or bad relatives in any other aspect of life and to do so sets a bad precedent for the future. Additionally the policy when it expands beyond just individual accountability starts to become more political which threatens the integrity of the system. Under this system patients with more relatives get priority and patients with a higher number of relatives who have already died could get priority too. Through this method we actually punish persons who haven’t got families. Which I think is a worrisome criterion for deciding who lives and who dies.
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