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Spain leads the world in organ donation. What’s stopping other countries?

mosaicscience.com

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Re: Spain leads the world in organ donation. What’s stopping other countries?

#31

Post by pjc50 »

hycaria wrote: post #27

Am I the only one not so very enthuastic about organ donation ? Except for cornea, it means a life long of heavy immunosuppressive treatments (which are not free afaik), leading to higher cancer rates and many other side effects. Things are rarely a pure win, there are downsides (even though they are suspiciously rarely mentioned). I don't think we have such a shortage of people that we have to save every and each on…

Your argument seems to be that surviving an otherwise incurable illness has .. downsides?

Re: Spain leads the world in organ donation. What’s stopping other countries?

#32

Post by walshemj »

robrenaud wrote: post #25

What is the bottleneck to organ donation? 46 out of 1 million seems atrocious, not laudable. How many people are willing to donate but medically unable?

You cant tell until it comes to it I had a kidney transplant last year and only one kidney was usable. I was the better match - so the guy on the bed next to me had to be told sorry and had to go home

Also some kidneys can be problematic I passed on one where the donor might have been HIV+ - I had gone on the list prior to needing diyalsis so it wasn't like I needed one immediately.

Re: Spain leads the world in organ donation. What’s stopping other countries?

#33

Post by ff317 »

icebraining wrote: post #20
croon wrote: post #7

Earlier quoted context omitted.

Money is persuasive, but can also buy coercive. If there are no boundaries or rule structures, then the incentives often (always?) bleed into some involved party not having a choice, or a Hobson's choice.

Is having an Hobson's choice worse than having no choice at all? Someone having to choose between selling a kidney or starving is terrible. But the solution shouldn't be to deny the first option - that just leaves starving. It should be to give them a third option. That said, obviously "no rules" would still be dangerous, but no legal sale is done without any rules.

Yeah, but I think in this case there's an issue where the choosing party lacks the ability to make an informed decision. The risk-weighted long-term medical costs of removing a kidney (in less-than-ideal operating conditions!) and living with just one (probably in an environment where kidneys work overtime due to low-quality resources!) make it a rather expensive proposition. It would've been easier to scrap/work/beg for food than for the potential medical after-care they'll need over time, in terms of the total long-term cost of maintaining their life and/or health levels. But those that understand this are withholding that level of understanding and forcing it to look like a rational Hobson's choice to the donor.

Re: Spain leads the world in organ donation. What’s stopping other countries?

#34

Post by severine »

dogma1138 wrote: post #13
grecy wrote: post #10

My first thought has always been to just make it mandatory, or at the very least opt-out instead of opt-in. I realize those are both very controversial, so I wonder why we don't have a monetary incentive. i.e. We will pay $1000 for every organ of yours we take to a person you nominate.

Some countries have it opt-out on gaining a driver’s license. The family however can always override it. There is another factor and is cause of death and age which directly is tied to doner suitability as well as if there is infrastructure to support organ donation across the nation and other process related issues. I would strongly suspect that Spain managed to solve the infrastructure and process related problems…

edit: sorry, I hadn't read the article, I see it says more or less the same than my link

> Spain managed to solve the infrastructure and process related problems

That's correct, the Organizacion Nacional de Transplantes is the main culprit.

You can read about it here: http://www.newsweek.com/2015/02/20/spain-has-become-world-le...

> Dr Matesanz rejects the idea of a Spanish miracle or a unique store of generosity in the hearts of his compatriots: “We have asked the same question in various surveys over the years and every time 56% or 57% say they would donate their organs after dying; roughly the EU average.” On the role of Spain’s transplant law, which presumes consent unless otherwise stated, Matesanz is also dismissive, pointing out that families always have the final say and that the only country in the world to enforce such a rule is Singapore. “Spain has not been a leader in surgery or research; we have hardly chalked up any firsts in transplant operations. What we have brought to this area is organisation. Following a philosophy that states that donors do not simply fall from the heavens, we have provided organisation and professionalisation.”

Re: Spain leads the world in organ donation. What’s stopping other countries?

#35

Post by saosebastiao »

grecy wrote: post #10

My first thought has always been to just make it mandatory, or at the very least opt-out instead of opt-in. I realize those are both very controversial, so I wonder why we don't have a monetary incentive. i.e. We will pay $1000 for every organ of yours we take to a person you nominate.

I would prefer the incentive be that you can't be on a list for a transplant if you have previously opted out of donating.

Re: Spain leads the world in organ donation. What’s stopping other countries?

#36

Post by croon »

mediascreen wrote: post #22
grecy wrote: post #10

My first thought has always been to just make it mandatory, or at the very least opt-out instead of opt-in. I realize those are both very controversial, so I wonder why we don't have a monetary incentive. i.e. We will pay $1000 for every organ of yours we take to a person you nominate.

Sweden has an opt out system, but still has very low participation: https://www.bbc.com/news/health-41199918

I don't know where BBC got that information, but it is very wrong. It's entirely opt-in.

You need to either:

1) Register your wishes with the National Board of Health and Welfare

2) Fill in a donor card and carry it in your wallet

3) Notify next of kin/will etc

Upon your death you need to be pronounced dead twice with at least 2 hours apart, sometimes after a brain scan.

The low participation is indeed true, but according to a 2010 poll, 83% Swedes were positive to organ donation, but very few register as such.

Edit: Actually the participation doesn't seem that low [1].

[1] https://ec.europa.eu/health/sites/health/files/blood_tissues...

On the Swedish system, in Swedish:

https://www.socialstyrelsen.se/donationsregistret

http://www.socialstyrelsen.se/pressrum/nyhetsarkiv/sverigeha...

Re: Spain leads the world in organ donation. What’s stopping other countries?

#37

Post by daliusd »

hycaria wrote: post #27

Am I the only one not so very enthuastic about organ donation ? Except for cornea, it means a life long of heavy immunosuppressive treatments (which are not free afaik), leading to higher cancer rates and many other side effects. Things are rarely a pure win, there are downsides (even though they are suspiciously rarely mentioned). I don't think we have such a shortage of people that we have to save every and each on…

Well, I believe in Denmark if you opt out you are put in the end of queue in case you will need donor in the end (and you can't be never sure about that). I think that's fair system which could be adopted in other countries.

Re: Spain leads the world in organ donation. What’s stopping other countries?

#38

Post by hutzlibu »

hycaria wrote: post #27

Am I the only one not so very enthuastic about organ donation ? Except for cornea, it means a life long of heavy immunosuppressive treatments (which are not free afaik), leading to higher cancer rates and many other side effects. Things are rarely a pure win, there are downsides (even though they are suspiciously rarely mentioned). I don't think we have such a shortage of people that we have to save every and each on…

I would be curious if you think the same about "why save everyone?", when it would be your life in need of a organ.

Re: Spain leads the world in organ donation. What’s stopping other countries?

#39

Post by eezurr »

pjc50 wrote: post #31
hycaria wrote: post #27

Am I the only one not so very enthuastic about organ donation ? Except for cornea, it means a life long of heavy immunosuppressive treatments (which are not free afaik), leading to higher cancer rates and many other side effects. Things are rarely a pure win, there are downsides (even though they are suspiciously rarely mentioned). I don't think we have such a shortage of people that we have to save every and each on…

Your argument seems to be that surviving an otherwise incurable illness has .. downsides?

I dont have a source for this, but I've been told a couple times that doctors who get cancer tend to decline chemotherapy/treatment because of what the treatments do to the body. It was described as aging your body to a frail old person (not matter what your initial age was), that is not reversible.

Or think about this on the extreme end: I think many people would choose a time to die peacefully rather than sit in a semi-vegetable state in a hospital bed for the rest of their life.

Re: Spain leads the world in organ donation. What’s stopping other countries?

#40

Post by emptyfile »

hycaria wrote: post #27

Am I the only one not so very enthuastic about organ donation ? Except for cornea, it means a life long of heavy immunosuppressive treatments (which are not free afaik), leading to higher cancer rates and many other side effects. Things are rarely a pure win, there are downsides (even though they are suspiciously rarely mentioned). I don't think we have such a shortage of people that we have to save every and each on…

>Am I the only one not so very enthuastic about organ donation ?

No but most other people have religious or similar reasons.

I don't see many people not donating organs because they simply don't care. So congratz I guess.

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