Spain leads the world in organ donation. What’s stopping other countries? • Hacker News Board

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

#41

Post by jaimebuelta » Thu, Jun 28, 2018, 1:43 PM UTC

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.

(Spaniard here) No sorry. No. Just no.

The fact that no money is involved is a critical part of this system. It also is the fact that no money is involved in RECEIVING an organ.

This makes the system purely altruistic a removes the kind of questions of "how much should an organ cost", "could I accelerate the process paying more for an organ?", "could I sell my organs, or the organs for my just deceased relative for more money?" "Is this enough money for selling my organs?"

Eliminating the money from the equation makes this simple. You don't win or lose anything for donating. If you don't want to, is cool. But if you want to, is totally selfless. Which strangely, makes more people be cool with the default and donate more. Because the only thing involved is feeling generous and helping others, unless you have some sort of religious feeling or fear. But, again, nothing to earn.

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

#42

Post by detaro » Thu, Jun 28, 2018, 1:43 PM UTC

croon wrote: post #36

mediascreen wrote: post #22

Earlier quoted context omitted.

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 acco…

From my understanding (although second-hand), the law theoretically describes an opt-out system, but this is (due to legal uncertainty about the details?) not acted on by the healthcare system, which instead relies on explicit consent.

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

#43

Post by baud147258 » Thu, Jun 28, 2018, 1:45 PM UTC

severine wrote: post #34

dogma1138 wrote: post #13

Earlier quoted context omitted.

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…

> transplant law, which presumes consent unless otherwise stated

The same law is being applied in France, you have to be registered as not a donor in a national database. But, as the doctor said, the problem is with the available organisation, not the laws that are applied.

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

#44

Post by mijamo » Thu, Jun 28, 2018, 1:47 PM UTC

wmccullough wrote: post #3

I think this is great for them. I think that depending on national culture, a person may want to die with what they came into this world with. I know that some world religions are against the practice. I say this with full realization that some folks will read that and think “how selfish!!” Regardless of any of our beliefs, organ donation is a very personal choice. Personally, I wouldn’t go about the issue by shaming…

Well sure, but the fact that it is personal belief doesn't make it less selfish.

As long as it is opt in you won't get much success, because there is no benefit and people are lazy by nature, which is normal.

I don't think paying organs donors should be a thing, so maybe have a priority list for organs where donors get higher? Seems fair: you promised to help society, and in exchange society promise to help you first instead of the selfish non participants.

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

#45

Post by RobertoG » Thu, Jun 28, 2018, 1:51 PM UTC

dmm wrote: post #17

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.

If you ask a lay person from any human culture how do you know when a person is dead I think you would get similar answers along the lines of: - no heartbeat - no breath - their body temperature falls to ambient temperature - blood pools on lower half of body - onset of decomposition - etc When organs are removed from a person for donation, none of those conditions apply. In order to accommodate this fact the concept…

>>"If you ask a lay person from any human culture how do you know when a person is dead [..]"

If you ask a lay person from any human culture very probably the most significant part of the definition would be "non-reversibility".

That works for brain death too.

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

#46

Post by trappist » Thu, Jun 28, 2018, 1:51 PM UTC

This is one of those interesting questions where almost all laymen agree it should be altruistic, and almost all economists, from every school of thought including Marxism, agree there should be a market.

Iran is currently the only country with a legal organ market. It also happens to be the only country with no shortages or wait lists. Both facts were true in India and The Philippines until the sale of organs was prohibited in those countries in 1994 and 2008 respectively.

https://en.wikipedia.org/wiki/Kidney_trade_in_Iran

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

#47

Post by chopin » Thu, Jun 28, 2018, 1:52 PM UTC

grecy wrote: post #21

dmm wrote: post #17

Earlier quoted context omitted.

If you ask a lay person from any human culture how do you know when a person is dead I think you would get similar answers along the lines of: - no heartbeat - no breath - their body temperature falls to ambient temperature - blood pools on lower half of body - onset of decomposition - etc When organs are removed from a person for donation, none of those conditions apply. In order to accommodate this fact the concept…

A friend from University has spent the last ~15 years working in the organ donation site of ER medicine. They actually spend more time trying to revive a donor and doing everything they possibly can because of misconceptions like what you said above. She is quite certain that if anything, being a donor actually increases the likelihood of you being revived by medical staff, who would much rather revive you than have…

>She is quite certain that if anything, being a donor actually increases the likelihood of you being revived by medical staff, who would much rather revive you than have to deal with people telling them they didn't try hard enough.

Is there any kind of (independent) check for this? In my country (Germany) there has been collusion to get ones patients on the top of the recipient list. I wouldn't be surprised of there were similar collusions for the donor side.

I've also heard that recovery procedures differ from organ prevention procedures (at least you don't want to apply medication which potentially damage organs for a potential donor). How does one get assurances that the latter are not applied prematurely if you are a donor?

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

#48

Post by overkalix » Thu, Jun 28, 2018, 1:54 PM UTC

Goodhart's law: When a measure becomes a target, it ceases to be a good measure.

Spain is at the top of the ranking because the medical staff have a huge economic incentive to convince donors/family (2k euros) and conduct transplants (e.g. from 10K euros to 15K euros for a liver transplant). The Spanish model has been criticized for many years for being a shady procedure controlled by even a shadier organization that is barely regulated by the government. When the success of the transplant is taken into account Spain loses a lot of places. Spain is at the bottom of Europe in terms of blood donation. The Spanish Model is definitely not one to be imitated.

https://elpais.com/elpais/2018/06/22/opinion/1529691789_6524...

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

#49

Post by rurban » Thu, Jun 28, 2018, 1:55 PM UTC

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?

They main bottleneck besides opt-in laws in some countries are the average age of the deseased. You really want young healthy accidental deaths, car or motorcycle accidents are the best. You don't that care much about older organs of sick people.

The second most important factor is good organization and infrastructure. That's Spain's and now also Croatia's strength. You really need to be able to transport the organ fast and cool to the next hospital where the organ is needed. And you need to have the recipient on call also, who should not have eaten something in the last 6 hours.

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

#50

Post by chopin » Thu, Jun 28, 2018, 1:58 PM UTC

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.

But if one has so little income that he is starving, selling an organ would only postpone the inevitable. You can do this only a single time. As well, this certainly will create perverse incentives.