
Dead enough - rl3
http://aeon.co/magazine/philosophy/we-should-harvest-organs-from-patients-before-death/
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brudgers
I became an organ donor shortly after turning 18. I was upgrading my driver's
license to one that would let me drive a big rig [not that I ever did, at the
time it was just a written test]. Being an organ donor had never even crossed
my radar. It was a collision with mortality because the people I knew never
talked about death as a part of life.

I'm certainly capable of making up a slippery slope argument where people are
being off'd for their organs. It just doesn't seem like people willing to do
that would be detoured very far by someone's lack of organ donor status and
even if nobody but organ donors were to be off'd prematurely, it's probably
low down on the likely reasons I'll get off'd for someone else's benefit.

I figure I'm much more likely to die waiting for an organ than to be off'd for
mine even well into the gray zone of organ harvesting.

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jacquesm
> It was a collision with mortality because the people I knew never talked
> about death as a part of life.

In the tech scene there is a particular aversion to facing up to the realities
of life. People tend to think that waiting for technology to improve will take
care of all of life's problems and death is just another one of those, so if
they just hold out long enough death will surely not happen to them.

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yk
Why not just let the patient choose, set a restrictive default and allow
individuals to relax this default. So in the case of assisted suicide, it
seems more reasonable to surgically remove the heart, than to first use poison
and then remove the heart.

[Edit] Spelling

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Totient
This makes perfect sense. I know people who would be terrified of the thought
that their organs could be harvested while they might yet recover, but also
people who be horrified that their perfectly good organs are just laying
there, unused, after their brain has died, but with artificial
respiration/circulation keeping some of the rest of their body going.

I think a sane default is to require opt-out for organ donation after brain
death (what Europe does now, I believe) with an opt-in "sliding-scale" for the
rest of the possibilities.

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Spoom
I am an organ donor. I think the chances of a scenario in which I am at
death's door _and_ a doctor decides _not_ to treat me _solely_ in order to
obtain my organs for donation is so far removed from reality that it's not
worth considering, at least in this country.

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gpvos
Several European countries have an opt-out system, i.e., everyone is a donor
by default. Mixing that with a "dead enough" system would ethically be
extremely dangerous. (I am an organ donor and would in principle have no
problem if this were done to me.)

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3pt14159
No more dangerous that just taking them off of life support.

We're talking about people in permanent, machine supported comas. If a doctor
offs someone that the doctor knew had a chance for survival the doctor should
get tried for murder.

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debacle
Once we're able to pull depositions right from the minds of defendants, we
might actually be able to try him/her, too.

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LordKano
My mind first goes to all of the things that could go wrong.

That's precisely why I am not an organ donor.

I don't want to put anyone in the position of making these decisions based on
probability and likelihood. Harvest the organs of the willing only after
clinical death has occurred.

I'm concerned that one day a poor person could sustain a traumatic brain
injury and just so happens to be a tissue match for someone who is rich,
famous, politically connected or influential who needs an organ.

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jacquesm
> I'm concerned that one day a poor person could sustain a traumatic brain
> injury and just so happens to be a tissue match for someone who is rich,
> famous, politically connected or influential who needs an organ.

The chances of that happening to any one particular person are quite small.

The wealthy in the current system already have an unfair advantage by being
able to 'multiple list', a path not open to those of lesser means. It's all
perfectly legal, of course.

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bbitmaster
As others have commented here, this is also exactly why I am not an organ
doner. There are cases where people have went into cardiac arrest, where their
heart stopped and everything, only to wake up and make a full recovery. "Is he
dead?" is not always a well defined state with a binary True/False answer. The
fact that this article is pushing for harvesting organs _before_ death, and
people who actually think this way, only serves to turn me off to it even more
so.

Call me selfish, antithetical to society, or whatever. If I really was in a
state where there was no chance I could recover, I would gladly give my organs
to help save someone else. As it is, I don't think a random E.R. doctor should
make that determination based on a note found in my wallet.

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jsprogrammer
>As it is, I don't think a random E.R. doctor should make that determination
based on a note found in my wallet.

I don't think live harvesting is common (or allowed) in the US.

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guard-of-terra
Should not we already get artificial organs out of the door?

To do so, first we should revisit all that stem cell debate.

It's kind of hard to argue that stem cells are more sacred than organs
harvested from still breathing body.

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nsxwolf
The successes in engineered organs are coming from adult stem cells so far,
which don't come with an ethical debate. We can't get there fast enough if
this ghoulishness is really what doctors are proposing.

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guard-of-terra
"which don't come with an ethical debate"

I would not be so sure. I don't think that laymen understand the difference
between evil baby-harvested stem cells and my rightfully own adult stem cells,
and that hurts research & funding.

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pbh101
Having been around a lot of people who care about this issue growing up, I can
tell you there is a lot of loud trumpeting of every advance in adult stem cell
research, specifically for this reason. I'm sure there are still some out
there who have ethical concerns about adult stem cells, but that is a separate
issue.

One example from a quick google search: [http://www.ncregister.com/daily-
news/adult-stem-cell-therapi...](http://www.ncregister.com/daily-news/adult-
stem-cell-therapies-are-the-future-scientist-says1)

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nsxwolf
And this is why I'm not an organ donor, because I knew it would eventually be
pushed to this and beyond.

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msandford
A friend of mine was a nurse who worked in an ER. I expressed similar concerns
of yours to her, "organ donor might mean that the doctors don't try and save
me as hard because hey, good organs!" and she was emphatic that the doctors
wouldn't do this.

I think the worry is that even if the particular doctors in her ER would
always try their hardest, there might be other doctors in other ERs who might
not.

What's difficult is that there's really very little way to truthfully
ascertain if someone did in fact try hard enough. How do you really quantify
effort? It's very similar to programming, if someone creates a bug was it an
accident or was it on purpose? You'd like to believe that it was always an
accident but you can never really know for sure.

What happens when organ donation is seen as a moral imperative and only a few
percent of people choose not to participate? Might doctors not try as hard to
save them as "punishment" for being "anti-social" or something?

There are a lot of thorny ethical questions surrounding organ donation, death,
and drawing hard lines where things are squishy.

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ceejayoz
> What happens when organ donation is seen as a moral imperative and only a
> few percent of people choose not to participate? Might doctors not try as
> hard to save them as "punishment" for being "anti-social" or something?

IMO, if you want to opt-out of donation, doing so should opt-out of the
receipt of donated organs as well.

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petercooper
What about people who don't donate blood? No blood for them?

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ceejayoz
No, I think that'd cross a major ethical line.

First, there's not an ongoing, nationwide shortage of blood - we have enough
of it, so people aren't dying needlessly because they can't get it.

Second, requiring an invasive medical procedure on a live subject is hugely
different to cadaver organ donation.

We already have an ethical framework in which the government at least
partially controls post-death use of the body - autopsies, regulation of
burials, etc.

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petercooper
I wonder what keeps US blood stocks healthy. Here in the UK there seems to be
an alarming story every few months about how we barely have more than a few
days' stock. Even just recently: [http://www.theguardian.com/uk-
news/2015/jun/05/sharp-drop-ne...](http://www.theguardian.com/uk-
news/2015/jun/05/sharp-drop-new-blood-donors-uk-stocks-at-risk) .. no-one gets
anything for donating blood here though, if The Simpsons is even slightly
realistic (!) sometimes people in the US give blood for cash?

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ceejayoz
> Here in the UK there seems to be an alarming story every few months about
> how we barely have more than a few days' stock.

That's how they drive up supply. When it gets too low here in the US they'll
actually use phone banks to call regular donors to ask them to come in. I'd
imagine the UK has something similar.

> if The Simpsons is even slightly realistic (!) sometimes people in the US
> give blood for cash?

I _believe_ it's illegal to pay donors for blood, but plasma donation can be
paid. It's problematic.
[http://www.theatlantic.com/health/archive/2014/05/blood-
mone...](http://www.theatlantic.com/health/archive/2014/05/blood-money-the-
twisted-business-of-donating-plasma/362012/)

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iamthepieman
A simple separation of concerns could solve a portion of the ethical and
pragmatic problems people have brought up in this discussion. The treating
doctor does not get to know the donor status of the patient and has nothing to
do with extracting the organs once the patient is either dead or "dead
enough".

The doctor reports on the patients chances of survival/waking up etc and this
is checked against the patients donor status including any permission to
harvest organs if there's no or only a tiny chance of survival.

Of course there's a number of hypothetical situations where this falls apart -
if there's only one qualified doctor available in a tiny hospital or if
there's no access to patient records/pre-recorded desires. However, it's a
place to start.

Until there are better options available or a series of well publicized abuses
I will continue to be an organ donor because, to put it simply, the golden
rule.

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spost
Honestly I don't believe I'd have a problem with this. If the odds of my
living are less than the odds of my organs allowing someone else to survive…

There is of course the issue of trusting people to make that call for me, but
I'm pretty sure I trust an awful lot of people to not kill me unreasonably.

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zeeed
> If the odds of my living are less than the odds of my organs allowing
> someone else to survive…

One of the big problems really is to determine the odds.

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tat45
As a prospective organ donor, I am comfortable with "dead enough" organ
harvest for myself as long as my living will and my family's wishes
(subordinate to the living will) were respected.

I can't draw that line for anyone else, though. From my perspective, the moral
thing for the government to do is to make it legal and require an extra opt-in
above and beyond the typical DDR version of organ donation enrollment we have
now.

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justignore
That's a very big "if."

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roflchoppa
Why not just grow organs in petri dishes. Then you don't have the problem of
the immune system rejecting these foreign organs?

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BigC15
I'm all for organ donation, medical euthanasia, and other issues that are
related to this but I feel a little uncomfortable about being considered "Dead
enough". I guess I would need a little more definition about what is actually
considered "dead enough".

Disclaimer: I didn't read the entire article so my concerns may have been
covered.

