
Spain leads the world in organ donation. What’s stopping other countries? - catfacedlady
https://mosaicscience.com/story/spain-uk-organ-donation-transplants-liver-kidney-heart-lungs-surgery-nhs/
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overkalix
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...](https://elpais.com/elpais/2018/06/22/opinion/1529691789_652478.html)

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perl4ever
I think what's stopping other countries is that only one can be at the top of
a relative ranking.

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QasimK
But there’s nothing that stops countries from being within 5% of each other at
top of that ranking. The main point is the large difference between the
countries.

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grecy
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.

~~~
dmm
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 of brain death was
created. But really brain death is an example of taking a word representing an
ancient and well understood concept, death, and applying it to something
completely new.

Really it's a form of deception. I don't think it's a malicious deception but
when the doctor comes in and says your loved one is brain dead that person is
not dead in the ways understood by a typical person.

I'm in favor of organ donation in general but until the medical community has
some very frank discussions about the medical definitions of death I'm opposed
to any form of mandatory or opt-out organ donation.

~~~
grecy
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 to deal with people telling them they didn't try hard enough.

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bjourne
That implies that ER personnel can tell organ donors from non-donors apart. Is
there any evidence that they can?

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grecy
Given the donor team are usually standing right outside the door waiting, I
would say they know.

~~~
bjourne
That seems like a bad situation. It can cause rumors like that hospital staff
doesn't try as hard to save donor patients because they can harvest their
organs can spread.

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wmccullough
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 nations that don’t belief
in the practice. I would instead go about it by having a campaign of
information on the life saving benefits of helping others. Undoubtedly someone
will tell me that these campaigns exists, but I’d say they don’t do a good
enough job yet.

~~~
icebraining
_a person may want to die with what they came into this world with._

Reminds me of the grandmother in Uri Orlev's book, who insisted on burning
every fingernail clipping, as otherwise their souls would be stuck on Earth
seeking for them after death.

In the end, nobody old enough to make that decision dies with what they came
with - the body changes too much over the years. But then again, we allow
everyone to destroy their organs with drugs, dangerous sports, sitting for
most of the day, etc. It would be hypocritical to deny others the equivalent
choice.

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karmaseed
Organ donation attracts a lot of scum elements and dubious practices which
require government policy frameworks and oversight. Then the hospitals need to
confirm to a lot of paperwork/trail which is cumbersome. If i’m waiting for a
kidney, i can wait in a queue to receive it from someone who’s dying or i can
“bring my own donor”, maybe a relative. Is the relative really related to me
or have i lured him/her with money.

See, not as simple as it sounds.

~~~
krageon
What is the problem exactly with buying a kidney?

~~~
croon
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.

~~~
icebraining
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.

~~~
ff317
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.

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robrenaud
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?

~~~
rurban
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.

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trappist
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](https://en.wikipedia.org/wiki/Kidney_trade_in_Iran)

~~~
bjourne
There are clearly some ethical concerns with creating an open market for
organs. The Israeli system I think is a great compromise. In Judaism, corpses
are sacred so even autopsies can be controversial in some circles. Therefore
the organ donor rate was very low. The solution? Whoever is a registered organ
donor receives priority over those who aren't. Since there are so few organ
donors in Israel, having priority is crucial and can mean the difference
between life and death. Therefore the number of organ donors have skyrocketed.
I think it is an ingenious system.

[https://www.tabletmag.com/jewish-news-and-
politics/164976/is...](https://www.tabletmag.com/jewish-news-and-
politics/164976/israel-organ-donation)

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Oletros
A thing to be very proud of

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hycaria
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 one no matter the cost.

So yes, I for one am not interested at all by donating my organs (here it is
an opt out). I'd rather be dissected, as I learned a lot on (in my case
animal) cadavers.

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pjc50
Your argument seems to be that surviving an otherwise incurable illness has ..
downsides?

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eezurr
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.

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the_af
> _" [...] I've been told a couple times that doctors who get cancer tend to
> decline chemotherapy/treatment [...] [Chemotherapy] was described as aging
> your body to a frail old person (not matter what your initial age was), that
> is not reversible"_

Maybe in some cases, but as an overall statement it seems seriously
misinformed. Not all cancers or their treatments are the same. My mom had
breast cancer surgery followed by chemotherapy and it certainly didn't age her
or make her body frail.

