In 2005, Kazuo Ishiguro, wrote Never Let Me Go, a work of fiction that explores the idea of mandatory organ donation. The topic has entered the ethical debate arena again, not just because the book is being turned into a movie, slated to hit theaters this September, but due to a bill proposed in New York that would automatically register all residents of New York as organ donors.
Articles keep misrepresenting the idea as "mandatory" organ donation, which isn't true. It is merely changing organ donation to an opt-out plan rather than an opt-in plan. Right now, a person needs to make the active choice to become an organ donor. If this bill becomes a law, residents of New York would automatically be an organ donor unless they signed paperwork stating otherwise. New York would be the first state to create such a law, though 24 other countries already have laws like this on the books and other states, such as Delaware, have attempted to bring a bill like this to committee.
The drive for this law comes from the fact that few people are organ donors, therefore creating a long wait list for those needing a transplant. According to Health and Human Services,
The number of people needing a transplant continues to rise faster than the number of donors. About 4,100 transplant candidates are added to the national waiting list each month. Each day, about 77 people receive organ transplants. However, about 18 people die each day waiting for transplants that can't take place because of the shortage of donated organs.
There are now more than 105,000 people on the waiting list for solid organ transplants. Experts suggest that each of us could save or help as many as 50 people by being an organ and tissue donor.
The benefits and drawbacks of this law are clear. On one side is the fact that people waiting would have the organs they need, it would be easier to be an organ donor, and it would remove the choice from distraught families after an accident has made their loved one a possible organ donor. On the other side are the fears--that this law would compromise health care if doctors saw that they could save more lives with the donation than by saving a single person--and the realities--that it would mean government was making personal, ethical choices about your body.
The New York Times debated this on their blog, bringing in five opinions of experts in the field including a bioethics professor and a sociologist. They point out the multitude of truths connected to this law including the fact that there are many people who might choose to be a donor, yet don't because of the legwork to become a donor. In addition, they point out the bill's flaws, such as its divergence from Spain's presumed consent law which still gives relatives veto power (the right to stop a donation from taking place would be removed with New York's law).
Of course, this argument is something that only concerns the living. As Feministe points out, "I usually err on the side of bodily autonomy and not presuming consent for much of anything, but when you’re dead you’re dead." Organ donation has long been a reality in this country and the fear that donation will change the quality of health care has never been realized. And once dead, unless it is for religious reasons, few care if they take their organs to the grave.
Yet most who take offense with this bill don't do so for religious reasons, but more the idea of government making what they view as a personal choice. Our organs are our organs, owned by the person and presumably their choice to give to another person. Just as we wouldn't want mandatory blood donations every time we visited our doctor for a wellness visit, many do not want the government to choose what happens to their organs in the event of their death nor do they want it to be more difficult to hold onto their organs than donate them.
Similar to this idea is one that is constantly proposed as a way to approach the use of donor eggs in IVF. Rather than have healthy, young women serve as egg donors, the idea has been floated that those already undergoing IVF split their eggs, keeping some for themselves and donating some to another woman who requires donor gametes to conceive.
While shared oocyte programs have had high success rates and many happy participants (it is certainly a solution that is cost effective), these programs are also rare and underutilized because people have strong feelings about their gametes. While we all want gametes available if we need to utilize donor gametes, we might not hold the same feelings about donation coming from the side of having something to give.
What laws such as the one proposed in New York do is disregard the feelings people hold for their body parts, something that cannot be quantified in statistical numbers or even explained in rational terms. There are few people out there, if their religion permits it, who are anti-donation in theory. We all know that if we were on the waiting list, we'd want available organs to save our life, especially ones that would be lost to the grave instead of going into another body. But being on the other side, with healthy organs, we pause, wondering if we'd go ahead with the paperwork to opt-out of the program, knowing how much our organs would mean to another family after we don't need them anymore.
Are you an organ donor? Why or why not?
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