In 2007 the balance between supply and demand of donated organs was off. The waiting lists to transplants were still growing, but the number of donated organs was falling. Those two facts put together equal a high death rate on behalf of a problem, that is however solvable.
The term ‘death’ was in 1968 redefined. The dividing line between life and death now depends on more than the presence or absence of vital signs. In general clinical death is not necessary for a determination of legal death. A patient with working heart and lungs who is determined to be brain dead can be declared legally dead, without a clinical death occurring. In such a situation where the brain ceases to function, the heart may continue to beat with the support of drugs, and the breathing is maintained with a respirator. When an individual is declared brain dead, it is legal to use its organs for transplants.
But as highlighted in text 1, line 35: “Just 1 percent to 2 percent of patients who die in hospitals are declared brain dead. And because continuous circulation is needed to keep organs healthy, deaths that occur outside a hospital are almost never a source of usable organs”. Beyond this there has to be an approval of donation. Either from the individual itself (before the legal death) or from its family. Therefore the number of donation opportunities is low and the number of actual donations even lower.
In the texts there is presented three different solutions to the problem of organ donation. In text 1 the main solution is to switch from the ‘opt-in’ to an ‘opt-out’ system. It means that the individual is presumed willing to have its organ removed after death unless it has opted out, which is the opposite of the current legislation in this area. This switch is welcomed be many organisations including the British Medical Association, but greeted coolly by the Patient’s Association.
Mrs Keeling has had a good experience with organ donation when her daughter was declared legally dead, but she still does not think presumed consent is the best solution yet. She believes that we should try harder to get people to register before going ‘down the opt-out route’.
The switch between the two systems is a huge step to take, but if what is claimed in text 2, line 40 is also current elsewhere, this solution could be suitable: “While most Americans say they approve of donations, only one out of four has indicated that by signing forms”.
In text 3 the presented solution is a legislative amendment which will legalize trading of organs as any other product on the marked. The theory behind it is that the marked would work its usual magic and thereby re-establish the balance of supply and demand as well as a quality improvement of the donated organs. An extension of the theory Adam Smith in 1776 introduced to the world in his book ‘the wealth of nations’. The Economists also point out, that: “if just 0,06 percent of healthy Americans aged between 19 and 65 parted with one kidney, the country would have no waiting list… buyers would get better kidneys, faster. Both sellers and buyers would do better than in the illegal market, where much of the money goes to the middleman” (text 3, line 22, 23+37, 38). The legislative amendment does however require increasing control and proper governmental regulation in the area. In Iran the waiting list has been eliminated and fewer people are therefore dying because of the lack of organs for transplantations. The marked ‘magic’ mechanism could after my opinion work out, and create the improvements, the theory promises. None of the texts has presented economy as being a problem in this cause. And therefore I deplore the use of economy as an argument for this type of organ donation. I am also worried that this type of legally organ trade will, in stead of replacing the black marked, just strengthen it by opening up more opportunities. E.g. easier access to the type of health check-ups that is required to donate and thereby making trades in the black marked safer and more attractive. This type of marked-developing is also, because of the economic aspect, causing a greater gap between rich and poor in the communities. In my opinion, organs are not meant to be a luxury trading object, given to the highest bidder and not to the one with highest need as the situation is nowadays.
Personally I choose to agree with Mrs Keeling, who believe that we should make an effort to increase the attention of this very important area, and try harder to get people to register before making any legal changes. After that, my choice would be the opt-out route, which to me seem more morally correct and the safest alternative from the texts.
The Dutch television program made by BNN, where three candidates who desperately needed a kidney, tried to convince ’37-year-old Lisa’ why they should be the recipient of one of her kidneys, was very provoking. At the end of the show, Lisa confessed to be an actor, who had been in this game to make some attention to organ donation, the three other contestants were real kidney-failure patients. The show got widespread media attention, and was among other expressions called ‘inappropriate and unethical’. In this I do not agree. I understand the people’s reactions to this very rough program, and that it at first can seem unethical. My opinion is that programs like this in Holland are necessary to make people understand the importance of organ donation. In the other texts, the imbalance is proving of a terrible lack of information, attention and human charity towards each other. I do not believe it is unethical to set focus on such an important matter not even with these rough methods; the world clearly needs a wakeup-call.