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Re: increasing donations -- I've always wondered why it doesn't work roughly as follows: if you're an adult who finds yourself in need of a donated organ and ar

Re: increasing donations -- I've always wondered why it doesn't work roughly as follows: if you're an adult who finds yourself in need of a donated organ and are not yourself a donor, you're at the bottom of the list (below any donors) as a potential recipient from strangers who are donors. Puts the incentive in the right place and seems fair to me. What are the issues with that idea? Maybe the donor system would need to be made an opt-out rather than opt-in system first (as the article suggests), otherwise ignorance could be an issue.

mulmen 10y ago
Wouldn't people just wait until they need an organ to join the list? How does punishing a subset of needy organ recipients increase the actual number of available organs?
- throwaway287391 10y ago
  Right, obviously you'd need to record the date they opted in and not give someone "credit" for registering once they were in need of a donation. It would help to increase the number of available organs because some people who don't care to register now might do so knowing that it means if they ever get into an accident they have a higher likelihood of receiving an organ.
  - theonemind 10y ago
    This sounds more like punishing the person who changed their mind. If they receive an organ, they can still die and give their organs. Logically, shouldn't they get moved up in the list to receive organs, but possibly not have the option to withdrawal their donation once they've received organs?
    - throwaway287391 10y ago
      The problem with that is it removes the incentive to sign up until you need an organ yourself. The vast majority of people don't need organs (at any given time), so if you allow them to opt in only once they need an organ, very few additional people would register, basically defeating the purpose of the idea. I agree that it would be better than the current system though -- there would still be a small increase in the supply of organs, but not a big one.
- mcv 10y ago
  It's not so much punishing, as letting them live (or die, as the case may be) with the consequences of their choices. Not being a donor means less donor organs available. Those go first to registered donors, and then to the non-donors. It sounds harsh at first, but from every angle I look at this, I can't really find anything unreasonable about it.
MereInterest 10y ago
People are rather bad at handling low-probability events. We underestimate the likelihood of bad events, and overestimate the likelihood of good events. If people were purely rational, your solution would work. However, people would underestimate the chance that they themselves will need an organ transplant, and so the lower chance of getting a transplant if needed would not be a good motivator. I am strongly in favor of organ donation being opt-out, rather than opt-in.
- shshhdhs 10y ago
  > I am strongly in favor of organ donation being opt-out, rather than opt-in. You're right. This would be an acceptable approach, with (perhaps) opting out placing you at the bottom of the list (if organ donation is not out of their control). Question to HN: What is the best method to propose this within the US government? The surgeon general? The CDC director? The United Network of Organ Sharing director? Or just my congressman/senator? I'm wondering who has the most clout to make this change.
- pbhjpbhj 10y ago
  >I am strongly in favor of organ donation being opt-out, rather than opt-in. // Whilst the state assumes control of a person's body around the time of their death, a little pre- or post- mortem, do you also consider that they should assume control of the persons other material assets? If you're in favour of the assumption of state possession of [portions of] a persons body it seems logical you should also think the public should be able to assume the good from that persons other cherry-picked assets. To emphasise the point, suppose a landed millionaire dies, their kidneys prove useful to someone - the state has written in to law that the persons bodily organs will be assumed to be possessions of the state. Would not also that persons properties, liquid assets, and other such non-bodily possessions be beneficial. Indeed they may give far greater benefit than their organs in some cases. Why the organs but not the non-bodily assets? Despite bodies being ruled as "not property" in UK law I'm of the opinion that a person's own body should be as much as feasible theirs to control as the other assets of that person are post-mortem. If people get to say what happens to their house, why should they not get to say what happens to their retinas, say? Personally I find a greater moral good in assuming the possession of the non-bodily assets to the state and allowing people to choose to donate their bodies.
tomjen3 10y ago
Or we could do what works in absolutely all other cases and stop murdering people who are waiting for organs: PAY FOR THEM. If we had only food as provided as a voluntary gift, we would have a waiting list for food too and quite a lot less people.
- Oletros 10y ago
  Pay for what?
rickycook 10y ago
decent idea i think, but there are a number of situations outside of people's control that may make them ineligible for organ donation, and i don't think they shouldn't be punished because they can't be a donor
- devoply 10y ago
  such as? how about you opt-in and the doctor gets to decide whether you are in a position to donate organs or not. you made the intention known even if you are not capable, like for instance you have a disease or something.
- throwaway287391 10y ago
  Well yeah, I certainly wouldn't say someone who opted in but turned out to be ineligible for whatever reason should be deprioritized like someone who didn't opt in (or opted out). The point is just to get as many people to opt in (or not opt out) as possible to increase the overall supply.
maxcan 10y ago
The Singapore HOTA law works like that. It's opt-out and if you opt out you lose priority
kahrkunne 10y ago
Frankly I'd be OK with that, even though I'd rather die than have them harvest my organs and desecrate my corpse. I guess being at the bottom of the queue is not that bad a price to pay for that, it's only fair. I'm against an opt-out system, though. I don't think the default should be for people to cut pieces out of someone, and I think most people wouldn't want that.
- unclenoriega 10y ago
  > Frankly I'd be OK with that, even though I'd rather die than have them harvest my organs and desecrate my corpse I'd love it if you could elaborate on this position. In contrast, I feel like once I'm dead, my body has served its purpose, and if it can do some final good through donation, all the better. It would be interesting to hear more about your perspective. > I don't think the default should be for people to cut pieces out of someone, and I think most people wouldn't want that. This doesn't seem to be true, at least in the US and UK (although the US is/was right around 50%): https://www.organdonor.gov/dtcp/nationalsurveyorgandonation.pdf https://www.organdonor.gov/dtcp/nationalsurveyorgandonation.... http://www.bbc.co.uk/news/uk-wales-politics-17226610 http://www.bbc.co.uk/news/uk-wales-politics-17226610
Oletros 10y ago
Spain has an opt out system and it has the greatest donation per capita in the world. By the way, only 5% of the organs came from vehicle accidents

mulmen 10y ago

Wouldn't people just wait until they need an organ to join the list? How does punishing a subset of needy organ recipients increase the actual number of available organs?

throwaway287391 10y ago
Right, obviously you'd need to record the date they opted in and not give someone "credit" for registering once they were in need of a donation. It would help to increase the number of available organs because some people who don't care to register now might do so knowing that it means if they ever get into an accident they have a higher likelihood of receiving an organ.
- theonemind 10y ago
  This sounds more like punishing the person who changed their mind. If they receive an organ, they can still die and give their organs. Logically, shouldn't they get moved up in the list to receive organs, but possibly not have the option to withdrawal their donation once they've received organs?
  - throwaway287391 10y ago
    The problem with that is it removes the incentive to sign up until you need an organ yourself. The vast majority of people don't need organs (at any given time), so if you allow them to opt in only once they need an organ, very few additional people would register, basically defeating the purpose of the idea. I agree that it would be better than the current system though -- there would still be a small increase in the supply of organs, but not a big one.
mcv 10y ago
It's not so much punishing, as letting them live (or die, as the case may be) with the consequences of their choices. Not being a donor means less donor organs available. Those go first to registered donors, and then to the non-donors. It sounds harsh at first, but from every angle I look at this, I can't really find anything unreasonable about it.

MereInterest 10y ago

People are rather bad at handling low-probability events. We underestimate the likelihood of bad events, and overestimate the likelihood of good events. If people were purely rational, your solution would work. However, people would underestimate the chance that they themselves will need an organ transplant, and so the lower chance of getting a transplant if needed would not be a good motivator. I am strongly in favor of organ donation being opt-out, rather than opt-in.

shshhdhs 10y ago
> I am strongly in favor of organ donation being opt-out, rather than opt-in. You're right. This would be an acceptable approach, with (perhaps) opting out placing you at the bottom of the list (if organ donation is not out of their control). Question to HN: What is the best method to propose this within the US government? The surgeon general? The CDC director? The United Network of Organ Sharing director? Or just my congressman/senator? I'm wondering who has the most clout to make this change.
pbhjpbhj 10y ago
>I am strongly in favor of organ donation being opt-out, rather than opt-in. // Whilst the state assumes control of a person's body around the time of their death, a little pre- or post- mortem, do you also consider that they should assume control of the persons other material assets? If you're in favour of the assumption of state possession of [portions of] a persons body it seems logical you should also think the public should be able to assume the good from that persons other cherry-picked assets. To emphasise the point, suppose a landed millionaire dies, their kidneys prove useful to someone - the state has written in to law that the persons bodily organs will be assumed to be possessions of the state. Would not also that persons properties, liquid assets, and other such non-bodily possessions be beneficial. Indeed they may give far greater benefit than their organs in some cases. Why the organs but not the non-bodily assets? Despite bodies being ruled as "not property" in UK law I'm of the opinion that a person's own body should be as much as feasible theirs to control as the other assets of that person are post-mortem. If people get to say what happens to their house, why should they not get to say what happens to their retinas, say? Personally I find a greater moral good in assuming the possession of the non-bodily assets to the state and allowing people to choose to donate their bodies.

tomjen3 10y ago

Or we could do what works in absolutely all other cases and stop murdering people who are waiting for organs: PAY FOR THEM. If we had only food as provided as a voluntary gift, we would have a waiting list for food too and quite a lot less people.

Oletros 10y ago
Pay for what?

rickycook 10y ago

decent idea i think, but there are a number of situations outside of people's control that may make them ineligible for organ donation, and i don't think they shouldn't be punished because they can't be a donor

devoply 10y ago
such as? how about you opt-in and the doctor gets to decide whether you are in a position to donate organs or not. you made the intention known even if you are not capable, like for instance you have a disease or something.
throwaway287391 10y ago
Well yeah, I certainly wouldn't say someone who opted in but turned out to be ineligible for whatever reason should be deprioritized like someone who didn't opt in (or opted out). The point is just to get as many people to opt in (or not opt out) as possible to increase the overall supply.

maxcan 10y ago

The Singapore HOTA law works like that. It's opt-out and if you opt out you lose priority

kahrkunne 10y ago

Frankly I'd be OK with that, even though I'd rather die than have them harvest my organs and desecrate my corpse. I guess being at the bottom of the queue is not that bad a price to pay for that, it's only fair. I'm against an opt-out system, though. I don't think the default should be for people to cut pieces out of someone, and I think most people wouldn't want that.

unclenoriega 10y ago
> Frankly I'd be OK with that, even though I'd rather die than have them harvest my organs and desecrate my corpse I'd love it if you could elaborate on this position. In contrast, I feel like once I'm dead, my body has served its purpose, and if it can do some final good through donation, all the better. It would be interesting to hear more about your perspective. > I don't think the default should be for people to cut pieces out of someone, and I think most people wouldn't want that. This doesn't seem to be true, at least in the US and UK (although the US is/was right around 50%): https://www.organdonor.gov/dtcp/nationalsurveyorgandonation.pdf https://www.organdonor.gov/dtcp/nationalsurveyorgandonation.... http://www.bbc.co.uk/news/uk-wales-politics-17226610 http://www.bbc.co.uk/news/uk-wales-politics-17226610

Oletros 10y ago

Spain has an opt out system and it has the greatest donation per capita in the world. By the way, only 5% of the organs came from vehicle accidents