12 ms·

Organ donation becomes opt-out in France

91 points by MaysonL 10y ago

sdfhbdf 10y ago
It's been like that in Poland for many years now, but in reality this doesn't really work since families are always asked before the donation and they usually refuse and the law doesn't really expect the doctors to ask the families but they still do it anyway, just to be on the safe side and not have to deal with repercussions like the family suing the doctor.
- x1798DE 10y ago
  This seems like a perfectly sensible thing to do, honestly. If I were designing the system, I'd say that the default option is opt-out and that if you make an affirmative choice (yes or no) during your lifetime, that choice overrides your family's wishes, but otherwise your family gets a "veto" over your organ donation. The whole problem that "opt-in" organ donation is that most people just do whatever the default is and no actual human decisionmaking takes place, so it's preferable to have sensible defaults. If a human is overriding the default, that's the desired behavior.
  - jhasse 10y ago
    Why wouldn't you want to donate your organs though? And especially: Why wouldn't the family want to donate the organs of their relative?
    - jobigoud 10y ago
      That's a different issue. Some people are religious or superstitious, and I guess there are religions against organ donation.
      - ryanlol 10y ago
        Why can't we expect people to have reasonable reasons for their refusal?
        BugsJustFindMe 10y ago
        Reasonable reasons unrelated to superstition? Name one?
        ryanlol 10y ago
        I can't think of any, but I do strongly believe that anyone who can come up with one should be allowed to keep their organs :)
    - nhaehnle 10y ago
      Some people are afraid that doctors will make less of an effort to keep you alive if you're an organ donor. Knowing doctors I find that fear extremely implausible, but it exists.
    - slv77 10y ago
      Families are typically out of their depth in these situations and completely dependent on medical staff to guide them in decisions regarding their loved one. Medical staff may confront the family with the question of organ donation before they have been able to internalize the decision to withdrawl life support. Without time to internalize the decision to withdraw life support families may feel that allowing organ donation may be bias medical staff and, even subconsciously, tip the scales. Families may be uncomfortable with yielding control of their loved ones body to the medical establishment. The question of organ donation is presented as a binary choice to families (all or nothing) and requires a significant degree of trust in the medical community. They may worry that they are unwittingly consenting to donations of germ cells; that part of their loved one may end up in a student lab or that organ donation may delay a funeral. Families may worry that donation will incur additional costs or that someone will profit from the deceased organs (see Henrietta Lacks and HeLa). Also making an opt-in decision in any complex situation that requires unanimous consent of what is essentially a committee is typically going to result in no-action.
  - jobigoud 10y ago
    This would render the whole point moot. Why have a default in the first place if you always require an affirmative choice, either from the person or from the family?
    - ghaff 10y ago
      That is basically the practical problem with an opt out system. Defaults are sufficiently powerful that lack of an opt out can't really (and really shouldn't) be taken as an affirmative choice.
    - x1798DE 10y ago
      Well, ideally yes you'd just enforce an affirmative choice here, but I think the whole point of having an organ donor registry is for time-critical situations like when you can't find someone to ask or when there is not clear person to ask.
- marcosdumay 10y ago
  This. Is there any place where the de-facto policy isn't to ignore anything on paper and ask the family? I am not sure this change makes any difference.
Insanity 10y ago
This has been the case in Belgium for about 20 years. The law does make it possible for the family to _refuse_ in case they have objections against it. It is the default, but the family is still considered. And a link, in Dutch. I'm not sure how well you'd fare with google translate so sorry for that: http://reborntobealive.be/orgaandonatie/belgische-wetgeving-orgaandonatie/ http://reborntobealive.be/orgaandonatie/belgische-wetgeving-...
- rudy1220 10y ago
  Any stats to show how this has helped reduce the transplant waitlist?
- the_duke 10y ago
  It's opt-out in Austria as well. You can register your opt-out with a simple signed letter to the government. I don't have the time to dig up the statistics right now, but the percentage of donors is considerably higher than, for example, in Germany, which is opt-in.
  - basicplus2 10y ago
    You don't have to be brain dead in Australia anymore either.. only your heart has to stop. "Identify cessation of circulation (absence of circulation for a period of not less than 2 minutes and not more than 5 minutes)" While the plain English information sheet cherry picks some severe cases.. "Generally they are patients with very severe brain injury from which they cannot recover. Less often, they are patients with terminal heart or lung failure, or have suffered a very severe spinal injury where they cannot breathe unassisted" The actual protocol says... "resuscitative attempts are either contraindicated on medical grounds, given that it has been determined that meaningful recovery of the patient is unlikely, or the patient (or the person with legal authority to make his or her medical decisions) has decided that resuscitative measures would be unduly burdensome." Which pretty much gives the green light no matter what. http://www.donatelife.gov.au/national-protocol-donation-and-cardiac-death http://www.donatelife.gov.au/national-protocol-donation-and-...
ghaff 10y ago
Defaults are an extremely powerful policy lever--sometimes worryingly powerful. FWIW, Richard Thaler, who played a big role in creating the field of behavioral economics, has argued in favor of "mandated choice" for organ donations at the time people renew their drivers license [1]. His concern with default opt-in, as I recall from one of his books, is that defaults are so powerful that they may not really create implied consent. [1]http://www.nytimes.com/2009/09/27/business/economy/27view.html http://www.nytimes.com/2009/09/27/business/economy/27view.ht...
- Freak_NL 10y ago
  Mandated choice sounds like a very useful mechanism, but I would fear that for many people being confronted with this choice when you are renewing your driver's licence means defaulting for the 'safe' option of non-donor. The tricky thing about organ donation is that the default choice tends to be 'postpone deciding'. For society at large this is harmful. Hypothetically, if you could ask someone's ghost after they've died on the hospital table, I bet most people would gladly donate their organs (perhaps with the occasional “Oh but can you please leave my face untouched?” thrown in) after accepting their untimely demise. But we can't. So with opt-in and a with a mandated binary choice at a set time you go for the safe option, which is 'non-donor' (“I'll change it after I've thought it through.”).
  - ghaff 10y ago
    I don't disagree with any of that. The alternative though with opt out is that you're effectively not giving many people a choice because they don't get around to making one. Maybe that's ok as a matter of policy but it has both philosophical and practical issues.
  - michaelt 10y ago
    Hypothetically, if you could ask someone's ghost [...] I bet most people would gladly donate their organs Don't you think it's a bit of a stretch to imagine you know someone's preferences better than they do when they've explicitly stated their preferences through a forced choice mechanism?
  - 10y ago
Randgalt 10y ago
This is appalling. Are not our bodies our own? The remains of our bodies should belong to whomever we will it to.
- Freak_NL 10y ago
  You are welcome to register yourself as non-donor.
  - Randgalt 10y ago
    You are free to file a form so as not to have your body stolen at death. Sounds great.
    - Freak_NL 10y ago
      Living in any modern society means taking on some duties and obligations for the benefit of the society. This will bother you for five minutes in France before clicking 'submit' and getting on with your (hopefully long lasting) life. You would wish dealing with taxes was as easy that. Besides, what are you going to do with your body? It'll be gone sooner or later.
      - Randgalt 10y ago
        Besides, what are you going to do with your <fill in the blank>? It'll be gone sooner or later
        gattilorenz 10y ago
        The difference being, there's not much use for your heart once you're dead. Not only that, but it's useless even for your family, since they can't simply sell it or profit in any way as they would with most things (unless you're also advocating for the family right to sell your organs).
    - orf 10y ago
      > Stolen Sorry, you mean some critical organs used to save others lives after you die? Or where you planning to use that lovely healthy heart after you die, when a patient in the next room is dying because they cant find a suitable transplant.
df3 10y ago
Many will benefit from this change, but France should not force anyone to opt into what is a very personal and emotional decision. The government should not tell you what to do with your body even after death. The online opt-out registry and opt-out form options will give people a chance to express their wishes to avoid donation. However, there will be a sizable portion of the population who do not fill these out due to ignorance, especially in the less advantaged fringes of society. What is the government going to do to make sure everyone knows about the change and the ability to opt-out?
- eloff 10y ago
  In this case I respectfully disagree. If it's opt-in, many, many fewer people opt-in. The data on this is a striking and huge difference between opt-in and opt-out countries. All countries should change to opt-out because it would save a lot of lives - and that's exactly the kind of trade off between personal freedom and the greater good that governments are in the best position to make. That's why we have seat-belt laws and helmet laws and government vaccination programs, etc. The tragedy in this is actually how long countries are taking to wake up to the data and take action. In Canada (BC anyway) it's still opt-in.
- d4adb33f 10y ago
  You do not need your body after you are dead. This is good for society. If anything the opt out should be further restricted. You may opt out, but you'd need a valid reason. Any held superstition should not be grounds.
  - jobigoud 10y ago
    > Any held superstition should not be grounds Well, I feel that by the time a government can take decisions that are oblivious to any sort of superstition, religion included, the society will have matured so much than donating your organs after you die will be so obvious to be a non-issue.
  - afastow 10y ago
    > If anything the opt out should be further restricted. You may opt out, but you'd need a valid reason. Any held superstition should not be grounds. This is insane and a reason why some people would be against "opt-in by default" is fear of it expanding into something draconian like you are describing. You don't respect religious beliefs(which you were clearly referring to derisively as "superstition"). Fine. But please don't advocate for your contempt to be codified into laws that discriminate against people different than you. I'm all for making organ donation opt-in by default since I believe that accurately reflects most people's actual preference. But I'm not for tricking or forcing anyone into it. The default should be made clear and people should be able to easily opt-out for any reason they see fit or even no reason at all.
Freak_NL 10y ago
In The Netherlands a similar bill has been submitted to our upper house for approval last September. I hope it passes, although there is vocal opposition against this issue. From a society's perspective opt-out makes perfect sense. If you are really against organ donation, just register yourself as such; it takes all of five minutes. I don't even care why you would want to keep all your organs after death, it's not my call. The reason to go for opt-out rather than opt-in is because a lot of people simply don't register their preference, even when they are, rationally speaking, all for organ donation — that's the critical point. Thinking about your own mortality sucks, and visiting the website where you can register yourself as a donor (necessary for the opt-in model) is something that hovers somewhere on the eternal to-do list, but somehow they never get around to it. Because it is never you that suddenly dies in a freak accident. If you are against organ donation, you will however register that preference the moment such a bill is passed into law. That's it. Statistics and psychology (and saving lives) are the reason states consider opt-out over opt-in. The state isn't invading your corporeal sovereignty, you are not being harvested for organs the moment you enter a hospital (well, not in France or The Netherlands at least), and you still get to decide.
- shaqbert 10y ago
  The "nudge" effect has had significant positive results [1] where it got introduced. It basically is the difference between a many year organ waiting list and getting a rapid transplant. [1] http://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-014-0131-4 http://bmcmedicine.biomedcentral.com/articles/10.1186/s12916...
- jhg7877 10y ago
  "From a society's perspective opt-out makes perfect sense." It's very troubling to follow that line of thought. It's also arguably in societies interest to make all your private medical data publicly available for research and all your private communications, purchases and movements available to any government agency to prevent crime etc. How many people would be comfortable with what are considered by many to be fundamental rights being opt-in all of a sudden? "The state isn't invading your corporeal sovereignty". It is, in the most fundamental and intimate way possible. If you support opt-out at least be honest about what it is. I carry an organ donation card but this is a line I think should not be crossed. There are alternative which don't make your body ownership opt-in (like doctors guidelines about approaching families etc).
pd0wm 10y ago
The title of the article is misleading. France has had an opt-out sytem for organ donation for years. The only thing that has changed is that it is no longer required to consult relatives for a second opinion. > Until 1 January, when the legislation took effect, unless the person who had died had previously expressed a clear wish for or against donation, doctors were required to consult relatives who, in almost a third of cases, refused.
- jobigoud 10y ago
  So it wasn't really "opt-out" nor "opt-in" if the default case was that you had to consult relatives.
  - catwell 10y ago
    You had to consult relatives and ask them: "do you know if the deceased was opposed to this"? This meant the way to opt out was to tell your relatives. It has been the case for 40 years. [1] There were posters in most hospital waiting rooms telling people to do this (which I found creepy as I found myself there a few months ago, waiting for news on whether a relative would live or die, by the way). See [2] for an example. Now the only way to opt out is to send snail mail (!) to be added to a nationwide file. It should become possible to do it over the Internet someday. Fun fact - we have a pin card that has been designed to store that information since 2006, but the feature has never been made accessible to the public. [3] [1] (fr) http://www.lemonde.fr/les-decodeurs/article/2016/12/22/don-d-organe-quarante-ans-apres-la-loi-sur-le-consentement-presume-ou-en-est-on_5053129_4355770.html http://www.lemonde.fr/les-decodeurs/article/2016/12/22/don-d... [2] (fr) http://fr.slideshare.net/amfe/guide-du-don-dorganes-2015-de-lagence-de-biomdecine http://fr.slideshare.net/amfe/guide-du-don-dorganes-2015-de-... [3] (fr) https://www.agence-biomedecine.fr/Carte-Vitale-2-et-don-d-organes?lang=fr https://www.agence-biomedecine.fr/Carte-Vitale-2-et-don-d-or...
    - jobigoud 10y ago
      Oh, so instead of saying "I don't know" to trigger the default, people were possibly lying and taking a decision on behalf of their deceased relative…
JoeAltmaier 10y ago
Its an emotional subject. Doesn't it boil down to "I'm uneasy about thinking about what happens to my body after I'm dead" versus "Don't let living people die". One is, in my opinion, a much stronger argument.
- jhg7877 10y ago
  That's not what the debate is. It's about the dark pattern of opt-out in which other people make the choice for you and being forced to opt out of it. Many people, myself included, are for organ donation but oppose opt-out as unethical and dangerous.
  - JoeAltmaier 10y ago
    There's an equally compelling argument that 'opt-in' is a dark pattern, that 'makes the choice for you' and forces you to do paperwork. Its equally troubling to imagine your organs go to waste after you die because of incomplete paperwork. Why are not those concerned about that, given equal time?
  - pzh 10y ago
    I wonder how many people opted out just to protest the 'opt-in by default' law.
- Vinnl 10y ago
  In my case, it's "I'm not uneasy about thinking about what happens to my body after I'm dead, but I'm uneasy about 'tricking' people who might actually be uneasy about it". Where I think "I'm uneasy" is understating a feeling of which you might not understand the intensity if you're not feeling it that way.
nmc 10y ago
The article is entirely wrong. Organ donation has been opt-out in France since the first law on the subject in 1976. The only new thing in 2017 is that you can now easily opt-out online.
cpr 10y ago
The real and serious problem with this is that the organ donation process biases the medical profession into declaring you "dead" as soon as possible, and ideally even sooner, so that your organs are as fresh as possible.
- mikeash 10y ago
  Does this actually happen? I see this concern mentioned several times here, but always as a hypothetical. Has there been any research done to see if donors do indeed receive inferior care?
  - ta1029384756 10y ago
    How could you gather this data, and who could publish the study and be trusted by the public?
    - mikeash 10y ago
      Seems like it would be straightforward to compare care and outcomes between donors and non-donors and see how they differ. In any case, I'm not the one making the claim, so I'm not the one who has to back it up.
    - deleted 10y ago
      [deleted]
- ceejayoz 10y ago
  That would indeed be a serious problem, but you've got a funny definition of real.
Nexxxeh 10y ago
Wales has relatively recently moved to "opt-out". It appears to have already made a huge positive difference. I was disgusted at how many people opted out though. The Welsh aren't generally thought of as selfish. I had opted in long before the change, why would I hoard my meat bits when I die? I should stress, in Wales at least, it is still worth explicitly opting in. The presumed consent only applies if you die in Wales. If you died on the wrong side of the Severn, like a trip to Cribbs Causeway over the border in England had a tragic twist, the presumed consent doesn't apply.
deleted 10y ago
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pkaye 10y ago
One never knows that they might eventually need an organ transplant. Two years ago I was feeling reasonably healthy for my age but internally a uncommon auto immune disease are fighting a battle and my kidney were losing it with hardly any symptoms of the damage. In a manner of months I had some joint pains that wouldn't go away and my weight started ballooning. I went to the doctor and he didn't take it seriously until tests indicated that I was stage 4 kidney disease. Generally at this point is it too late and kidney function may slowly degrade further over time. I found my diagnosis at that point and even if discovered early the auto immune disease I have still doesn't have a cure to stop it other than treat the symptoms. My short term hopes are to stay healthy as possible and when required switch to dialysis and try to live a long normal life until I get a transplant. But in most places in the US, a kidney transplant takes 3-5 years on a list due to organ shortage. In many parts of the EU the wait is just under a year. Also organ transplant is not a cure in any way since one needs a lifetime of drugs to keeps prevent rejection but it is better than dialysis in trying to live a normal life. On the question of organ donation being opt-in/out I certainly would like a shorter wait time but I would like people to be informed as much as possible to make a decision. I think much of it is people believing it will never happen to them that they need it. But just remember that on a roll of dice things can change for you without even knowing it.
Cozumel 10y ago
There's an angle to organ transplants that I've not heard discussed. We are who we are to a certain extent through DNA, when you receive a transplant you're receiving someone else's DNA, you receive all their genetic dispositions. There's lots of cases of people undergoing personality changes after a transplant, as far as I know no-one has ever studied this in depth but it's real. Can An Organ Transplant Change A Recipient's Personality? Cell Memory Theory Affirms 'Yes' - http://www.medicaldaily.com/can-organ-transplant-change-recipients-personality-cell-memory-theory-affirms-yes-247498 http://www.medicaldaily.com/can-organ-transplant-change-reci... This study confirms behavioural changes but puts it down to 'fantasy' - https://www.ncbi.nlm.nih.gov/pubmed/1299456 https://www.ncbi.nlm.nih.gov/pubmed/1299456 Another paper - http://www.namahjournal.com/doc/Actual/Memory-transference-in-organ-transplant-recipients-vol-19-iss-1.html http://www.namahjournal.com/doc/Actual/Memory-transference-i... Transplants don't save lives, they violate it in the worst possible way. And allowing the state to harvest your organs without your consent is bad. The alternative is regrowing the needed organ from your own cells and using that, there's already been some progress growing them from stem cells.
- arjie 10y ago
  > Transplants don't save lives, they violate it in the worst possible way. How? The recipient is consenting to receive. As for the donor, here's a tale about Diogenes of Sinope: > When asked how he wished to be buried, he left instructions to be thrown outside the city wall so wild animals could feast on his body. When asked if he minded this, he said, "Not at all, as long as you provide me with a stick to chase the creatures away!" When asked how he could use the stick since he would lack awareness, he replied "If I lack awareness, then why should I care what happens to me when I am dead?"
- d4adb33f 10y ago
  > Transplants don't save lives, they violate it in the worst possible way. Wait, what? I don't even know where to begin. That whole sentence does not make any sense. > And allowing the state to harvest your organs without your consent is bad. So opt-out and call it a day. Not that I oppose mandatory organ donation. I'm not even going to touch that cell memory theory.
- 10y ago
WalterBright 10y ago
From an episode of "House", why not expand the pool of donors by accepting organs from old people or otherwise more marginal organs? If it's a matter of life & death for the recipient, wouldn't a more marginal organ be better than none?
phkahler 10y ago
The problem is verification. As things are today, you have to verify that a person has registered as a donor. If they are and you can't confirm it then nothing happens as far as that person is concerned. In the new system if you can't confirm someone is a non-donor they'll take all your usable parts. I propose a compromise where every person is "supposed" to register their preference one way or the other. That would probably increase the number of registered donors, and if you can't find someone in the database you don't assume a default choice for them.
eternalban 10y ago
https://youtu.be/aclS1pGHp8o https://youtu.be/aclS1pGHp8o [Monty Python's take on this question]

91 points by MaysonL 10y ago

It's been like that in Poland for many years now, but in reality this doesn't really work since families are always asked before the donation and they usually refuse and the law doesn't really expect the doctors to ask the families but they still do it anyway, just to be on the safe side and not have to deal with repercussions like the family suing the doctor.

x1798DE 10y ago
This seems like a perfectly sensible thing to do, honestly. If I were designing the system, I'd say that the default option is opt-out and that if you make an affirmative choice (yes or no) during your lifetime, that choice overrides your family's wishes, but otherwise your family gets a "veto" over your organ donation. The whole problem that "opt-in" organ donation is that most people just do whatever the default is and no actual human decisionmaking takes place, so it's preferable to have sensible defaults. If a human is overriding the default, that's the desired behavior.
- jhasse 10y ago
  Why wouldn't you want to donate your organs though? And especially: Why wouldn't the family want to donate the organs of their relative?
  - jobigoud 10y ago
    That's a different issue. Some people are religious or superstitious, and I guess there are religions against organ donation.
    - ryanlol 10y ago
      Why can't we expect people to have reasonable reasons for their refusal?
      - BugsJustFindMe 10y ago
        Reasonable reasons unrelated to superstition? Name one?
        ryanlol 10y ago
        I can't think of any, but I do strongly believe that anyone who can come up with one should be allowed to keep their organs :)
  - nhaehnle 10y ago
    Some people are afraid that doctors will make less of an effort to keep you alive if you're an organ donor. Knowing doctors I find that fear extremely implausible, but it exists.
  - slv77 10y ago
    Families are typically out of their depth in these situations and completely dependent on medical staff to guide them in decisions regarding their loved one. Medical staff may confront the family with the question of organ donation before they have been able to internalize the decision to withdrawl life support. Without time to internalize the decision to withdraw life support families may feel that allowing organ donation may be bias medical staff and, even subconsciously, tip the scales. Families may be uncomfortable with yielding control of their loved ones body to the medical establishment. The question of organ donation is presented as a binary choice to families (all or nothing) and requires a significant degree of trust in the medical community. They may worry that they are unwittingly consenting to donations of germ cells; that part of their loved one may end up in a student lab or that organ donation may delay a funeral. Families may worry that donation will incur additional costs or that someone will profit from the deceased organs (see Henrietta Lacks and HeLa). Also making an opt-in decision in any complex situation that requires unanimous consent of what is essentially a committee is typically going to result in no-action.
- jobigoud 10y ago
  This would render the whole point moot. Why have a default in the first place if you always require an affirmative choice, either from the person or from the family?
  - ghaff 10y ago
    That is basically the practical problem with an opt out system. Defaults are sufficiently powerful that lack of an opt out can't really (and really shouldn't) be taken as an affirmative choice.
  - x1798DE 10y ago
    Well, ideally yes you'd just enforce an affirmative choice here, but I think the whole point of having an organ donor registry is for time-critical situations like when you can't find someone to ask or when there is not clear person to ask.
marcosdumay 10y ago
This. Is there any place where the de-facto policy isn't to ignore anything on paper and ask the family? I am not sure this change makes any difference.

Insanity 10y ago

This has been the case in Belgium for about 20 years. The law does make it possible for the family to _refuse_ in case they have objections against it. It is the default, but the family is still considered. And a link, in Dutch. I'm not sure how well you'd fare with google translate so sorry for that: http://reborntobealive.be/orgaandonatie/belgische-wetgeving-orgaandonatie/ http://reborntobealive.be/orgaandonatie/belgische-wetgeving-...

rudy1220 10y ago
Any stats to show how this has helped reduce the transplant waitlist?
the_duke 10y ago
It's opt-out in Austria as well. You can register your opt-out with a simple signed letter to the government. I don't have the time to dig up the statistics right now, but the percentage of donors is considerably higher than, for example, in Germany, which is opt-in.
- basicplus2 10y ago
  You don't have to be brain dead in Australia anymore either.. only your heart has to stop. "Identify cessation of circulation (absence of circulation for a period of not less than 2 minutes and not more than 5 minutes)" While the plain English information sheet cherry picks some severe cases.. "Generally they are patients with very severe brain injury from which they cannot recover. Less often, they are patients with terminal heart or lung failure, or have suffered a very severe spinal injury where they cannot breathe unassisted" The actual protocol says... "resuscitative attempts are either contraindicated on medical grounds, given that it has been determined that meaningful recovery of the patient is unlikely, or the patient (or the person with legal authority to make his or her medical decisions) has decided that resuscitative measures would be unduly burdensome." Which pretty much gives the green light no matter what. http://www.donatelife.gov.au/national-protocol-donation-and-cardiac-death http://www.donatelife.gov.au/national-protocol-donation-and-...

ghaff 10y ago

Defaults are an extremely powerful policy lever--sometimes worryingly powerful. FWIW, Richard Thaler, who played a big role in creating the field of behavioral economics, has argued in favor of "mandated choice" for organ donations at the time people renew their drivers license [1]. His concern with default opt-in, as I recall from one of his books, is that defaults are so powerful that they may not really create implied consent. [1]http://www.nytimes.com/2009/09/27/business/economy/27view.html http://www.nytimes.com/2009/09/27/business/economy/27view.ht...

Freak_NL 10y ago
Mandated choice sounds like a very useful mechanism, but I would fear that for many people being confronted with this choice when you are renewing your driver's licence means defaulting for the 'safe' option of non-donor. The tricky thing about organ donation is that the default choice tends to be 'postpone deciding'. For society at large this is harmful. Hypothetically, if you could ask someone's ghost after they've died on the hospital table, I bet most people would gladly donate their organs (perhaps with the occasional “Oh but can you please leave my face untouched?” thrown in) after accepting their untimely demise. But we can't. So with opt-in and a with a mandated binary choice at a set time you go for the safe option, which is 'non-donor' (“I'll change it after I've thought it through.”).
- ghaff 10y ago
  I don't disagree with any of that. The alternative though with opt out is that you're effectively not giving many people a choice because they don't get around to making one. Maybe that's ok as a matter of policy but it has both philosophical and practical issues.
- michaelt 10y ago
  Hypothetically, if you could ask someone's ghost [...] I bet most people would gladly donate their organs Don't you think it's a bit of a stretch to imagine you know someone's preferences better than they do when they've explicitly stated their preferences through a forced choice mechanism?
- 10y ago

Randgalt 10y ago

This is appalling. Are not our bodies our own? The remains of our bodies should belong to whomever we will it to.

Freak_NL 10y ago
You are welcome to register yourself as non-donor.
- Randgalt 10y ago
  You are free to file a form so as not to have your body stolen at death. Sounds great.
  - Freak_NL 10y ago
    Living in any modern society means taking on some duties and obligations for the benefit of the society. This will bother you for five minutes in France before clicking 'submit' and getting on with your (hopefully long lasting) life. You would wish dealing with taxes was as easy that. Besides, what are you going to do with your body? It'll be gone sooner or later.
    - Randgalt 10y ago
      Besides, what are you going to do with your <fill in the blank>? It'll be gone sooner or later
      - gattilorenz 10y ago
        The difference being, there's not much use for your heart once you're dead. Not only that, but it's useless even for your family, since they can't simply sell it or profit in any way as they would with most things (unless you're also advocating for the family right to sell your organs).
  - orf 10y ago
    > Stolen Sorry, you mean some critical organs used to save others lives after you die? Or where you planning to use that lovely healthy heart after you die, when a patient in the next room is dying because they cant find a suitable transplant.

df3 10y ago

Many will benefit from this change, but France should not force anyone to opt into what is a very personal and emotional decision. The government should not tell you what to do with your body even after death. The online opt-out registry and opt-out form options will give people a chance to express their wishes to avoid donation. However, there will be a sizable portion of the population who do not fill these out due to ignorance, especially in the less advantaged fringes of society. What is the government going to do to make sure everyone knows about the change and the ability to opt-out?

eloff 10y ago
In this case I respectfully disagree. If it's opt-in, many, many fewer people opt-in. The data on this is a striking and huge difference between opt-in and opt-out countries. All countries should change to opt-out because it would save a lot of lives - and that's exactly the kind of trade off between personal freedom and the greater good that governments are in the best position to make. That's why we have seat-belt laws and helmet laws and government vaccination programs, etc. The tragedy in this is actually how long countries are taking to wake up to the data and take action. In Canada (BC anyway) it's still opt-in.
d4adb33f 10y ago
You do not need your body after you are dead. This is good for society. If anything the opt out should be further restricted. You may opt out, but you'd need a valid reason. Any held superstition should not be grounds.
- jobigoud 10y ago
  > Any held superstition should not be grounds Well, I feel that by the time a government can take decisions that are oblivious to any sort of superstition, religion included, the society will have matured so much than donating your organs after you die will be so obvious to be a non-issue.
- afastow 10y ago
  > If anything the opt out should be further restricted. You may opt out, but you'd need a valid reason. Any held superstition should not be grounds. This is insane and a reason why some people would be against "opt-in by default" is fear of it expanding into something draconian like you are describing. You don't respect religious beliefs(which you were clearly referring to derisively as "superstition"). Fine. But please don't advocate for your contempt to be codified into laws that discriminate against people different than you. I'm all for making organ donation opt-in by default since I believe that accurately reflects most people's actual preference. But I'm not for tricking or forcing anyone into it. The default should be made clear and people should be able to easily opt-out for any reason they see fit or even no reason at all.

Freak_NL 10y ago

In The Netherlands a similar bill has been submitted to our upper house for approval last September. I hope it passes, although there is vocal opposition against this issue. From a society's perspective opt-out makes perfect sense. If you are really against organ donation, just register yourself as such; it takes all of five minutes. I don't even care why you would want to keep all your organs after death, it's not my call. The reason to go for opt-out rather than opt-in is because a lot of people simply don't register their preference, even when they are, rationally speaking, all for organ donation — that's the critical point. Thinking about your own mortality sucks, and visiting the website where you can register yourself as a donor (necessary for the opt-in model) is something that hovers somewhere on the eternal to-do list, but somehow they never get around to it. Because it is never you that suddenly dies in a freak accident. If you are against organ donation, you will however register that preference the moment such a bill is passed into law. That's it. Statistics and psychology (and saving lives) are the reason states consider opt-out over opt-in. The state isn't invading your corporeal sovereignty, you are not being harvested for organs the moment you enter a hospital (well, not in France or The Netherlands at least), and you still get to decide.

shaqbert 10y ago
The "nudge" effect has had significant positive results [1] where it got introduced. It basically is the difference between a many year organ waiting list and getting a rapid transplant. [1] http://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-014-0131-4 http://bmcmedicine.biomedcentral.com/articles/10.1186/s12916...
jhg7877 10y ago
"From a society's perspective opt-out makes perfect sense." It's very troubling to follow that line of thought. It's also arguably in societies interest to make all your private medical data publicly available for research and all your private communications, purchases and movements available to any government agency to prevent crime etc. How many people would be comfortable with what are considered by many to be fundamental rights being opt-in all of a sudden? "The state isn't invading your corporeal sovereignty". It is, in the most fundamental and intimate way possible. If you support opt-out at least be honest about what it is. I carry an organ donation card but this is a line I think should not be crossed. There are alternative which don't make your body ownership opt-in (like doctors guidelines about approaching families etc).

pd0wm 10y ago

The title of the article is misleading. France has had an opt-out sytem for organ donation for years. The only thing that has changed is that it is no longer required to consult relatives for a second opinion. > Until 1 January, when the legislation took effect, unless the person who had died had previously expressed a clear wish for or against donation, doctors were required to consult relatives who, in almost a third of cases, refused.

jobigoud 10y ago
So it wasn't really "opt-out" nor "opt-in" if the default case was that you had to consult relatives.
- catwell 10y ago
  You had to consult relatives and ask them: "do you know if the deceased was opposed to this"? This meant the way to opt out was to tell your relatives. It has been the case for 40 years. [1] There were posters in most hospital waiting rooms telling people to do this (which I found creepy as I found myself there a few months ago, waiting for news on whether a relative would live or die, by the way). See [2] for an example. Now the only way to opt out is to send snail mail (!) to be added to a nationwide file. It should become possible to do it over the Internet someday. Fun fact - we have a pin card that has been designed to store that information since 2006, but the feature has never been made accessible to the public. [3] [1] (fr) http://www.lemonde.fr/les-decodeurs/article/2016/12/22/don-d-organe-quarante-ans-apres-la-loi-sur-le-consentement-presume-ou-en-est-on_5053129_4355770.html http://www.lemonde.fr/les-decodeurs/article/2016/12/22/don-d... [2] (fr) http://fr.slideshare.net/amfe/guide-du-don-dorganes-2015-de-lagence-de-biomdecine http://fr.slideshare.net/amfe/guide-du-don-dorganes-2015-de-... [3] (fr) https://www.agence-biomedecine.fr/Carte-Vitale-2-et-don-d-organes?lang=fr https://www.agence-biomedecine.fr/Carte-Vitale-2-et-don-d-or...
  - jobigoud 10y ago
    Oh, so instead of saying "I don't know" to trigger the default, people were possibly lying and taking a decision on behalf of their deceased relative…

JoeAltmaier 10y ago

Its an emotional subject. Doesn't it boil down to "I'm uneasy about thinking about what happens to my body after I'm dead" versus "Don't let living people die". One is, in my opinion, a much stronger argument.

jhg7877 10y ago
That's not what the debate is. It's about the dark pattern of opt-out in which other people make the choice for you and being forced to opt out of it. Many people, myself included, are for organ donation but oppose opt-out as unethical and dangerous.
- JoeAltmaier 10y ago
  There's an equally compelling argument that 'opt-in' is a dark pattern, that 'makes the choice for you' and forces you to do paperwork. Its equally troubling to imagine your organs go to waste after you die because of incomplete paperwork. Why are not those concerned about that, given equal time?
- pzh 10y ago
  I wonder how many people opted out just to protest the 'opt-in by default' law.
Vinnl 10y ago
In my case, it's "I'm not uneasy about thinking about what happens to my body after I'm dead, but I'm uneasy about 'tricking' people who might actually be uneasy about it". Where I think "I'm uneasy" is understating a feeling of which you might not understand the intensity if you're not feeling it that way.

nmc 10y ago

The article is entirely wrong. Organ donation has been opt-out in France since the first law on the subject in 1976. The only new thing in 2017 is that you can now easily opt-out online.

cpr 10y ago

The real and serious problem with this is that the organ donation process biases the medical profession into declaring you "dead" as soon as possible, and ideally even sooner, so that your organs are as fresh as possible.

mikeash 10y ago
Does this actually happen? I see this concern mentioned several times here, but always as a hypothetical. Has there been any research done to see if donors do indeed receive inferior care?
- ta1029384756 10y ago
  How could you gather this data, and who could publish the study and be trusted by the public?
  - mikeash 10y ago
    Seems like it would be straightforward to compare care and outcomes between donors and non-donors and see how they differ. In any case, I'm not the one making the claim, so I'm not the one who has to back it up.
  - deleted 10y ago
    [deleted]
ceejayoz 10y ago
That would indeed be a serious problem, but you've got a funny definition of real.

Nexxxeh 10y ago

Wales has relatively recently moved to "opt-out". It appears to have already made a huge positive difference. I was disgusted at how many people opted out though. The Welsh aren't generally thought of as selfish. I had opted in long before the change, why would I hoard my meat bits when I die? I should stress, in Wales at least, it is still worth explicitly opting in. The presumed consent only applies if you die in Wales. If you died on the wrong side of the Severn, like a trip to Cribbs Causeway over the border in England had a tragic twist, the presumed consent doesn't apply.

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pkaye 10y ago

One never knows that they might eventually need an organ transplant. Two years ago I was feeling reasonably healthy for my age but internally a uncommon auto immune disease are fighting a battle and my kidney were losing it with hardly any symptoms of the damage. In a manner of months I had some joint pains that wouldn't go away and my weight started ballooning. I went to the doctor and he didn't take it seriously until tests indicated that I was stage 4 kidney disease. Generally at this point is it too late and kidney function may slowly degrade further over time. I found my diagnosis at that point and even if discovered early the auto immune disease I have still doesn't have a cure to stop it other than treat the symptoms. My short term hopes are to stay healthy as possible and when required switch to dialysis and try to live a long normal life until I get a transplant. But in most places in the US, a kidney transplant takes 3-5 years on a list due to organ shortage. In many parts of the EU the wait is just under a year. Also organ transplant is not a cure in any way since one needs a lifetime of drugs to keeps prevent rejection but it is better than dialysis in trying to live a normal life. On the question of organ donation being opt-in/out I certainly would like a shorter wait time but I would like people to be informed as much as possible to make a decision. I think much of it is people believing it will never happen to them that they need it. But just remember that on a roll of dice things can change for you without even knowing it.

Cozumel 10y ago

There's an angle to organ transplants that I've not heard discussed. We are who we are to a certain extent through DNA, when you receive a transplant you're receiving someone else's DNA, you receive all their genetic dispositions. There's lots of cases of people undergoing personality changes after a transplant, as far as I know no-one has ever studied this in depth but it's real. Can An Organ Transplant Change A Recipient's Personality? Cell Memory Theory Affirms 'Yes' - http://www.medicaldaily.com/can-organ-transplant-change-recipients-personality-cell-memory-theory-affirms-yes-247498 http://www.medicaldaily.com/can-organ-transplant-change-reci... This study confirms behavioural changes but puts it down to 'fantasy' - https://www.ncbi.nlm.nih.gov/pubmed/1299456 https://www.ncbi.nlm.nih.gov/pubmed/1299456 Another paper - http://www.namahjournal.com/doc/Actual/Memory-transference-in-organ-transplant-recipients-vol-19-iss-1.html http://www.namahjournal.com/doc/Actual/Memory-transference-i... Transplants don't save lives, they violate it in the worst possible way. And allowing the state to harvest your organs without your consent is bad. The alternative is regrowing the needed organ from your own cells and using that, there's already been some progress growing them from stem cells.

arjie 10y ago
> Transplants don't save lives, they violate it in the worst possible way. How? The recipient is consenting to receive. As for the donor, here's a tale about Diogenes of Sinope: > When asked how he wished to be buried, he left instructions to be thrown outside the city wall so wild animals could feast on his body. When asked if he minded this, he said, "Not at all, as long as you provide me with a stick to chase the creatures away!" When asked how he could use the stick since he would lack awareness, he replied "If I lack awareness, then why should I care what happens to me when I am dead?"
d4adb33f 10y ago
> Transplants don't save lives, they violate it in the worst possible way. Wait, what? I don't even know where to begin. That whole sentence does not make any sense. > And allowing the state to harvest your organs without your consent is bad. So opt-out and call it a day. Not that I oppose mandatory organ donation. I'm not even going to touch that cell memory theory.
10y ago

WalterBright 10y ago

From an episode of "House", why not expand the pool of donors by accepting organs from old people or otherwise more marginal organs? If it's a matter of life & death for the recipient, wouldn't a more marginal organ be better than none?

phkahler 10y ago

The problem is verification. As things are today, you have to verify that a person has registered as a donor. If they are and you can't confirm it then nothing happens as far as that person is concerned. In the new system if you can't confirm someone is a non-donor they'll take all your usable parts. I propose a compromise where every person is "supposed" to register their preference one way or the other. That would probably increase the number of registered donors, and if you can't find someone in the database you don't assume a default choice for them.

eternalban 10y ago

https://youtu.be/aclS1pGHp8o https://youtu.be/aclS1pGHp8o [Monty Python's take on this question]