6 ms·

Spain leads the world in organ donation. What’s stopping other countries?

59 points by catfacedlady 8y ago

Oletros 8y ago
A thing to be very proud of
wmccullough 8y ago
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 8y ago
  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.
- mijamo 8y ago
  Well sure, but the fact that it is personal belief doesn't make it less selfish. As long as it is opt in you won't get much success, because there is no benefit and people are lazy by nature, which is normal. I don't think paying organs donors should be a thing, so maybe have a priority list for organs where donors get higher? Seems fair: you promised to help society, and in exchange society promise to help you first instead of the selfish non participants.
karmaseed 8y ago
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 8y ago
  What is the problem exactly with buying a kidney?
  - croon 8y ago
    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 8y ago
      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.
      - maxerickson 8y ago
        The false triectomy? There's little reason for anyone to submit to organ harvesting to eat. The idea that our society is just enough for individuals to face that choice is kind of laughable. Of course the best thing is to make artificial organs work, but that's not something most potential organ donors have much influence over.
      - RobertoG 8y ago
radiorental 8y ago
China is working on it https://en.wikipedia.org/wiki/Organ_harvesting_from_Falun_Gong_practitioners_in_China https://en.wikipedia.org/wiki/Organ_harvesting_from_Falun_Go... https://www.cnn.com/2016/06/23/asia/china-organ-harvesting/index.html https://www.cnn.com/2016/06/23/asia/china-organ-harvesting/i...
perl4ever 8y ago
I think what's stopping other countries is that only one can be at the top of a relative ranking.
- ferkad 8y ago
  I think there is more into it: "It has maintained its position as the clear leader for the past 26 years."
- QasimK 8y ago
  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.
grecy 8y ago
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.
- LeifCarrotson 8y ago
  A monetary incentive results in people getting blackmailed into selling their organs and nominating the thugs as the recipients of the money.
- dogma1138 8y ago
  Some countries have it opt-out on gaining a driver’s license. The family however can always override it. There is another factor and is cause of death and age which directly is tied to doner suitability as well as if there is infrastructure to support organ donation across the nation and other process related issues. I would strongly suspect that Spain managed to solve the infrastructure and process related problems rather than it simply being a cultural factor or that Spain has somewhat more non-toxicity, cancer/congenital or massive trauma deaths of otherwise healthy people between the age of and 20-45.
  - severine 8y ago
    edit: sorry, I hadn't read the article, I see it says more or less the same than my link > Spain managed to solve the infrastructure and process related problems That's correct, the Organizacion Nacional de Transplantes is the main culprit. You can read about it here: http://www.newsweek.com/2015/02/20/spain-has-become-world-leader-organ-donations-305841.html http://www.newsweek.com/2015/02/20/spain-has-become-world-le... > Dr Matesanz rejects the idea of a Spanish miracle or a unique store of generosity in the hearts of his compatriots: “We have asked the same question in various surveys over the years and every time 56% or 57% say they would donate their organs after dying; roughly the EU average.” On the role of Spain’s transplant law, which presumes consent unless otherwise stated, Matesanz is also dismissive, pointing out that families always have the final say and that the only country in the world to enforce such a rule is Singapore. “Spain has not been a leader in surgery or research; we have hardly chalked up any firsts in transplant operations. What we have brought to this area is organisation. Following a philosophy that states that donors do not simply fall from the heavens, we have provided organisation and professionalisation.”
robrenaud 8y ago
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?
- walshemj 8y ago
  You cant tell until it comes to it I had a kidney transplant last year and only one kidney was usable. I was the better match - so the guy on the bed next to me had to be told sorry and had to go home Also some kidneys can be problematic I passed on one where the donor might have been HIV+ - I had gone on the list prior to needing diyalsis so it wasn't like I needed one immediately.
- rurban 8y ago
  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.
hycaria 8y ago
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.
- pjc50 8y ago
  Your argument seems to be that surviving an otherwise incurable illness has .. downsides?
  - eezurr 8y ago
    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.
    - the_af 8y ago
      > "[...] 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.
    - shabda 8y ago
      Plus with organ transplant you hardly "sit in a semi-vegetable state ". I am a transplant recipient, and have a near normal life.
trappist 8y ago
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 8y ago
  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/israel-organ-donation https://www.tabletmag.com/jewish-news-and-politics/164976/is...
overkalix 8y ago
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_652478.html https://elpais.com/elpais/2018/06/22/opinion/1529691789_6524...

59 points by catfacedlady 8y ago

A thing to be very proud of

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 8y ago
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.
mijamo 8y ago
Well sure, but the fact that it is personal belief doesn't make it less selfish. As long as it is opt in you won't get much success, because there is no benefit and people are lazy by nature, which is normal. I don't think paying organs donors should be a thing, so maybe have a priority list for organs where donors get higher? Seems fair: you promised to help society, and in exchange society promise to help you first instead of the selfish non participants.

karmaseed 8y ago

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 8y ago
What is the problem exactly with buying a kidney?
- croon 8y ago
  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 8y ago
    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.
    - maxerickson 8y ago
      The false triectomy? There's little reason for anyone to submit to organ harvesting to eat. The idea that our society is just enough for individuals to face that choice is kind of laughable. Of course the best thing is to make artificial organs work, but that's not something most potential organ donors have much influence over.
    - RobertoG 8y ago

radiorental 8y ago

China is working on it https://en.wikipedia.org/wiki/Organ_harvesting_from_Falun_Gong_practitioners_in_China https://en.wikipedia.org/wiki/Organ_harvesting_from_Falun_Go... https://www.cnn.com/2016/06/23/asia/china-organ-harvesting/index.html https://www.cnn.com/2016/06/23/asia/china-organ-harvesting/i...

perl4ever 8y ago

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

ferkad 8y ago
I think there is more into it: "It has maintained its position as the clear leader for the past 26 years."
QasimK 8y ago
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.

grecy 8y ago

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.

LeifCarrotson 8y ago
A monetary incentive results in people getting blackmailed into selling their organs and nominating the thugs as the recipients of the money.
dogma1138 8y ago
Some countries have it opt-out on gaining a driver’s license. The family however can always override it. There is another factor and is cause of death and age which directly is tied to doner suitability as well as if there is infrastructure to support organ donation across the nation and other process related issues. I would strongly suspect that Spain managed to solve the infrastructure and process related problems rather than it simply being a cultural factor or that Spain has somewhat more non-toxicity, cancer/congenital or massive trauma deaths of otherwise healthy people between the age of and 20-45.
- severine 8y ago
  edit: sorry, I hadn't read the article, I see it says more or less the same than my link > Spain managed to solve the infrastructure and process related problems That's correct, the Organizacion Nacional de Transplantes is the main culprit. You can read about it here: http://www.newsweek.com/2015/02/20/spain-has-become-world-leader-organ-donations-305841.html http://www.newsweek.com/2015/02/20/spain-has-become-world-le... > Dr Matesanz rejects the idea of a Spanish miracle or a unique store of generosity in the hearts of his compatriots: “We have asked the same question in various surveys over the years and every time 56% or 57% say they would donate their organs after dying; roughly the EU average.” On the role of Spain’s transplant law, which presumes consent unless otherwise stated, Matesanz is also dismissive, pointing out that families always have the final say and that the only country in the world to enforce such a rule is Singapore. “Spain has not been a leader in surgery or research; we have hardly chalked up any firsts in transplant operations. What we have brought to this area is organisation. Following a philosophy that states that donors do not simply fall from the heavens, we have provided organisation and professionalisation.”

robrenaud 8y ago

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?

walshemj 8y ago
You cant tell until it comes to it I had a kidney transplant last year and only one kidney was usable. I was the better match - so the guy on the bed next to me had to be told sorry and had to go home Also some kidneys can be problematic I passed on one where the donor might have been HIV+ - I had gone on the list prior to needing diyalsis so it wasn't like I needed one immediately.
rurban 8y ago
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.

hycaria 8y ago

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.

pjc50 8y ago
Your argument seems to be that surviving an otherwise incurable illness has .. downsides?
- eezurr 8y ago
  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.
  - the_af 8y ago
    > "[...] 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.
  - shabda 8y ago
    Plus with organ transplant you hardly "sit in a semi-vegetable state ". I am a transplant recipient, and have a near normal life.

trappist 8y ago

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 8y ago
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/israel-organ-donation https://www.tabletmag.com/jewish-news-and-politics/164976/is...

overkalix 8y ago

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_652478.html https://elpais.com/elpais/2018/06/22/opinion/1529691789_6524...