Does the State Own Your Organs?
When I was in medical school I worked for a tissue bank: the New York Firefighters’ Skin Bank. The Skin Bank operates out of New York- Presbyterian Hospital. It was founded and continues to operate through the kind donations of the Firefighters of New York. Some truly wonderful and dedicated people run the tissue bank (Nancy, Avery, Heather - you guys are the best, keep up the good work). Organ procurement is an extraordinarily regulated endeavor and there is obviously a limited supply of human tissue. Everyone remembers the newsworthy incidents of illegal organ trafficking.
The skin bank harvests skin only, but stores and distributes heart valves, veins, artificial dermis and some bone. When you think of organ donation the words heart, liver and kidney usually come to mind not skin, bone and cornea. In fact the procurement of the latter tissues outpaces the former by a margin of about 20:1 (rough estimate from personal experience). This is simply due to the relative frequency of cause of death. While tissues such as veins and skin can be harvested up to 24 hours after one’s heart stops, tissues such as kidneys require a beating heart to maintain perfusion. Thus only people with brain death (stroke, head trauma etc.) are good candidates for donating these organs.
One common misconception is that once you’ve signed the back of your license and consented to donate your organs, it is a done deal. Not true. Regardless of whether you declare yourself a donor or not, your next of kin always makes the final consent decision regarding donation. So if you truly want to donate, it is important to discuss this with your relatives prior to you becoming eligible.
The linked article wades through some swampy ethical terrain. Apparently one of Obama’s regulatory czars wrote a book recommending that organ donatation be an “opt out” program. That is, unless you declared that you did NOT want to donate, you would automatically have consented to donate. To justify his stance he has co opted a study previously used to encourage opt out type retirement savings accounts. The study implied that humans are irrational when it comes to certain decision making processes and hence automatic mechanisms may be better form of “nudging” people into “wise” choices. A slippery slope becomes quickly apparent. Couldn’t such a study be used to justify just about any policy that aims to correct certain “irrational” tendencies in the population? Are we not breaching the ethical boundaries of autonomy and personhood? If such a policy was made law, who then would own your body after you die? What if no next of kin could be reached and you (the deceased) never knew about the opt out program - but never really wanted to donate.
This policy strikes me as ethically bankrupt. I could easily draw the analogy to clinical research. In order to participate in clinical research patients must go through an extensive informed consent process. Why not make it an opt out program as well? Think of how much data we’re missing by not enrolling everyone in clinical research. In short, we consent patients to protect them against harm - physical harm, loss of personal information etc. To imply that this is different in the dead is to imply that the dead cannot be harmed. Untrue. I would categorize grave robbery and mutilation of corpses as harm. And surviving relatives certainly could be hurt. A key distinction can be drawn between opt-out organ donation programs and opt-out savings plans. In the former, property is taken from one individual and given to another. In the latter an individual’s own property is “saved” and given back to him/her at a later date.
The future will bring better technological solutions to bear on these problems, but the issues of scarcity will still exist. Consideration should be given to better solutions that respect the ethical boundaries of the individual. At a minimum, only contracts that are freely entered into by both parties should be considered ethical.
