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.
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.
If you ask a lay person from any human culture how do you know when a person is dead I think you would get similar answers along the lines of:
- no heartbeat
- no breath
- their body temperature falls to ambient temperature
- blood pools on lower half of body
- onset of decomposition
- etc
When organs are removed from a person for donation, none of those conditions apply. In order to accommodate this fact the concept of brain death was created. But really brain death is an example of taking a word representing an ancient and well understood concept, death, and applying it to something completely new.
Really it's a form of deception. I don't think it's a malicious deception but when the doctor comes in and says your loved one is brain dead that person is not dead in the ways understood by a typical person.
I'm in favor of organ donation in general but until the medical community has some very frank discussions about the medical definitions of death I'm opposed to any form of mandatory or opt-out organ donation.
The fact that no money is involved is a critical part of this system. It also is the fact that no money is involved in RECEIVING an organ.
This makes the system purely altruistic a removes the kind of questions of "how much should an organ cost", "could I accelerate the process paying more for an organ?", "could I sell my organs, or the organs for my just deceased relative for more money?" "Is this enough money for selling my organs?"
Eliminating the money from the equation makes this simple. You don't win or lose anything for donating. If you don't want to, is cool. But if you want to, is totally selfless. Which strangely, makes more people be cool with the default and donate more. Because the only thing involved is feeling generous and helping others, unless you have some sort of religious feeling or fear. But, again, nothing to earn.
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.
Yes make it opt-out by law, with central database and (formless) opt-out pass, which people can carry around. If neither is found relatives need to be contacted.
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.
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.
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.
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.
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?
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.
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.
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.
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.
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.
Well, I believe in Denmark if you opt out you are put in the end of queue in case you will need donor in the end (and you can't be never sure about that). I think that's fair system which could be adopted in other countries.
I am a kidney transplant recipient. I received my transplant 9 years ago.
My immunosuppressive treatments is a walk in the park compared to the 6 months I was on dialysis. I got married and had a kid after my transplant, none of which I even considered while I was on dialysis.
Which is to say, you are horribly misinformed. :). I hope you will read more about organ donation before making the decision to not opt in.
As someone who has lived more than an extra 10 years of life due to receiving a transplant, I am very happy to take my daily immunosuppressant medication.
For context, I was in my 30s when I had the transplant. If I was 70+, then perhaps I might pass.
I hope you are never in the position of being on a waiting list for an organ donation, but it is much easier to dismiss an abstract idea of saving some unspecified life versus facing short term uncertainty about your own continued life.
[+] [-] overkalix|7 years ago|reply
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_6524...
[+] [-] perl4ever|7 years ago|reply
[+] [-] QasimK|7 years ago|reply
[+] [-] ferkad|7 years ago|reply
[+] [-] grecy|7 years ago|reply
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.
[+] [-] dmm|7 years ago|reply
- no heartbeat - no breath - their body temperature falls to ambient temperature - blood pools on lower half of body - onset of decomposition - etc
When organs are removed from a person for donation, none of those conditions apply. In order to accommodate this fact the concept of brain death was created. But really brain death is an example of taking a word representing an ancient and well understood concept, death, and applying it to something completely new.
Really it's a form of deception. I don't think it's a malicious deception but when the doctor comes in and says your loved one is brain dead that person is not dead in the ways understood by a typical person.
I'm in favor of organ donation in general but until the medical community has some very frank discussions about the medical definitions of death I'm opposed to any form of mandatory or opt-out organ donation.
[+] [-] jaimebuelta|7 years ago|reply
The fact that no money is involved is a critical part of this system. It also is the fact that no money is involved in RECEIVING an organ.
This makes the system purely altruistic a removes the kind of questions of "how much should an organ cost", "could I accelerate the process paying more for an organ?", "could I sell my organs, or the organs for my just deceased relative for more money?" "Is this enough money for selling my organs?"
Eliminating the money from the equation makes this simple. You don't win or lose anything for donating. If you don't want to, is cool. But if you want to, is totally selfless. Which strangely, makes more people be cool with the default and donate more. Because the only thing involved is feeling generous and helping others, unless you have some sort of religious feeling or fear. But, again, nothing to earn.
[+] [-] dogma1138|7 years ago|reply
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.
[+] [-] LeifCarrotson|7 years ago|reply
[+] [-] flother|7 years ago|reply
http://icelandreview.com/news/2018/06/07/all-icelanders-are-...
[+] [-] saosebastiao|7 years ago|reply
[+] [-] unknown|7 years ago|reply
[deleted]
[+] [-] mediascreen|7 years ago|reply
[+] [-] singularity2001|7 years ago|reply
[+] [-] wmccullough|7 years ago|reply
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|7 years ago|reply
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|7 years ago|reply
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|7 years ago|reply
See, not as simple as it sounds.
[+] [-] krageon|7 years ago|reply
[+] [-] robrenaud|7 years ago|reply
[+] [-] rurban|7 years ago|reply
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.
[+] [-] walshemj|7 years ago|reply
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.
[+] [-] trappist|7 years ago|reply
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
[+] [-] bjourne|7 years ago|reply
https://www.tabletmag.com/jewish-news-and-politics/164976/is...
[+] [-] Oletros|7 years ago|reply
[+] [-] radiorental|7 years ago|reply
[deleted]
[+] [-] hycaria|7 years ago|reply
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.
[+] [-] daliusd|7 years ago|reply
[+] [-] pjc50|7 years ago|reply
[+] [-] shabda|7 years ago|reply
My immunosuppressive treatments is a walk in the park compared to the 6 months I was on dialysis. I got married and had a kid after my transplant, none of which I even considered while I was on dialysis.
Which is to say, you are horribly misinformed. :). I hope you will read more about organ donation before making the decision to not opt in.
[+] [-] emptyfile|7 years ago|reply
No but most other people have religious or similar reasons.
I don't see many people not donating organs because they simply don't care. So congratz I guess.
[+] [-] Frqy3|7 years ago|reply
For context, I was in my 30s when I had the transplant. If I was 70+, then perhaps I might pass.
I hope you are never in the position of being on a waiting list for an organ donation, but it is much easier to dismiss an abstract idea of saving some unspecified life versus facing short term uncertainty about your own continued life.
[+] [-] hutzlibu|7 years ago|reply