Are You In or Out? (Revised)
You can hear the sound of a pin drop in the tense silence of the Emergency Room
waiting area. With each passing moment, more and more uncertainty fills the hearts of
the weary parents who wait to be updated on the status of their 25-year-old son who was
involved in a serious accident. What feels like days later, the silence is broken by the
doctor’s footsteps on the laminate floors and the clearing of his throat. In his most
compassionate voice he delivers the worst news any parent can ever receive, “…his
injuries were far too extensive. We performed every life-saving procedure that we could,
but we could not do much more for your son.” After a brief pause, he continues, “Your
son is brain dead, which means that all brain activity has ceased.” This is when the
grieving parents are asked to make a decision on behalf of their deceased son; would they
be willing to donate his organs? There is a 50% chance that they will say no (Spital 1).
Even if their son is a registered organ donor, the family makes the final decision.
Learning about the loss of a loved one is the most devastating news anyone can
ever receive, and no one should ever have to deal with grief such as this- no one. The sad
truth is that accidents happen and people die every day. Then, again, far too many deaths
occur annually that can easily be prevented- I am referring to the thousands of lives that
can be saved on the operating table through transplant surgery. There is a severe shortage
of organs. Every day more people are added to the waiting list for an organ while the
number of available organs remains disappointingly low. Part of the reason for the
shortage is “the high rate of refusal among families who are asked for permission to
remove organs from a recently deceased relative” (Spital 1). Mandated consent, an
alternative to the current system of cadaveric organ procurement, is the most effective
1
way to increase the number of organ donors by making all citizens clearly indicate their
wishes about whether they want their organs donated or not. This would be done either
by putting the question about organ donation on tax forms or driver’s license applications
and by refusing to accept the forms or applications until the question is answered (Gill
52).
With mandated consent in place, the choice to donate organs is left entirely up to
the individual, not to the family, and those orders would be followed properly carrying
out the wishes of the individual who died. According to the Organ Procurement and
Transplantation Network (OPTN), at the present moment there are over 95,000 patients
on the waiting list for one or more organs, and for every patient who is removed from this
list, two more are added (“Uniting People”). This is a dramatic increase from ten years
ago when more than 45,000 people were listed on the waiting list for transplantation
(Spital 1). While the national waiting list grows every day, unfortunately, the number of
donors does not even come close to meeting the overwhelming need for organs.
The current system in the United States requires explicit consent before organs
can be removed and used for transplantation. Under the Uniform Anatomical Gift Act, all
competent adults have the authority to decide the ultimate fate of their bodies after their
deaths. Relatively few people take advantage of this law to record their wishes about
donating their organs, and even in cases of those who do give consent to organ donation,
the immediate family can make the final decision sometimes not honoring the deceased’s
wishes (Spital 1). This system works under the “default presumption that individuals
prefer not to donate their organs” considering that about 70% of Americans would prefer
to donate their organs after their death (Gill 37).
2
Those opposed to the mandated choice system maintain that requiring people to
decide about organ donation would be coercive; however, this system in no way would
condemn those who choose not to donate, nor would it reward those who check “yes”
next to the organ donor question. Mandated choice merely ensures that a definite
decision regarding organ donation is made clear legally and that it will be honored. The
opposition also claims that there is no guarantee that more people would consent to be
organ donors. There is evidence that shows that a majority of the public, not only
supports mandated choice, but that they would opt to donate their organs under this
system.
In a [1993] Gallup poll of 1002 randomly selected adults in the United States,
63% said they would sign up to donate their organs if mandated choice became
law. Furthermore, because devoting thought to organ donation correlates with a
positive response, and because mandated choice forces everyone to consider this
issue, this system may actually encourage the 13% who were undecided to say
yes. If so, under mandated choice, as much as 75% of the U.S. adult population
would become committed potential organ donors (Spital 3).
With more people being faced with the question of whether or not to become organ
donors, public awareness about the issue would increase and more people would make
more informed decisions.
Furthermore, the opposition claims that the mandated choice policy completely
alienates the family by following the wishes of the individual over his or her survivors
(Klassen 1). “The unfortunate reality of cadaveric organ donation is that it is the family,
not the deceased patient, who comes home from the hospital” (Klassen 3). It is true that
3
the family has to live with the knowledge that their loved one was harvested for organs
after their passing. At the same time, though, those same family members have to live
with the knowledge that they may have violated the deceased’s last wishes with regard to
what should be done with the body after death. Honoring a loved ones last wishes as to
what should happen to the body should be of utmost importance to the family just as the
wishes with regard to the loved one’s estate are currently respected.
Though the family may not agree with the choice a deceased patient made about
donating his or her organs, it is still essentially their choice. Just like they may disagree
with Aunt May’s decision to leave her mint-condition Cadillac to her cousin rather than
someone else, it was still her decision to make and her last wish should be honored
regardless of family views. The Uniform Anatomical Gift Act cites that the individual’s
wishes are paramount. Also, the Council on Ethical and Judicial Affairs of the American
Medical Association recently concluded that “the individual’s interest in controlling the
disposition of his or her own body and property after death suggests that it is ethically
preferable for the individual, rather than the family to decide to donate organs” (Spital 2).
A ISHLT/FACT poll conducted in 2002 showed that of 739 respondents, 77.2% did not
think that family consultation should be required if the patient had already decided to be
an organ donor or not (Oz, et. al. 1). This by no means says that the family should be left
out of the decision-making process entirely. The individual should discuss his or her
choice with those closest to him/her and make their wishes known prior to their death.
Many people oppose the idea of organ donation based on their religious beliefs
and misconceptions about organ donation. There are some religious groups such as
Christian Scientists and Jehova’s Witnesses who oppose, not only organ donation, but
4
most general hospitalization. Organ donation, against popular belief, is actually
consistent with all larger religious denominations in the United States that consider
anatomical gift-giving a great charitable act. This includes Catholicism, Protestantism,
and most branches of Judaism (OrganDonor.gov). Another deciding factor is the desire to
have an open-casket funeral for the deceased. They have the flawed idea that nothing will
be left of the person post-harvest. That is a myth; just as bodies can be displayed postautopsy, the bodies of organ donors are left presentable. The torso is stitched up just like
in any surgery and clothed so no evidence of organ donation would be apparent.
The idea of being cut into and having your organs removed is not something some
may be very comfortable with but, considering the embalming and decaying processes, it
is not as frightening and unpleasant. Take an unembalmed, decomposing body, for
instance. After death, putrefaction takes place and bacteria begin to break down and
liquefy bodily tissues. Internal organs turn into something that looks like a yellow broth
inside the body cavity, and muscles are eaten by carnivorous beetles. As gases build up,
the body swells and gives off a smell resembling something between rotting meat and
rotting fruit. Soon after, not much more is left of the body than a skeleton (Roach 68).
Embalming, according to Michel Ragon, is like a victory over the inevitable
decomposition, or rotting of the human body (Ragon 17). It made people slightly less
disgusted by the body post mortem. The process of embalming the body is not a
permanent fix and does not prevent decomposition, it merely postpones it. Also,
embalming, in and of itself, is not a pretty process either; it is invasive like organ
donation. First, the features are set by sewing the jaw and eyelids shut, and placing cotton
in the anus and vagina to prevent leakage. Then, the blood is drained out and replaced by
5
embalming fluids through a large artery located on the right side of the body near the
collarbone. Following arterial embalming comes cavity embalming. In this step, a long
metal tube, called a trocar, with sharp blades at one end and a connector for a hose at the
other is used. The hose is connected to a device that creates suction. The sharp blades on
the trocar are used to pierce through the abdomen near the belly button. From this entry
point, the embalmer directs the trocar towards and pierces all the internal organs to
suction off the fluids. After fluids have been suctioned off, the organs are filled with a
stronger embalming fluid (Edwards). Seeing how the body decays and what happens
during the embalming process, it is easy to see that organ donation is no more or less
gruesome than ordinary decay or suctioning out bodily fluids by piercing all the internal
organs.
Finally, a major argument against implementing mandated choice laws is the issue
of the cost of such a system. Taking into consideration the incredible costs of alternative,
short-term treatments such as dialysis, funding this system would not be as costly as it
may appear. According to OPTN, the average annual cost of hospitalized dialysis for a
patient on the waiting list for a kidney is roughly about $75,400 U.S. dollars. At any
point, there are about 55,000 people on the waiting list for at least a kidney (“Uniting
People”). The annual cost for all these people would be staggering, clearly enough to
cover the cost of the mandated choice system. The benefit of the many lives that would
be saved and the decrease in medical costs of temporary treatments such as dialysis
would surely trump the cost of creating a uniform system of organ donors under the
mandated choice system.
6
Losing a loved one is hard enough and having to make an immediate decision as
to whether or not to donate his/her organs is a tough choice to make; especially in such an
emotional state. The mandated choice laws would transfer the decision from the family to
the individual. Under this system, everyone would have to decide on being an organ
donor after death or not, and that decision is what would be honored upon death. The
deceased’s last wishes with regard to the fate of their bodies would be guaranteed to be
followed. Furthermore, this would increase the number of available organs for
transplantation, and this is a system that can be implemented easily through a question on
tax forms or driver’s licenses. Just as Aunt May had the right to give her Cadillac to
whomever she wished, so should her organs be treated as she would have indicated
through the mandated choice system.
7
Works Cited
Edwards, Arnold. "Embalming Techniques." Everything You Ever Wanted to KNow
About Embalming. 2003. 24 Feb. 2007 <www.embalming.net>.
Gill, Michael B. "Presumed Consent, Autonomy, and Organ Donation." Journal of
Medicine and Philosophy 29.1 (2004): 37-59. Academic Search Premier. EBSCO
Host. 7 Feb. 2007 <http://web.ebscohost.com.ezproxy2.lib.depaul.edu>.
Klassen, Ann C., and David K. Klassen. "Who are the Donors in Organ Donation? the
Family's Perspective in Mandated Choice." Annals of Internal Medicine 125.1
(1996): 70-73. 9 Feb 2007 <www.annals.org>.
OrganDonor.Gov. Health Resources and Services Administration. 11 Feb. 2007
<www.organdonor.gov>.
Oz, Mehmet C., Afteb R. Kherani, Amanda Rowe, Leo Roels, Chauncey Crandall, Md,
Luis Tomatis, and James B. Young. "How to Improve Organ Donation: Results of
the ISHLT/FACT Poll." The Journal of Heart and Lung Transplantation 22
(2003): 389-410. Abstract.
Ragon, Michel. The Space of Death. Charlottesville: University P of Virginia, 1983.
Spital, Aaron. "Mandated Choice for Organ Donation: Time to Give It a Try." Annals of
Internal Medicine 125.1 (1996): 66-69. 9 Feb 2007 <www.annals.org>.
"Uniting People and Information to Save Lives." OPTN: Organ Procurement and
Transplantation Network. 2003. Division of Transplantation. 10 Feb. 2007
<www.optn.org>.
8