It’s an idea which keeps popping up.

There is a proposal in the state of Illinois legalize “presumed organ donation”.

Most people say that they would agree to donating their organs after they die, but sometimes they “forget” to mark it on their driver’s license, or the consent can’t be found quickly, or the family objects.Voila. Just do like Belgium, and pass a law presuming organ consent. and instant increase in available organs for those dying of failing kidneys, livers, hearts, etc.Lives will be saved. Those with religious scruples or paranoia can simply sign a paper saying they want to opt out. No problem.

In Belgium, only 2 percent of folks bothered to do that.But using Belgium as an example, and then assuming that that tiny affluent country can be compared to the wild and wooly multicultural USA may not recognize the problem.Belgium is the equivalent of suburban and middle class America, and I suspect there will be no problem in that population, no matter what is the ethnicity

However, what about blacks, or other minorities who remember the medical discrimination in the past?

As bioethicist Wesley Smith points out:

The USA is not Europe.  We are more individualistic here, and besides, I can think of few things that will sow distrust in the health care system more than presumed consent.  Think about it: We already have bioethicists advocating for futile care theory, that is the right to refuse wanted life sustaining treatment based on quality of life judgmentalism, resource allocation, or both.  Add in the motive for taking organs to this volatile field–and wary families will become even less trusting, and medical issues will become even more likely to end up in court.  Square that if we ever enact explicit health care rationing, or redefine death to include a diagnosis of PVS–as many luminaries in the transplant field advocate.

Translation: Beware of the trends of medical ethics.

One: Some organs are being taken from those who aren’t brain dead, but they are taken off machines and organs removed when their hearts stop.

Two: Texas has a “futile care” law that allows docs to refuse to treat you or your loved ones if they (not you or your family) decide it “won’t help”.

Three: Often “Quality of life.” criteria is included in these decisions

Four: Rationing is coming.

Five, some bioethicists want to extend “brain death” to include those with profound brain damage, but who are able to live for years with minimal care.

Six; One third of those diagnosed as PVS are misdiagnosed; newer ways of diagnosis, including brain scans, suggest it might be higher.

Seven: There are already groups pushing for paying families to donate organs. They seem to think that poor folks will donate organs of their loved ones out of greed when they won’t do it from altruism.

Eight: Right now most folks trust their docs.However, some minorities don’t.All you need is to combine exaggerated rumors of number one to seven, and all you need is a few cases given publicity and voila, a lot of folks will refuse to donate organs, period.

Trust is a fragile thing between docs and patients. It doesn’t take much to destroy that trust.

A better way to increase donation is to use ordinary public relations techniques.Use public service announcements, using celebrities.Add organ donation success stories to TV shows.Continue with  the driver’s license consent cards, and go out to churches, health fairs, schools, and other neighborhood institutions to encourage minorities to donate.I know that we did this at Health fairs,in the casinos and dance festivals for our Native American patients, whose blood types differ from the white population, to encourage registering as bone marrow donors for patients. Donating the organs of loved ones will come from outreach and trust, not coercion.

Nancy Reyes is a retired physician living in the rural Philippines. She blogs at Hey Doc Xanga Blog. 

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