All your livers belong to us!

[Philippus Flavius Homovallumus]

It doesn't mean this at all. As I posted in the above:

Spoiler Alert, click show to read: 

Corrections:
1) it is not the mentally handicapped. It is not mentally capable, there is a very big difference. Think vegetative-state and discussing end of life.
2) it is based on preferences ie:living-will in consultation with friends and family and a range professions including an independent assigned by the state to 'act in the persons behalf' which most often or not, always take the 'safe approach' thus will rule to opt-out.
3) This is based on when the client is dead, not when they are alive.

Really?

If that's the case why mention it at all?

The new law allows them to take everyone's organs once they die unless they opt out so what matter the incapable? We're all incapable once dead.

The term "living doner" is understood to mean someone donating whilst alive - and that they will remain so after donating - so what the BBC has said is that the living but incapable, which does not just mean the comatose, may donate without giving their consent if it is deemed to be in their interests.

I don't know where you get the idea that this is only applicable once they die because that isn't what the article says.

is the legislation published yet?

[Montmorency]

PVC, it's rather simple: the "mentally-incapable" will not be given an opt-out.

[Philippus Flavius Homovallumus]

PVC, it's rather simple: the "mentally-incapable" will not be given an opt-out.

Then why use the term "living doner"?

That's a technical term: https://www.organdonation.nhs.uk/abo...ving-donation/

[Montmorency]

As it turns out, the BBC text is at-best misleading and I was entirely wrong.

Bill text:

8 Activities involving material from adults who lack capacity to consent
(1) This section applies where—
(a) a transplantation activity within sections 3(2)(d) (storage of relevant material
which has come from a human body) or 3(2)(e) (use of such relevant material)
involves relevant material from the body of a person (“P”) who—
(i) is an adult, and
(ii) lacks capacity to consent to the activity, and
(b) no decision of P’s to consent, or not to consent, to the activity is in force.
(2) P’s consent to the activity is to be deemed if the activity is done in circumstances of a kind
specified by regulations made by the Secretary of State for the purposes of section 6 of the
Human Tissue Act 2004.

Explanatory Notes:

36. The Mental Capacity Act 2005 confirms that a person must be assumed to
have capacity to make decisions unless it is established otherwise. It is recognised
that people may have the mental capacity to make decisions about some aspects of
their lives but not others; that some people may never have the mental capacity to
make that decision; that some may lose their mental capacity, and for others mental
capacity may fluctuate.
37. The Bill does not alter the current ability of any person to express, during their
lifetime, a wish to donate their organs or not to donate. People will be able to use the
new register for Wales to express a wish. In doing so, and as happens now, mental
capacity will not be questioned.
38. Every effort should be made to facilitate those lacking capacity to understand
the new law and to make a decision in the light of it. This emphasis on facilitation
during a person’s lifetime will form part of our communications programme. At the
time of death, if organ donation is a possibility, then in a similar situation to that
described for children and young people, the deceased’s wishes will take
precedence and next of kin will be sensitively encouraged to accept their decision.
Where a person who lacked capacity had not expressed a wish to donate or not to
donate, their consent will not be deemed to be given since, if there is doubt as to
whether they had capacity with regard to understanding the law, this could make
such consent invalid. In these cases, the person in a qualifying relationship or an
appointed representative will be asked to make the decision about organ donation.

[Papewaio]

So does this bill allow the most physically sick to steal organs from the most mentally ill?

[Montmorency]

Per the quoted Paragraph 38: If someone "lacking capacity" specifies consent or lack-thereof, this decision becomes binding. If there is no specification either way upon death, then legal guardians and health professionals make the decision.

This is basically the softest "presumed-consent" transplantation legislation in the world, quit the hand-wringing.

[Gilrandir]

After death. It says it right in the first paragraph, they aren't going to euthanise the incapable for organs.

Death is a tricky thing and taking the organs out raises ethical problems.

As far as I know you gotta be very quick with cutting out the organs from a dead body before they are inutile. It means you can't wait long enough to make sure the dead IS dead. And relatives are still sitting in the corridor and hoping for the doctors to kickstart the injured man's heart or something. And then the doctor comes out and says: "You know, we did all we could but he didn't make it. Now can we have his gall bladder and a kidney - they look so temptingly healthy?" Do you expect the relatives who are almost out of their mind for grief to take such decisions, sign some papers and hear something like: "You can't say good-bye to your father. Right know we are busy with taking his lung out" or "Could you be a little quicker with your good-byes, his heart is getting colder, you know" or "The dismemberment will take some time, so I'm afraid you can have the body no sooner than tomorrow. And do we have to stitch it together or you will take it as it is - it will be dust to dust all the same."

[Greyblades]

What motivation would those doctors have to do so?

[Gilrandir]

What motivation would those doctors have to do so?

They have to notify a patient when a suitable donor is around and be very quick to get the organs before they are wasted.

[Greyblades]

Hrm, I think I misread your post for "doctors would let patients die for organs".

Presumably they would do what they do now, allow them a minute or two to mourn before wheeling the body to the morgue. It's not as if before this the NHS lets the dead rot in their beds for the sake of the bereaved.

[Gilrandir]

Presumably they would do what they do now, allow them a minute or two to mourn before wheeling the body to the morgue.

When you are supposed to take something out of the body, minutes are too precious to waste. So my picture of mourning relatives and a doctor patting their shoulder from behind or impatiently tapping his foot a yard away seems credible.

[Greyblades]

My picture is a doctor patiently waiting until the surgeon to finish preparing for surgery on short notice before trying to retrieve the body.

But it's rather a moot point as the emotional distress is unlikely to be anywhere near as significant as the lives saved. Besides getting the body out of the reach of an irrational relative is unlikely to get any easier whether or not they have a minute.

[Montmorency]

Gil, I don't get your complaint. Cardiac death is the baseline for organ removal.

That's why there are so few organs available for transplant - as you say, time is of the essence, so an individual typically needs to die within the hospital.

These are not acute cases - no relatives are waiting for any hearts to be jumpstarted, which is almost never done in any cases anyway.

[Greyblades]

I think Gil is imagining the usual Hollywood scene of a man dying in a hospital bed surrounded by grieving relatives, and he predicts they'd probably react badly if the hospital confiscates the body immediately after death.

[Gilrandir]

I think Gil is imagining the usual Hollywood scene of a man dying in a hospital bed surrounded by grieving relatives, and he predicts they'd probably react badly if the hospital confiscates the body immediately after death.

I don't think it's entirely Hollywood picture. I've seen something like that, I can assure you that donating the body of the one they love (especially if this is not an old person who has been on the deathbed for quite a time so his family are kind of ready for the end to come but a young man whose death (e.g. in a carcrash) was a shock) to save someone else's life is the last thing the relatives are thinking about at the moment and they really can be distressed (to put it mildly) if there is a surgeon "whetting his scalpel" waiting for his turn to come.

[Montmorency]

You still don't seem to understand how the process works fundamentally.

You don't just go ahead and remove one or more organs from a cadaver until:

1. Full medical history has been obtained and reviewed.
2. The health of each organ has been assessed on the spot.
3. The wait-list for organ-transplant is cross-referenced to determine the best match.

With the image you have in mind, haven't you ever wondered how there isn't a massive glut in spare organs?

Even without the issue of consent, it's an extremely-complicated process. You might also notice that the black-market trade in organs is not actually all that big? Why is this? Because regardless of the conditions under which the organs are collected, without extensive consultation over the medical histories and innate biomarkers of the donor and recipient, the risk of transplant failure and host death is dramatically higher - no matter how much money you have.

[Beskar]

Gilrandir, you definitely have an over-active imagination or you lived in one of the most morally depraved places in the world if you ever think healthcare service is like that.

[I of the Storm]

Pragmatic approach, I like it.

I can see that other people with ... a firm set of beliefs may have problems with it though.

[Philippus Flavius Homovallumus]

OK, so from reading the bill it appears that those resident in Wales will be assumed to have given their consent to their bodies being used for transplant after death unless they explicitly express a reservation before death or a relative or appointed agent expresses their wishes after death.

In the case of the mentally incapable, which means anyone not deemed able to understand the law, their consent will be assumed unless (again) a relative comes forward to express a differing view.

So, seems to me, mental patients and the retarded who lack capacity can be assumed to be doners if they have no close family. Whether it actually works like that or not in practice we shall have to see but it seems to me it would be better to assume that all those without capacity do NOT give their consent, that would be more humane, rather than potentially harvesting the lonely and handicapped for their organs - which is what COULD happen.

[I of the Storm]

...

So, seems to me, mental patients and the retarded who lack capacity can be assumed to be doners if they have no close family. Whether it actually works like that or not in practice we shall have to see but it seems to me it would be better to assume that all those without capacity do NOT give their consent, that would be more humane, rather than potentially harvesting the lonely and handicapped for their organs - which is what COULD happen.

That would be the less controversial stance indeed.

[Beskar]

Yeah, I think if they actually tried to make it so they could harvest the vulnerable, they would get lynched.

Only slippery slope of "what COULD happen" I would like to see is that those who opt-out also opt-out of receiving organ transplants. There is something very hypocritical and disturbing about opt-ing out but yet still wanting to receive.

Then again, I am someone who opted-in and is an organ donor. So this law doesn't actually change anything for me practically.

[Greyblades]

I don't think those who are too handicapped to be mentally capable of applying for the opt out program will be too bothered what happens to their body after death.

[Gilrandir]

You still don't seem to understand how the process works fundamentally.

You don't just go ahead and remove one or more organs from a cadaver until:

1. Full medical history has been obtained and reviewed.
2. The health of each organ has been assessed on the spot.
3. The wait-list for organ-transplant is cross-referenced to determine the best match.

It doesn't make the picture I painted invalid. Notwithstanding all the procedures you have mentioned, there is one thing that stands: THE DOCTORS GOTTA BE QUICK if they want to get an eligible organ fit for further use. The speed neccessitates disregarding the feelings of the mourners as much as it can be helped.

With the image you have in mind, haven't you ever wondered how there isn't a massive glut in spare organs?

If spare organs were something like cereals whose shelf life and preservation conditions allowed them to be bought almost anywhere at any time I would be the one to wonder why there is an excess of demand over supply. But this is a different story, so I can offer several reasons:
1. Technical problems - not all hospitals (not even in Western countries, I'm afraid, to say nothing of the Third world) have staff and equipment to get things cut out, preserved/delivered and "installed" properly.
2. Delivery problems - organs "get unfit" before a proper care can be taken of them (the hospital is too far, too long time before the body is delivered to the hospital, there is a hiatus in the delivery process (like the police needs to document everything on the crime scene, etc)).
3. Attitude problems - not many people (or their relatives) are willing to donate their organs - for various reasons.

When you get an organ available have to solve all these problems asap, which is not that simple.

Gilrandir, you definitely have an over-active imagination or you lived in one of the most morally depraved places in the world if you ever think healthcare service is like that.

It is both. You evidently know very little of healthcare service in Ukraine.

[Montmorency]

It doesn't make the picture I painted invalid. Notwithstanding all the procedures you have mentioned, there is one thing that stands: THE DOCTORS GOTTA BE QUICK if they want to get an eligible organ fit for further use. The speed neccessitates disregarding the feelings of the mourners as much as it can be helped.

But then there's no difference either way.

You evidently know very little of healthcare service in Ukraine.

https://en.wikipedia.org/wiki/Organ_theft_in_Kosovo

[Philippus Flavius Homovallumus]

Yeah, I think if they actually tried to make it so they could harvest the vulnerable, they would get lynched.

Really? The voice of Young Britain:

I don't think those who are too handicapped to be mentally capable of applying for the opt out program will be too bothered what happens to their body after death.

Only slippery slope of "what COULD happen" I would like to see is that those who opt-out also opt-out of receiving organ transplants. There is something very hypocritical and disturbing about opt-ing out but yet still wanting to receive.

Then again, I am someone who opted-in and is an organ donor. So this law doesn't actually change anything for me practically.

Not, no, no.

A decision you make at age 20 when you're healthy and irresponsible should not leave you off the transplant list at age 40 when you have a wife and kids. Not to mention, this is yet another example of people wanting doctors to violate the Hippocratic Oath and allow someone to die for political reasons.

[a completely inoffensive name]

Talk to a lawyer before you enter a coma and you won't have this problem.

[Beskar]

Not, no, no.

A decision you make at age 20 when you're healthy and irresponsible should not leave you off the transplant list at age 40 when you have a wife and kids. Not to mention, this is yet another example of people wanting doctors to violate the Hippocratic Oath and allow someone to die for political reasons.

Knowingly deciding to opt-out of organ transplantation is pretty self-explanatory. It is a conscious decision being made, no one would do it for giggles. Besides, you can always realise your mistake and opt back in though I don't think they would opt-out originally anyway for that reason, if anything, it is religious reasons and they reject receiving organs because of that too anyway. Example: Jehovah's Witnesses.

Cannot cherry pick the best parts, you either buy the whole cake or have none of it.

[Montmorency]

A decision you make at age 20 when you're healthy and irresponsible should not leave you off the transplant list at age 40 when you have a wife and kids. Not to mention, this is yet another example of people wanting doctors to violate the Hippocratic Oath and allow someone to die for political reasons.

Perhaps you are not aware of this, but physicians and surgeons regularly deny individuals transplants on the basis of irresponsibility and uncooperativeness.

[rory_20_uk]

Perhaps you are not aware of this, but physicians and surgeons regularly deny individuals transplants on the basis of irresponsibility and uncooperativeness.

Given how rare organs currently are it makes perfect sense - and was also the case when dialysis was first an option.

[Papewaio]

I don't think those who are too handicapped to be mentally capable of applying for the opt out program will be too bothered what happens to their body after death.

Those who are most vulnerable should be the best protected. Otherwise it is very easy for less then scrupulous people to legitimately harvest organs of the weakest members of our community.

Don't rely on people's morals where a law should be. Look up about organ harvesting in India and China before you think that rich won't take advantage of the weak.