Opt out would be good. For example I thought it was on our driver's licenses. But apparently it has moved elsewhere and I am not sure where.

EO:  In Ontario:  http://www.ontario.ca/en/services_for_residents/ONT05_039074.html

I suppose I could find it for BC easily enough. But I haven't. Which makes me think opt-out would be better.
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But it might offend too many people. I think it might be contrary to some religions (but I am not sure).

In Alberta, there is a spot to sign the back of our health care cards.  I don't know how often that's actually looked for though.  I think the driver's licence was just American, but maybe another province did have it there.

I think opt out would be a great idea.  I accept that it may be against some people's religion - but they have the option to opt out.  Many people don't even think about donating organs - and some hospitals (I have been told) are reluctant to ask families when their loved one is dying.

There is so much need for organs to save lives.

RIght now, opting in doesn't really legally mean anything (at least in Alberta it doesn't).  The next of kin still makes the decision.

I don't see the issue with opting out.  I've seen it suggested a few times, haven't seen any reason not to, yet it hasn't been implemented.

I'm for opting in.

I am also for expressing our wishes to our families about these matters, difficult as that may be.

Why opting in, instead of opting out P3?

I guess I see an element of coercion (or potential coercion) in the requirement to opt out.

Opt out is what is needed and it would safe untold lives to do so, while at the same time allowing family and friends to not be asked about something, just moments after being told bad news

P3, I would hope if someone wanted to opt-out they could do so freely, and relatively privately.  I think as it is set up, there is more coercion for the next of kin, simply because they are vulnerable.

Alex, I agree.  Also, as it would be the individual who would make the decision, they should be able to figure out if they opted-out immediately, instead of the delay in contacting family.

Hmmm ... interesting.

We had a big fuss here in Ontario a few years ago about a cable company which required us to opt out of some additional services.

I also had a run-in with a lawn care company which insisted I was contracting with them for an additional year of service because I failed to opt out. They threatened to send my file to a collection agency, but I never heard from said agency.

This is different, I know. But I still don't like it.

That's fair P3.

EO - as I recall, we used to add stickers to our Care Cards here in BC. 

Here is the website for British Columbians to go to if you wish to become a donor: http://www.transplant.bc.ca/index.asp.

At one timee in NB we could sign a line on our drivers' license to opt-in.  Now we carry a separate card.  It just indicates your wishes; your next-of-kin has the final choice.  In my case I carry the card - Seelerman doesn't.  It puts me in a bind.  If I die first, I'm not sure Seelerman would agree - if he dies first, can I morally go against something he is ambivalent about. 

I would prefer if it was opt-out.  I don't think that Seelerman would make a point to refuse something that was considered automatic.  We were both blooddonors when we were healthy.  Our son is also registered as a possible bone marrow donor.  I know that either one of us would have done anything we could to save Seelergirl when she was sick.  I would like to think if somebody needed my eyes, liver, heart, kidneys, skin or whatever when I'm through with them, that arrangements could be made without much fuss about signing papers.  The thing is, the longer I live the less likely I think my organs will be of any use - I'll wear them out myself.

I find the opt out has an appealing logic on the first look, but find it disturbing the longer I look at it.  Opt out removes control of your own body from you.  Opt out violates some religious sensibilities (which would make an interesting charter case given the freedom of religion is gauranteed).

Should more families (it is in the end the family/next of kin that has the final say) have the discussion about organ donation?  YES.  Should trhere be more information about how the systme works?  YES.  But in the end a default to organ donation does not seem right to me.

In fact, when this idea was floated in Ontario about 8 years ago I remember my mother saying that a close friend of ours, whose husband lived many years thanks to a donatied kidney, saying that as someone who was intimately touched by donation she felt that a default/required donation was not the way to go.

Gord, how does opt-out remove control over your own body?  As it is now, you can't decide for yourself if your organs will be donated if they are suitable.  Why should next of kin make that decision?

What other information do you want to see be made available?  I think the organ donation organizations have done a decent job of making information available.

CHemgal I would argue that it is your wishes that should be the guideline now for that very reason.  And that is why in the current situation famillies NEED to have the discussion about "what would you want" (also important in terms of how much life-saving/prolonging intervention is desired and when to say enough).   In the end the current reality is generally based on the fact that by this point you can no longer speak for yourself and so others need to speak for you.

THere are a lot (less than before) of misconceptions about how organs are harvested, what happens to the body, when organs can/can't be donated.  You can never deal with all these issues (people will believe what they want to believe despite all the information placed in front of them) but you can make the information more available.  Starting with high schools would be a point in favour (and  as I type that I realize that may be being discussed in some schools already) -- possibly as part of discussions about citizenship.

I think there are difficulties I an "opt out" program.

There is a risk that the organs can become more valuable than the ill patient.

The risk that the patient care could be compromised by some in order to get the life saving organs for others.

The issue now is that after death, with the tragedy of death the docs have to ask for the organs.

It is a difficult ask and families can be in shock and not take it all in

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I think that. Upon admission to hospital all patients should sign a consent as part of their admission procedure. That takes some pressure off families and docs and as a legal hospital document would be binding.

That doesntcover those emerg admissions from traffic accidents unfortunately and they are often the best donors being otherwise healthy.

Those families need to be asked but hospitals should hae a donor team that makes the ask and offers support and help over the decision.

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If we go down the road where the state in fact owns your body the I think it opens us up to lots of more intrusive possible laws

Should families have the final say and be able to override an individual's wishes to donate his/her organs? NO. Only in the case where the wishes of the deceased are not clear could I see a possible role for the family. My family doesn't own my body, either dead or alive. To deny my right to extend the life of another against my stated intention otherwise is nothing less than murder, since they would be denying life knowingly.

LP said "There is a risk that the organs can become more valuable than the ill patient". That's no different than with the "opt-in" scenario.  Are you then suggesting that all organ donation be forbidden to avoid this possibility?

Lastepointe, I could see where that would be more of a concern if donation was opt-out.  With opt-in, if the family doesn't feel care was handled properly, they more be more likely to choose not to donate.  For me, it's not a strong enough arguement.  I do think it's important to keep the transplant team separate from those who were responsible for caring for the donor.  I feel that guidelines could be implemented where it wouldn't become an issue.

Gord, I agree about having conversations with family when things are going well.  It doesn't mean that family will respect someone's wishes though.

I also agree that the information that is available could be presented in more places.  I do think that the amount of information availalbe if one seeks it out is sufficient though.

BUt if you go to opt out and one has not sought out the information then what happens...

In the case of opt-out, if the paperwork pieces and communication patterns remain the same, the medical staff still have to ask the family what the option of the person would be.

I might not have been clear

I think if organs can be harvested without consent, unless you opt out then there is potential for risk.

Maybe it's a slight possibility but I can see the scenario that a person with a perfect heart is languishing and no treatment is given because the heart is needed. Most families are not aware enough of medical treatment to see the difference if it is subtle.

Push that further and we could move into whether the elderly deserve care when they have good organs for use.

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The medical community already struggles for resources and who to save and care for. Those competing struggles will continue as our population ages.

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W already have a scenario where most health dollars are spent in the last month of life. It isnt a stretch to see that a person with good organs is more valuable dead and donating.

Potentially

Lastpointe, I understood your point.  Maybe someone will be in a coma for a long time, no hope for them to be the person they once were.  Some of their organs are good.  There are patients in the hospital who could lead productive lives with those organs.

I don't think level of care decisions would be affected by the need for organs, but maybe I am too optimistic that way.

Gord, if the system were to be opt-out the overall system would need changes.  There would have to be a reliable system to quickly check to see if someone has decided to opt-out.  If identification of someone was an issue, I think it would be best to default to not harvest the organs until their identification could be verified.

I think you are optimistic if you think that organs wouldnt be taken

I think the temptation would be huge.

Already there are those "angel of mercy" cases were docs or nurses make life and death decisions. I think there would be huge temptation to end a life to save a more worthy patient or at least one with a better chance

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I think there are some very big ethical discussions that need to take place. The value we place on life, the decision makers, the costs of sustaining a life, who makes those decisions....

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There will be very big issues as care costs sky rocket

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Before medical advances, people died. They got sick and died.

Now they survive, at huge costs.

Even organ donations

In the past, if your heart conked out, you died. Now you go on an artificial heart perhaps and wait for a donor.

People with diabetes often get kidney disease. Now they get dialysis and transplants.

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I am not saying this is wrong but it is a situation we have created.

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Ii guess ethically, is my right to cling to life less important than the person with liver disease who needs my liver.

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We already have the issues of deserving patients. Who is more deserving. It is a tough call. The person who is sickest or the one who is youngest or the one who has the best chance of recovery or the one who is the primary caregiver to children.........

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It isnt clear. Add in the spiraling health care costs, and transplants and after care and life long drugs are not cheap, and we need to wonder if the costs of transplants are affordable. Those are the types of ethical decisions that will get made.

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W already have the issues of patients who ruin their own bodies, perhaps through adult onset diabetes or alcoholism. Do they get an organ?

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So much of our health care costs hae just ballooned without perhaps sitting back and wondering, not can we do something , but should we do it.

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From my nursing practice I can easily look at the costs of infertility treatments. The actual costs of the care, the other costs of the premature babies, the ongoing health costs of care for those children, the costs of having high risk neonatal and prenatal beds for all these moms and babes.

It is just one example of how we have allowed our desire to cure and prolong life to send our costs ever upwards.

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I wonder where it will take us.

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I wonder what percent of our health dollars will continue to go to these extraordinary costs.

. And what will we be giving up in return.

Ethical questions that I don't know the answer to but I know is being discussed

I'm still for the "opting in" process.  I think organ donation requires thought and a decision to do so by the donor, rather than "opting out" because you are not sure or don't want to.  To me if a person doesn't "opt out", but has not given it thought or made the decision it is like becoming an organ donor by default.  In saying this I fully support organ donation, but I think the onus lies on the donor to decide, rather than having to opt out if it is something you don't want to do.

Lots of good question, Lastpointe, that, not being in the medical field, I would not have thought of.
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I'm going to discuss this with my daughter, who is a surgeon.
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I opted in when it was on our drivers license. Not sure why they stopped that.

I was just about to type the very same thing! I am on the donor registry and have been for years. I think that since I am signed up for this, my family should not be asked for their permission, should I meet an untimely end. That said, I have spoken with my family about this and I don't think there'll be a problem.

I have heard of cases when no one at the hospital bothered to check to see if a patient wanted to donate organs if the circumstances were right for that to happen.  To me it seems such a waste to not use organs that could be shared.  Complex subject though, with possible opportunites for unethical behavior from medical staff. 

Beloved, I have similar feelings that lead me to the opposite conclusion.  Why should people die waiting for an organ simply because a potential donor was on the fence, or never gave it much of a thought.

Kay, I imagine they do not ask, as it doesn't make a difference with how things are set right now.  There may also be ethical issues with staff talking to a patient about organ donation.