Organ donor, or not?
August 31, 2011 2:51 PM   Subscribe

Should I sign up to be an organ donor? I like the idea of individuals getting my heart, lungs, kidney, liver, eyes, etc. I do not like the idea of having my body sent to a corporation to harvest my tissues and then packaging them and selling them for profit. I've read that this does happen, hospitals and transplant centers can thereby profit from the sales as well. How can one prevent that from happening and yet allow organs to be used by those needing them. My state donation site has a blanket consent form that reads as if my body could be taken to 'another facility' and "tissues" harvested. No mention of by whom, what for, and at what price they would be sold.
posted by NorthCoastCafe to Science & Nature (41 answers total) 1 user marked this as a favorite
Yes. You can save someone's life. And you're dead.
posted by alex_skazat at 2:57 PM on August 31, 2011 [17 favorites]

Maybe I'm being naive, but selling organs is illegal in the US.
posted by muddgirl at 3:03 PM on August 31, 2011 [4 favorites]


I don't know to what extent for-profit harvesting happens, but there is no question that organ donor programs save lives. If you choose to be a donor, there is a chance you could save a life. If you choose to not be a donor, you have eliminated the chance entirely.

The "another facility" just means another hospital (as in when a heart gets super fast airlifted to another hospital where one is needed) and "tissues" just means the organs you have opted to donate. Vague, sure, but again, why totally eliminate the chance of saving a life?
posted by dayintoday at 3:06 PM on August 31, 2011 [1 favorite]

Yes yes yes! After all, YOU won't need those organs anymore (since you'd be dead), and they might help someone else. You've got nothing to lose, and lots of good karma to gain.
posted by easily confused at 3:10 PM on August 31, 2011

When I got my license in California (ca. 5 years ago), they gave me a little card to fill out and keep with my driver's license. It has various ticky boxes where you can choose to donate any body part, or specify only certain organs and tissues - sort of like this (not my card, but the closest thing I could find). You could make up a little card like this and keep it in your wallet with your license, stating your wishes on exactly which organs you are willing to donate and how you'll allow them to be used. It's also important to express your wishes to your next of kin, who, I think, would have some say in what happened to your body after your death, regardless of what forms you've signed. My card has space for a witness to sign it; I'm pretty sure that's to encourage donors to talk about their wishes with their families.

So, yes, sign up to be an organ donor, because you could save lives. I don't about any of these supposed shady practices, but you can protect yourself from anything that concerns you by expressing your wishes to your family to medical personnel via some sort of form.
posted by mandanza at 3:11 PM on August 31, 2011 [1 favorite]

*I don't know about these practices, and express your wishes *to your family AND to medical personnel. Blah, can't type today!
posted by mandanza at 3:12 PM on August 31, 2011

Unless you believe in literal resurrection, there is no reason not to save or improve many many lives. Selling organs is illegal, and if you're curious about how donated organs are harvested, there's a good explanation in Stiff, by Mary Roach.
posted by elsietheeel at 3:15 PM on August 31, 2011

AFIAK Dayintoday is on the money as far as what each term means.

Try reading Mary Roach's book "Stiff" it's a very good look at the various things that can happen to a dead body...from what happens at the mortuary, to what happens to an organ donor, to what happens to an entire body being donated. Mary does a great job of being informative, but very human and warm.

Let's say you donate your whole body, and not just organs. Maybe a medical student can practice a surgery on a real body instead of a computer program. That's a surgeon that's going to be that much better at understanding how the human body works. REALLY works, and not just a model. They're going to be a better surgeon and their surgeries are going to go better. Isn't that also potentially saving lives?

Even if it were true that for profit selling is going on, which I'm not sure about (excluding black market, naturally), why not? You won't be doing anything with it?
posted by Caravantea at 3:18 PM on August 31, 2011 [2 favorites]

I am not a doctor, but I know that organ harvesting happens within minutes of a body being declared dead—in fact, there's a harvesting hierarchy. Heart comes first, then the lungs I think, after that the liver and other organs. So it's not like your cadaver is going to be Fedex'd off to Parts R Us.

Will hospitals make money off this? Hell yes. Transplant operations are expensive, and they charge for that service. But selling organs is illegal in the USA.

I would recommend that you hold your nose at the filthy lucre that hospitals and doctors will accumulate on the foundation of your goodwill and do it anyhow. None of us are going to need those parts where we're going, but others will.
posted by adamrice at 3:18 PM on August 31, 2011 [4 favorites]

Dangit, Elsietheel beat me to mentioning Stiff!
posted by Caravantea at 3:19 PM on August 31, 2011

My medical power of attorney and living will prepared by my lawyer explicitly state that I wish to donate all my organs except for X, Y, and Z. And it further states that I do not want organs harvested that could be used for purely cosmetic procedures, like collagen or joint cartilage. I don't want to end up in some Real Housewife's facial folds!

So, someday, some lucky recipient might get my awesome Eastern European Descendant Liver, but not my Unfortunately Prone To Skin Cancer And Keloid Scarring Skin. It's that simple.
posted by Asparagirl at 3:19 PM on August 31, 2011 [1 favorite]

I have more qualms about donating blood via the Red Cross than I do about being registered as an organ donor. My feeling is, "Why let any of it go to waste?" Even if someone does make a profit on it, I don't really care. And you have so few chances to save someone's life.

Also as I understand it, your family can choose to stop organs from being donated in the vast majority of cases - if you tell your family "Don't let them take my skin!" you will almost certainly get to keep your skin.

Also, my (very limited) understanding of tissue banks is that, just like there are for-profit and non-profit hospitals, and for-profit and non-profit dialysis providers, there are for-profit and non-profit tissue banks. Is it *preferable* to work with a non-profit? Absolutely. But working with a for-profit is not the end of the world.

(I want to be an articulated skeleton if possible but not if it gets in the way of organ harvesting. Eh, what do I care, I won't be there.)
posted by mskyle at 3:20 PM on August 31, 2011

I share some of your concerns, OP. I think the families of many people would be disappointed at how little good their donation did overall, but the process is not transparent so no one ever knows, and other people pay for it so there's no obvious cost.

Donation seems to be all or nothing in your state, so you have to decide whether you're willing to participate in something that might not have many benefits (or long-term consequences if your concern is that the profit motive is damaging to quality healthcare overall in the long term), but which might also save a life in the right situation.
posted by michaelh at 3:29 PM on August 31, 2011

Here's a thought: you probably recycle old newspapers, cans, glass and plastic bottles. Not to make a profit on your trash (which some recycling companies somewhere down the line from you do), but because Recycling Is Good, right? Do Not Waste, Reuse/Renew etc. etc. etc.

Think of organ donation as the ultimate recycling act you'll ever do.
posted by easily confused at 3:45 PM on August 31, 2011 [4 favorites]

I do not like the idea of having my body sent to a corporation to harvest my tissues and then packaging them and selling them for profit. I've read that this does happen...

Organs are not sold for profit in the United States.

Not every hospital or medical facility has the ability to procure organs for transplants. To do so, the organization must be registered with the Organ Procurement and Transplantation Network. These facilities are designated as Organ Procurement Centers and they have to abide by certain rules and procedures when they harvest organs for transplants. Many of those rules can be viewed on their website.

Since not all medical facilities are Organ Procurement Centers, it is certainly possible that your body will be moved to a different facility -- one that is an OPC -- if you die and your organs can be harvested.

There are currently 72,506 active waiting list candidates in the US for all types of organs; some of those people need multiple organs. In the first six months of 2011, 11,485 transplants were facilitated by UNOS. Donating your organs makes a lot of sense, given those figures.

Please make your wishes known to your family members as well, even if you register with your state as an organ donor.
posted by k8lin at 3:49 PM on August 31, 2011 [7 favorites]

What state are you located in? In Maryland you can designate to be an organ donor, tissue donor or both via Living Legacy. Yes, legislation can vary state by state so it will be helpful to know where you are located. I am a representative of my (large teaching hospital's) Donor Council so I can provide more info if needed.
posted by Asherah at 3:52 PM on August 31, 2011 [2 favorites]

I do not want organs harvested that could be used for purely cosmetic procedures, like collagen or joint cartilage. I don't want to end up in some Real Housewife's facial folds!

But that could end up in a burn victim's facial folds. Everyone has the right to choose to donate or not, but I figure people need my dead body more than I or the crematorium will, so I care not what happens to my body. :)

Selling organs is illegal is basically every developed and many developing countries the world over; you have nothing to worry about.
posted by smoke at 5:02 PM on August 31, 2011 [1 favorite]

There are no organ repackaging companies in the US. As k8lin explained above, the reasons for moving your cadaver to another facility are to ensure that a skilled and knowledgeable team harvests them. If you die in a hospital (particularly a trauma center) the odds are very high that they will be an Organ Procurement Center, and you won't have to be moved anywhere for harvesting.

The hospital will profit (probably; depends on the recipient's payer whether it is really a profit) from the transplantation, but hospitals also profit from births, cardiac surgeries, cancer treatment, mammograms, etc. That's the business model. If we didn't allow hospitals to "profit" from these services, they would close and that would really suck when you needed hospital care.

The physicians, nurses, transplant coordinators and others who are involved in the harvest and transplant will also make part of their living from your donation. And someone's life might be saved. I think this is all win.

The worst case scenario is not that you'll be sent to the abattoir for packaging and sale, but that your tissues might not be usable for a variety of reasons or that the recipient(s) die despite your gift.
posted by jeoc at 5:31 PM on August 31, 2011 [1 favorite]

Frankly, they can chop me up to feed birds of prey, for all I care. If you want to control where your parts go, then give a kidney away while you're alive, like Virginia Postrel. Worrying about who might profit, rather than who might benefit seems pointless to me.
posted by Ideefixe at 5:34 PM on August 31, 2011 [1 favorite]

Thanks for the replies so far, but too many are, IMHO, naive. Unless one takes the time and trouble to make a living will to be very specific about which organs are to be donated, one falls into the corporate harvesting and merchandising of tissue, for profit. It does not seem possible in my state to simply sign up with the DMV as an organ donor without also consenting to the processing and marketing of all cadaver tissue. I don't mind donating my heart to a patient so she can live. But I don't want my skin to be sold by some corporate type making hundreds of thousands of dollars so some jerk can enlarge his penis.

The following article is what prompted my initial question.

"American businesses make hundreds of millions of dollars selling products crafted from donated human bodies, even though it is illegal to profit from cadaver parts …

Body parts are the raw materials behind a $500 million industry. Skin, bone and tendons are treated like coal, timber and oil -- despite laws against profiting from tissue...The tissue trade now generates about $500 million annually

The National Organ Transplant Act, approved by Congress in 1984, banned profits from the sale of tissue. But no company or tissue bank has been prosecuted.

"People who donate have no idea tissue is being processed into products that per gram or per ounce are in the price range of diamonds," said Arthur Caplan, a professor at the University of Pennsylvania's Center for Bioethics.""
posted by NorthCoastCafe at 5:38 PM on August 31, 2011

So you're against saving a life in case someone makes a profit?

But yes, you CAN say "heart only" or whatever. They make it really easy. Your family can do it. You can also download an advance directive that's legal in your state and send a copy of it, filled out, to your MD, family, SO, and hospital. (That's what I've done, though not for donation reasons. I just don't want to end up like Terry Schiavo.)
posted by small_ruminant at 5:50 PM on August 31, 2011 [5 favorites]

Maybe we're all being naive, and certainly there are some people, somewhere, making money out there and using organs for less than what you consider to be 100% worthy causes. At the same time, your heart, in the off chance that the stars align for you to be a donor, has a 0% chance of helping anyone if you don't donate.

On the other hand, let's take that article at face value and assume that this is a $500 million industry despite the lack of a citation for this stat. Compare that figure to Johnson and Johnson's 2010 $62 billion net revenue (per Wikipedia) or the nearly $2 billion in sales Viagra was doing while it was under patent. Heck, Medicare spent nearly $100 million on walkers alone in 2001, and I'm sure that number is a lot higher today. Sadly, $500 million/year is awfully small potatoes in the medical world, especially for a highly lucrative trade in human organs and tissues, which frankly suggests to me that it's not nearly as big of a problem as you might fear.
posted by zachlipton at 6:09 PM on August 31, 2011 [6 favorites]

[This question needs to look like a question and not an argument and not an ad, please stick to the original question and don't turn this into a debate. Thank you.]
posted by jessamyn (staff) at 6:15 PM on August 31, 2011

Yes, you should sign up to be an organ donor. Yes, people will make money from your organs. No, that shouldn't matter a bit to you; you'll be dead and people will be helped by your donation.

The article you mention is fully eleven years old and is completely laced with FUD. Moneymaking from organ donations is obviously going to happen when organ donations occur in a medical system centered around making profit.

I'm of the opinion that barring genuine medical disqualifying factors, only an asshole wouldn't sign up for organ donation. You don't want to be an asshole.
posted by Sternmeyer at 6:25 PM on August 31, 2011 [3 favorites]

From that same article:
The products enhance millions of lives, according to industry trade groups. Cadaver tendons help athletes return to the playing field. Slings crafted from human skin solve bladder troubles. Corneas prepared for implant allow the blind to see.
This juxtaposition doesn't make any sense
executives of tissue banks — nonprofit groups that obtain body parts — routinely earn six-figure salaries. The products are rarely life-saving as advertised.

"I thought I was donating to a nonprofit. I didn't know I was lining someone's pocket," said Sandra Shadwick of Burbank, whose brother died two years ago.
"Non-profit" doesn't mean that employees don't get paid. Executives at non-profit companies like tissue banks still deserve a salary commensurate with their skills and experience. So yes, when you donate tissue you are "lining someone's pocket" - from the nurse that comforts your family after you die, to the helicopter pilot who transports your organs, to the doctor that implants them, to the researcher that uses your bones to study osteoperosis, all the way up to the non-profit executive who makes this all possible. Should they NOT get paid?

Reading further down, the nonsense comes from the fact that the article mixes up statistics for non-profit and for-profit companies. In one sentence, they report the salary of the CEO of a for-profit bank, and in the next they report the gross sales of a non-profit bank.
The Register began its investigation last November after allegations that the head of the Willed Body Program at the University of California, Irvine, profited from the sale of donated body parts.
Willed Body programs seem to be very different from generic organ donor requests. You actually have to fill out witnessed, legal forms willing your body to a particular program. Willed Body programs seem to be very explicit that those organs will not go directly to save a life, but rather to medical research and drug development. Frankly it's irresponsible for the reporters in this piece not to explain the difference.
posted by muddgirl at 6:39 PM on August 31, 2011 [7 favorites]

Please do.
Several years ago, a young (early twenty-something) 2nd cousin of mine was killed in a car accident. It was awful and sad - the driver was going too fast, no one was wearing seat belts, senseless tragedy, etc.

His mother has said that the only thing that has made this bearable for her was knowing that all of his major organs were harvested. Even though her child was dead, someone else's (actually, I believe 4 or 5 someone else's) child got a 2nd chance at life.
posted by pointystick at 6:39 PM on August 31, 2011 [2 favorites]

I'm a total donor, grew up in a family of total donors, and both my parents have recently completed the paperwork to donate their bodies to the local medical school upon their deaths, so my answer may be a little, you know, weighted.

1. I've been on LOTS of donor lists for a LONG TIME. Since I was legal. When this girl's story recently went viral, I realized I wasn't signed up for marrow donation and IMMEDIATELY rectified that.

2. NPR did a really very interesting piece debating the merits of donating-for-profit, and really what I came away with was that I don't have any problem with my loved ones selling off my innards after I don't need them any more, and that they very problem with privatization is that it artificially inflates cost by decreasing supply.

3. Medicine in the US is a for-profit enterprise. There simply isn't, can't, and won't be a way to safely and hygenically preserve you after you die, skillfully remove your organs, preserve them, transport them, and reintegrate them without accruing cost that someone will probably never actually pay.

4. Also, you'll be dead, and it probably won't matter much to you then.

5. I think most of what you're hearing about "for profit" stuff was that story that came out a year or so ago about the skeletons being sold to universities and med schools and stuff---where they were selling stolen skeletons and Indian and Chinese donor skeletons because, well, because they can't sell USian ones. If I knew that I could let my family sell mine and make enough to pay for my service and all my debt...well, hell, sell away! It's just a chunk of calcium after I'm dead anyway, right?
posted by TomMelee at 7:20 PM on August 31, 2011 [1 favorite]

All I can offer you are anecdotes: My grandfather was a donor and when he died 2 years ago they were able to take bone and skin. My grandmother still gets letters from the people he helped, which means so much to her. Grandpa was a great hero to my son and when he got his learner's permit the other day he enthusiastically checked the organ donor box. I was incredibly proud of him.
posted by Biblio at 7:35 PM on August 31, 2011 [1 favorite]

The site your article comes from is filled with absolutely nonsensical articles.

Excerpt from an article from the same place you are getting your "information" on organ donation:

As a former witch, I can speak with authority when I say that I have examined the works of Rowling and that the Harry Potter books are training manuals for the occult. Untold millions of young people are being taught to think, speak, dress and act like witches by filling their heads with the contents of these books. Children are obsessed with the Harry Potter books that they have left television and video games to read these witchcraft manuals.

...does that help you put the accuracy of the article you read in perspective? This is a kook site. It does not contain accurate information, or even, well, "information" in the usual sense of the word. I would, yes, say you should sign up to be an organ donor -- and you should research organ donation properly to put your mind at ease.
posted by kmennie at 7:57 PM on August 31, 2011 [6 favorites]

$500 million is peanuts. A medium-large-sized hospital near me has yearly revenues of $1.5 BILLION on 616 patient beds. (Expenses of $1.3B.) Chicago Public Schools has a yearly budget of $5.3 BILLION. Their DEFICIT is larger than the alleged profits on organ and tissue donations. If someone's trying to run some kind of organ/tissue selling racket for big bucks, they suck at it. And does the article say what counts as "profit"?

One of my roommates, her uncle was able to give her away at her wedding because a heart donor gave him a new ticker. He's had it 30 years now. Her father was not there because no donor was available when he needed one.
posted by Eyebrows McGee at 8:34 PM on August 31, 2011 [1 favorite]

Ticking that box on the drivers license is not, as far as I know, a blanket legal agreement that means you give up everything. Instead it's an indication that, should you be severely injured and unable to communicate, the medical staff know to alert the proper staff and ask an emergency contact person about your wishes. The few times I've heard about harvest situations, the family/next of kin of the donor have been very closely involved in what's shared and what's not. Often there's a team of specialists who come in to do the surgeries, and one of those folks is usually a nurse or social worker whose job is to liaise with the family and make sure they're comfortable with their decisions.

Best bet is to have a will and leave explicit directions for your family. If you were to decide, for example, that you only wanted to donate major organs, that's OK. Just make sure the person legally in charge knows what your wishes are, since that person will be signing the documents.

There are lots of good articles and studies about organ donation at the National Institute of Health, for example: The Instability of Organ Donation Decisions by Next-of-Kin and Factors that Predict It
posted by hms71 at 9:25 PM on August 31, 2011 [1 favorite]

Pull quote from the article...

"Legislation in most states now provide authorization for OPOs to remove organs from those who documented their donation intentions, even when family members are against organ donation. However, many OPOs continue to defer to the family if there are strong objections."
posted by hms71 at 9:29 PM on August 31, 2011

Everyone is correct when they state that selling organs for profit is illegal. However, as many people have mentioned, healthcare is not a charity, and this means that the law allows for "shipping and processing" fees to be charged by the entities involved in organ and tissue harvesting. Thus, after organs are harvested at an accredited hospital, the remaining body can be shipped to an outside tissue bank for further harvesting. They can then charge a processing fee for the harvested tissues, either directly or through a partner company. Partner companies are definitely for-profit and can make a tremendous amount of money selling the harvested tissues. (Hopefully Harvard is a believable source because I am too tired to dig around for US law.)

For instance, AlloDerm is a tissue product made from cadaveric skin by Lifecell, now a subsidiary of Kinetic Concepts Inc. It was originally marketed as a product for burns, has been used for hernia repair, and since ~2004 has had great success being used in conjunction with a tissue expander/implant for post-mastectomy breast reconstruction (looks like they took the info down since they got a warning letter from the FDA recently for marketing Strattice {porcine dermal tissue} inappropriately for breast recon, but AlloDerm is reimbursed by many major insurance companies). It is also used in many other ways, including cosmetically (nose job, anyone?). Doctors can also make a lot of money from this by consulting for (ie being paid by) the company selling the tissue.

Where does this cadaver skin come from? Donors. Another product very similar to AlloDerm is Flex HD sold by Ethicon, which has a direct deal with MTF (Musculoskeletal Transplant Foundation), "the nation's largest tissue bank." That other facility your donation card mentions? One of the many sites MTF has certified with the FDA to process cadaveric tissues, and collect a processing fee from Ethicon.

Where is the FDA in all of this? Mainly trying to ensure that the tissues are not full of communicable diseases and are marketed for uses similar to that of the original tissue in order to protect recipients.

So yes, people are making a profit off of donated human tissue. If this bothers you, then you should either not be a donor, or do as people suggested and write up something explicitly stating which organs or tissues you are donating (see the list of what the FDA regulates; HRSA oversees vascularized organ donations).

Am I a donor? Yes. Do I think you should be a donor after you read up on the ramifications and think about them? Yes.
posted by dormouse at 9:58 PM on August 31, 2011 [3 favorites]

Gah, posted too soon: you may find this 2001 report on Informed Consent in Tissue Donation interesting, though a bit outdated.
posted by dormouse at 10:13 PM on August 31, 2011

It does not seem possible in my state to simply sign up with the DMV as an organ donor without also consenting to the processing and marketing of all cadaver tissue.

Would still like to know where you ate located so we can provide specific answers to your question regarding if you can only be designated as an organ donor, since it seems that you would be agreeable to that as long as you could omit tissue donation, as that's where your disagreement with the system seems to be.
posted by Asherah at 11:31 PM on August 31, 2011

There is a good deal of questionable information about organ transplants in this thread, but the consensus answer to your question (yes, you should donate) is one I wholeheartedly agree with. I am not sure where all the quotes about organ transplant are coming from (did I miss a link to the original article somewhere or should I just do a little googling?) but since the original asker mentions Arthur Caplan in a quote, this link provides a more complete view of his thoughts on transplantation. For those of you not familiear with him, Arthur Caplan is one of the leading authorities on medical ethics in the US, and the Hastings Center (which publishes much of his work) is a think tank devoted to medical ethics that is very well thought of within the medical community.
posted by TedW at 4:54 AM on September 1, 2011 [1 favorite]

I am not sure where all the quotes about organ transplant are coming from (did I miss a link to the original article somewhere or should I just do a little googling?)

The article in question is from 2000 Orange County Register - If you google any sentence in the OP's followup comment, you will find many sites which host a copy. I hesitate to link to any sites which have quoted it, because the hosting sites are generally not up to any sort of rigorous scrutiny.
posted by muddgirl at 6:51 AM on September 1, 2011

Here's a link to the OCR piece from The story won a Society of Professional Journalists award for Public Service reporting, and this isn't some nut site.

Reading the whole piece makes me more like to donate my carcass, not less. Some of the parts go to scientific research, like the effect of air bags on children.
posted by Ideefixe at 12:26 PM on September 1, 2011

Thanks, Ideefixe.
posted by muddgirl at 12:28 PM on September 1, 2011

I've heard another unsettling rumor about donating organs (and I'm wondering if anyone else has heard anything about this) . . . that doctors will work a little less hard to save your life if they see that you're an organ donor. Sounds absolutely ridiculous, though I can't deny that it gives me pause.
posted by imalaowai at 1:06 AM on September 3, 2011

...doctors will work a little less hard to save your life if they see that you're an organ donor.

Unfortunately this is a too-common rumor, and it is absolutely untrue. I have been involved in organ transplants and organ harvests, and have taken care of potential donors in both the OR and the ICU. The transplant team does not get involved until the patient is declared dead and identified as an organ donor, and meanwhile the team caring for the donor is spending time with patient and their family. In that situation the ICU team is going to work much harder on behalf of the patient and family they know rather than the anonymous patients who may benefit from an organ harvest. Organ transplantation raises many ethical issues, but this is not one of them.
posted by TedW at 3:48 AM on September 3, 2011 [3 favorites]

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