Consent not required for organ donation

I came across a piece recently in The Connexion re organ donation. French rules governing this have been rewritten - meaning "any deceased adult will be considered to have given their approval for organs to be used, unless they refuse beforehand on a national register".

An amendment by Marisol Touraine, the Health minister, was put forward to a wide-ranging health law which is currently being debated in parliament. According to the Connexion, "the wording means close relatives will be told of plans to use a deceased adult's organs, rather than consulted at present."

These changes will not come into effect before January 2017 and anyone who wishes to refuse can sign up a register, called the Registre National des Refus.

This got me thinking, so I discussed it with Henry, and we are both agreed that should any of our organs be of use, we would be more than happy to know that we might have helped someone in need.

In Ireland, we could indicate our consent in two ways - by carrying an organ donor card, and by signing an organ donation consent (pre-printed) on our driving licences.

Would you donate a loved one's organs? If you would refuse, why?


Going back to the original topic, Lucy agrees with organ transplants tho' it's the way the system is implemented which is where we disagree. We seem to have gone off on a tangent which has developed into a tit for tat between you two.

We can all throw figures around and we can slant stats to justify on any subject but drugs companies are very big fish and we can speculate till the cows come home about costs & investments etc I'm sure we can equally make figures mean anything we wish which makes discussions like this pretty meaningless at the end of the day.

Can we stick to the original topic please ladies because I for one am losing the will to live...

Lucy. Why not get back to the topic under discussion. The way you contribute takes me back to those endless alcohol fuelled "discussions" one had as an undergraduate. Those on the side which was being bested would usually resort to introducing more and more extraneous "Ah but what ifs......" It all seemed quite robust and stimulating but the next morning one realised, if one remembered, what utter gibberish it had been. Kindly return to the subject or have a lie down in a darkened room with a wet towel pressed to your brow. On the whole I find so many references to the US of A as I find the opinions of many Americans a complete waste of space.

Maybe I wish I was narrow minded and wrong. But the word “believe” worries me in the context. You may believe and it may work for you, but your believes are not good enough. My preference is in fact based knowledge.
SO what are the facts: indeed the development of a new drug may cost anywhere 54 mln in 1970s and 800 mln in 2000. And then that drug is sold to the public for $10 - $1000 per pill for daily use The pills can made in nearly any warehouse meeting safety regulations. To put it in perspective development of a microchip costs approximately the same, but the factory construction requires upward of 1bln, and the chips sell for about 50 cents.
Some more numbers: let us assume that Prilosec development was that most expensive to date and did cost 800 mln.; the USA sale of Prilosec in a single year 2000 brought in 4 billions. You say only in 5 years, i.e. 20 Billions revenue for an investment of 0.8 B is not good enough. That is 2000% margin. Most business are happy when they have 30%.
Want more examples:in 2003 alone - Lipitor: sales were $9.2 Billions; Prevacid - 2.5 Billion.
Yes the market is difficult, it requires large R&D investements, but if you look into the big pharma budgets it is not R&D that is the biggest cost - the biggest costs are marketing, CEO’s and lawyers.
ALl companies, particularly those under US tax system have opportunity to engage in creative accounting, not cheating, but show huge losses – but in those legal losses there are deductions that European tax cheats would not even imagine were possible.
People smarter than me working on this subject published enough articles, most available on internet, that negate your believes with facts. Nobody is disputing that big pharma wants to make more money, but those who analyzed their efforts concluded that major problem is that big pharma would like to live off to little number of monopolies granted to them by patents, and instead of investing money into R&D are putting money into lawyers pockets to gain patents for variants of the same things.
Somebody is feeding you propaganda not facts.

I utterly disagree with you, you don’t know what you are talking about’ it cost well over 100 million to bring a drug to market and over 15 years leaving just 5 to try and recuop the development cost…governments cannot fund this, big pharma does. Countries that pirate drugs do no service to anyone and pirated drugs are a serious health hazard, who know what is in them or what their bioequivilence is…you just seem to be narrow minded. I believe in transplant, the French system and in clinical research run ethically and well.

Lucy I think your stats are a bit out of wack. One of the problems is that there is a differential between say heart or heart and lung transplants or even betweeen cascade plants where a heart lung recipient becomes a heart donor down the line. Your one year survival rates may well be correct although to me they seem a little low. What you don't quote are the incremental survival rates. So the expectation or actual survival beyond the one year survival rate . Thus one might expect that a recipient having survived beyond the limit at transplantation might have a better survival horizon than when first transplanted. By common report or apocrophally this seems to be the case. Liver transplants seem to be particularly successful and for the first year or five years produce good results However the underlying psychological causes of liver disease eventually trump the effects of transplantation.

Theo Fruendt - well said - ditto from me.

Liz Clark - I disagree with your statements. The drug patent laws are too long already and are getting longer while the prices do not drop - to the contrary they go up.
Only Countries/Government can afford doing and funding the research. The social contract made between USA and pharma was that US retirement and medical insurance will not huggle over the pharma prices and pharma is getting huge tax brakes for research. But they stopped doing the new research, because the patents protect them for too long, and after the patent expires they reformulate their chemistry (move that carbon from left to the right) and get perpetual patent. It is more cost effective for them to work on reformulation than on new stuff. Europe’s govs in general huggle for cost of pharma prices and this is why most of the prescriptions in Europe are 3 to 10 times cheaper in Europe. This only means that Europe rides on US taxpayers generosity.
The best is Brasil - they used to invalidate pharma patents and state initiated manufacture of generics if pharma refused to have reasonable prices.

I came across New York Times reporting in 2009 th USA there was 38% of drivers indicating organ donation on their licenses.
In 2015 I came across info on indicating that in the USA there are 100 mln drivers who indicated organ donation. Given than in 2012 there was over 200 mln active driver licenses in the USA - that would mean 50% of drivers.
And given that there re about over 300 mln people in the USA - that means that about 1/3 of the population of the USA Opted-IN and indicated their will to donate their organs.
All this accomplished through education, organization, and work of people with good will and not by state imposed law.
But people still dying while waiting for an organ - and the problem is not in the lack of supply - quality matters too.

Many a time news cames out about the living donation chains involving even 60 people. I.e. one that involves for example donation of an organ by a living person who continues life without it is telling. In the US if I want to give my kidney to somebody it does not mean that it will be a match (and matching is not a trivial task) - so that willingness is registered in a national registry, that registry finds a person that is a match and offers the kidney under the condition that the person finds another donor (matching or not) and so it goes until all matches are made. Of course the operations did not occur on the same day. The power of good will is much stronger than the power of dictum. Organ transplants success requires money to be organized and operated.

I did not know there is step down from Fox News aka Fix News.

Not irrational at all Fid.

Re-transfusions : When I came back to France full-time in the '80s I applied to give blood and the people said I had to wait fifteen years after having previously spent a few years in the UK (BSE etc). When the fifteen years were up I re applied to be a blood donor and they then said I was too old (50+) !!!!!!!!!!!!!!!!!!!!

Give me strength !

Clinical trias are regulated by amongst other things the Declaration of Helsink, the latest iteration being the 64 WMA general assembly in Brazil in 2013, the Eurpean Directive on Clinical trials, The International Conferance on Harmonisation of Good Clinical Practise, and then the many smaller requirements such as the FDA etc. Clinical trials must be peer reviewed and piblished, not all of them prove their hypothesis and so fail…but clinical trials in transplant do usually impact the number of organs available but are in the main aimed at preventing post op complications or ongoing health issues.

Governments cannot afford to pay for research’ so it is left to commercial companies, who are regulated as to how much they can spend on research and development. Given that it costs so much and takes so long to bring a drug to market, if the world governments chose to amend the patent laws to allow longer than just a few years pist launch of patent protection, the the cost of drugs would tumble. There isn’t so much in the press about research into orphan drugs or rare diseases, which ethical drug companies undertake, when there is almost no chance of recouping their costs. Nor the provision of HIV, malaria prevention etc in the third world and subsaharan africa.

The issue with transplant is that there are not enough organs and dialysis is not a perfect answer and the artifical heart still in early days…

Myself not being a do-gooder or one of these human rights hippies because political correctness is fascism, pretending to be manners. Everyone can wait till the commercial world is taking over full control and knocking at the door, but I want to be in charge to decide over the use of my organs not some commercially run hospitals or other industries. Their nature is to make profit to pay wages to by a posh houses and cars and all this nice things to show off.

Brian is mentioning Germany in context of this topic: the current law in Germany demands a clear expression of consent! There are no extractions per se allowed, in-fact they are strictly prohibited if there is not a written statement available. This is the lesson learned from the outrageous "Maengele" experiences. Others of you also mentioned that the forced extraction of human organs is probably as old as mankind. Don't forget that there have been changes and regulations for transparency and regulations to protect life's. Well, in times of the times of the New Machiavellians we begin to turn back to the dark ages and this is what I mean with political correctness... After all, there were lot of cases of organised crime in the resent past of Kosovo and Albania during NATO's KFOR presence with organ harvesting, just look it up, its all there the beloved cyberspace, - and these are not conspiracy theories, these are realities because the perpetrators have been found guilty by various courts.

So, because a written expression of a declaration and consent to be harvested does not have to be present in the future, it is logical that an "opt-in" of the law of the right to integrity of one's body is the closest you can get. This is why an automatically “opt-in” is absolutely incompatible with the currently valid law in Germany.

Saying this is because we are not being asked anymore when, by whom and why our cyber activities from banking over shopping and socialising are being harvested by thousands of privately owned companies (also when they do this with the consent of, or in assignment by governments). We have already lost the control over our privacy (don’t mumble this firewall “protection”, the plumbing is build in the product). So soon we will loose the control of our physical self-care. This will start when a law is being introduced that is like the one that today makes it obligatory for animals to have a chip implemented. Much to the pleasure of the security maniacs as well...As the new study about the relation of over-weight and dement / alzheimer shows what a payed study can produce and pretend to be scientific, it melts all down to money.

When I held an Irish driving licence, I did check the box..... the vast majority of people I knew either never thought about it, or "didn't have a pen handy" when I asked them if they intended on ticking the box. Many people seem to give off the impression of WANTING to be good people, but few people actually take the ACTIONS necessary to be that person.
People talk, but very few act. In my opinion, those with a real problem with it can opt out, the decision is not made for them, while all those people who talk like they're mother Teresa can rest assured that a good choice has been made for them.

Great Bruce, can I have your golf clubs and wallet ?

The thing is Liz many people on this forum and generally in France have never understood the rules. The opt-in system has been in operation in France for a long time in one form or another and each consequent law, including this present amendment has modified the law in some way.

Before or should I say now, until the latest amendment comes in in 2017 the opt-in system is in force but friends and relatives ie the next of kin have the right to refuse the organ donation on behalf of the deceased. That's the thing which will change in 2017. The relatives or whoever the next of kin is will no longer have a say. That's what the doctors seem to be against as I see it.

There has always been the opt-out national register where we, the people have the right to opt-out if we wish and that register currently contains about 90000 names. That is quite a number though cynics quite rightly in my opinion say this figure is low due to the fact that the public aren't aware of such a register. I agree with Lucy when she says the public need to be educated tho' maybe sucessive governments consider that 'a little knowledge is a dangerous thing' ?

When I die, anybody's welcome to come in and help themselves!

Thanks Brian, I don’t want to start talking about the US health policy…the gap between the haves and have nots is so huge there.

If folks don’t agree with transplanation, then they should opt out. I am extremely familiar with many clinical trials in this area, with those working in transplant, the transplant recipients and with donor families, they do not share Lucy’s views

What now? To 'scarify'? That means to lacerate, in order words make shallow cuts and also it is used with regard to lawns when purging moss! So what do you mean there?

The second point is absolute gibberish and looks like American pseudo science of the kind generated by right wing evangelistic haters of all modernity who then regard it as their science based on the Christian values they invented with which they psychologically enslave people by creating a fear of god. It is not science, it is not something with hard evidence but speculative views presented as fact that those of us with research skills cannot even be bothered to laugh out.

I too have been web searching and I do not find what you find. I used the WHO database of member countries since I have access. You then state ways of enforcing donation by facilitating opting in and coerced voluntary (that is an oxymoron if ever there was one) opting in. You really are then contradicting yourself by saying that force of law will not work.

The USA is not the only place on this planet. Statistics from the USA are not representative of 196 nation states by any means and anyway you are giving NO statistics despite saying where you sourced them. As I have politely asked before, would you please STOP thrusting your view down people's throats to prove the majority wrong because you hold a view of your own. You are now coming across as a zealot who stands up shouting about hellfire and brimstone but other people's arguments are solid and your own are simply becoming more and more absurd and contradictory. Please refrain from winding people up. However, if you wish I think Liz and I could continue the way we have, plus a bit of support from Peter, to a) keep this discussion on track without the numerous false trails and b) to respect the views of people who have responded so far and stop you continually trying to tell them they are all wrong. Please respect the views of others.

(1) if decisions are made on national basis stats do matter in that they give perspective what the fight is for. The 1 yr survival for population matters, for individuals 1 day can be good enough - but as you noted cannot afford in Switzerland. So 1,5 and 10 yr survival rates do matter when one wants to scarify individual freedoms on wholesale basis.
(2) The analysts who studied the problem from many sides noted that human nature is to go against governmental impositions of behavior that is intimately private and they attributed the drop as the direct result of raping the people’s by heavy handed imposition of the law.
(3) I just scanned the whole bunch of studies from different countries and the results are clear - imposition of opt-in does not do what is hoped for and in half of the countries produces the reverse result. The only way is to educate the public, provide incentives and facilitate voluntary opt-ins, coerced voluntary opt-in being second.
The culture needs to change and that cannot be accomplished by the force of law.

The stats I gave are for the USA.