SYNDICATED COLUMN: Why Isn’t Organ Donation Mandatory?


America’s Weird, Enduring Respect for Corpses

This week America’s news media obsessed over the shooting deaths of 12 people in Washington. The usual arguments over gun control seem irrelevant since there isn’t much that could have been done to prevent those particular killings. It was a navy base. Even in England, members of the military have access to automatic weapons. And even if we were inclined to start locking people up for hearing voices or feeling strange vibrations, we can’t build enough mental asylums to hold all of them.

On the other hand, it is estimated that 18 people die every day due to a national shortage of organ donations. This crisis can be solved.

Don’t worry: this is not one of Those pieces calling for you to consider signing the donor section on the back of your driver’s license.

My solution is more radical. When you die, the government should take your organs.

The transplant shortage is acute. Some patients are so desperate that they travel on ethically-dubious “medical tourism” junkets to China, which implants organs from executed prisoners. Others accept D-rate organs. Patients at the University of Maryland recently accepted kidneys that had recently been operated upon for benign or malignant tumors. Better bad kidneys than none at all.

The waiting list system is widely viewed as arbitrary and unfair. In June 2013 a federal judge made news by issuing an order suspending rules that effectively blocked children under the age of 12 from receiving organs from adult donors. Several children who might have died without the procedure benefited. Unfortunately, the court’s ruling probably killed a similar number of adult patients. Like cash, life is a zero-sum game.

It is widely believed that celebrities and wealthy people, most notably Billy Martin in 1995 and Steve Jobs in 2009, are able to cut the line, moving themselves up the waiting list. Technically, this isn’t true. But practically, it is.

A major factor determining whether or not you will receive a new organ is whether you can afford the $500,000-plus cost of the procedure and its maintenance, or whether your insurance coverage is sufficiently expensive to cover it. Rich people can pay, poor people can’t. “There’s a huge triage involved in getting in,” Arthur Caplan, chair of the department of medical ethics at the University of Pennsylvania, told CNN. “If you’re a homeless alcoholic sleeping on the streets of L.A., and you’re going toe-to-toe with Steve Jobs, you’re going to lose.”

Where resources are scarce, politics get ugly. In 2012 the University of California at San Francisco kidney exchange was accused of denying a kidney to a man because of his status as an undocumented immigrant. A petition campaign changed UC officials’ minds.

This being America and anything more progressive than the collected works of Ronald Reagan being off the table, the mainstream media turns to free-market solutions: paying prospective donors, either while they are alive or after they die, for their kidneys, livers and other body parts that could be used to enhance or save someone’s life. In 2010 The Wall Street Journal published an essay urging that we adopt Iran’s approach, which guarantees a year of health care and a cash payment to donors. A June 2013 Slate piece by Sally Satel, “How to Fix the Organ Transplant Shortage,” called for “providing in-kind rewards — such as a down payment on a house, a contribution to a retirement fund, or lifetime health insurance” to donors.

These merchantilist suggestions have gotten traction. A 2012 poll found that 55% of Americans now believe that selling your organs ought to be legal.

And maybe they’re right. But it’s easy to imagine how the commodification of body parts could corrupt an already flawed system. Do we want to live in a nation where the unemployed resort to auctioning off pieces of themselves to stave off foreclosure?

There’s not much we can do to reduce demand for organs. So let’s focus on the supply side of the equation.

Efforts to guilt Americans into donating voluntarily are failing those 18 Americans a day. But not every healthy person who refuses to sign a donor card is heartless. I know because I’m one of them. I refuse to endorse a system that rewards the rich at the expense of the poor. If the system were more transparent, and treated everyone equally, there’d be more donors.

However, the system being what it is, that’s not going to happen.

Which brings us to the government’s role. I don’t understand why organ donation isn’t mandatory. Why isn’t every corpse harvested for all of its usable organs?

It isn’t a property-rights issue. You don’t own your corpse. Neither does your family. If it did, they could leave your body to rot in the backyard. Laws dictate how to properly dispose of a dead person.

There have been baby steps toward mandatory donation. In 2010 a New York assemblyman introduced a “presumed consent” bill that would have automatically enrolled all New Yorkers as organ donors unless they opted out (analogous to the federal “do not call” list for people who don’t want to get telephone solicitations). Two dozen other nations have similar laws. The bill failed.

If the government can save 18 people a day by harvesting every available organ, why doesn’t it pass a law making it so?

The blogger Stewart Lindsey expresses the most passionate, coherent and logical argument I can find against mandatory organ donation: “If I OPT to donate my liver, kidneys, heart or any other worthwhile organ at the time of my death, I will make that decision known. Don’t we have enough intrusion from the government into our personal lives already? If they can dictate whether or not you should be an organ donor, how much longer before they will be making the choices of where you can live, where you can work, go to church or school, who you can marry, what stores you can shop in and ultimately, how long should you be allowed to live, before your organs are no longer a viable option for harvesting!”

As a student of history, I am sympathetic to slippery slope arguments. And as I wrote above, I despise the way that the current health care system prioritizes wealthy Americans over the less fortunate. But when you boil it down, Lindsey’s argument is purely emotional. It’s my liver, and you can pry it out of my cold, dead carcass…or not.

Anyway, our top government officials don’t care about those concerns.

In the end, it comes down to the power of superstition.

When we die, we cease to exist in every way. Our bodies decompose. Only idiots believe in God, the Devil, Heaven, Hell, an afterlife. Whether your body is harvested for organs, eaten by cannibals, or minced to fertilize topsoil, you will never know the difference. Anyway, no major American religion teaches that what happens to your corpse affects your destiny in the hereafter.

Between our smart phones and amazing technology that allows our government to spy on our every digital moment, citizens of the United States of America feel that they live in an incredibly modern society. But not in our hearts, not in our souls, and certainly not in our brains.

About 2.5 million Americans die every year. Most are burned or planted in the ground, completely wasted. Vast numbers of them rot away, their bodies containing potentially life-saving organs, left intact — or embalmed — for only one reason: politicians are too cowardly to challenge the ancient idea that there is something sacred in a hunk of flesh.

(Ted Rall’s website is Go there to join the Ted Rall Subscription Service and receive all of Ted’s cartoons and columns by email.)



  • aaronwilliams135
    September 20, 2013 5:26 PM

    This is the kind of article that keeps me coming back to rallblog. Visionary, radical, effective solutions, that nobody else is talking about. Thanks.

  • I vacillate between thinking Ted is brilliant, and a moron. Today is one of those days where I think he’s a fucking moron. I mean that.

    Let’s just say this: If the government made it mandatory for me to donate my organs upon death, I can guarantee you that I would contract with someone to take an axe to my body upon expiration. I mean, I’d pay them thousands to just chop me up into little bits, nothing left usable.

    In short: Fuck you.

    • Oh, come on, Ex.

      We’ve already established that the government can do whatever they want to you and that you won’t do anything back. They are spying on all of your emails and your phone calls and reading your mail, but you and I never want else is perfectly fine with it. What are you going to do about it once you’re dead?

  • Ted Rall — a man for whom the state is never too powerful. There’s no aspect of your life the state shouldn’t control, for Ted Rall. Peel back the skin of any liberal and you’ll find a fascist.

  • Ted:

    1. The system didn’t care whether I lived or died. By contributing actively to that system, I would be condoning it. Being forced to contribute to it after death? Just as offensive. Knowing that someone I cared about was “processed” by the same system that grudgingly provided him or her dribs and drabs of care while some asshat who was willing to eliminate thousands of jobs at a time to improve quarterly profits got hyper-platinum care? Sorry, Ted. This bitch won’t kiss the whip. (Can’t remember who used the phrase originally, but a tip o’ the pen.)

    2. If we’re going to talk about “after death” situations, then, well, if some single person who had no relatives leaves a million dollars to a pet shelter, shouldn’t that automatically be struck down in the will and the monies confiscated and used for “better” purposes as dictated by the state? Like the distribution of pro-life leaflets in Texas? Or shock therapy to cure homosexuals? I mean, the person’s dead, they won’t know either way. Right? What’s this fetish about honoring last wishes?

    3. Somewhere out there the family and friends of the person whose heart Dick Cheney now has are still in misery. Dick Cheney, one of the most criminal monsters ever, gets an extended life so that he can continue to destroy and ruin. Old Dick went right to the top of the list. You or I? We’d be dead. The same thing happened with the douchebag Steve Jobs and the drunk baseballer Mickey Mantle. They went to the top of the list–oh, we assure you, it was just the luck of the draw, say the seven-figure directors who run the agencies that handle these things–and someone died so that they could get one more privilege in their overly privileged lives.

    Just wait, in 50 years, when Mark Zuckerberg, who got his start as a creepy little pervert swiping student information off the Harvard database, needs a new cerebral cortex or whatever, he will get it in about 30 minutes. Bill Keller, cheerleader for the Iraq War which killed hundreds of thousands? The Times pays for his retarded ramblings still. He’ll have the best of care until the day he dies at an advanced age. I should contribute to that?

    4. The system is homophobic. If you’re gay, you can’t donate blood. Why? Well, for a bunch of reasons that all apply to heterosexuals as well. But only the gays are segregated.

    One thing I’ve learned along the way? You don’t GIVE and then ask the other party to make things better when the other party is that particular brand of cocksucker that succeeds so well in gummint and industry. You tell them, flat out: “No. You do this, this, and this. When those are done, THEN I’ll come through with my side of it. You don’t like it? Fine.”

    • Alex: Perhaps my column wasn’t clear enough, but I don’t consider myself an organ donor and I don’t think you should either. Not until the system changes. Which is what I think I wrote.

      What I was asking was why does the government kowtow to ridiculous superstition? I think it’s an interesting observation about our society.

    • By the way, yes, when someone donates millions of dollars to their dog or cat, the will should automatically be overturned and the funds should be confiscated.

  • “My solution is more radical. When you die, the government should take your organs.”

    But what if the might-makes-right government takes your organs from you first and then you die? What guarantee is there that when the government takes your organs they won’t keep them for themselves just the way they keep publicly funded health care for themselves. There are some disgusting people in government that I would hate to see live a day longer because of their use of my organs.

    How about some guillotine action on some of the worst but wealthiest public/private connected criminals, who operate in the name of the state, in retribution for their crimes against the people who struggle to survive and die under their misrule.

    “From those who have the ability to donate organs to those who have the need for donated organs,” is a good communalist idea among friends, but I expect some Dick Cheney type will force their way to the front of the line and some American Medical Association affiliated doctor, who supports scarcity of doctors for higher profits and opposes single payer, will make a political donation of some poor person’s organs in exchange for stronger legislation against single payer health care.

  • Ted,

    Why the government kowtows to superstition? That is a conversation we could have all day long. But, in 25 words or less? Because the superstitious are the easiest to control.

  • ex,

    And you know what else is crazy? The government thinks it has the right to lock you up in prison just for killing some random person! What business is it of theirs anyway?! What is this? East Germany?

    In all seriousness, liberals believe there is a proper, productive role for government; it should keep people from doing dangerous and stupid things like, oh I don’t know, wasting their organs for instance. The problem isn’t the amount of power of a given government per se. Ours can already do whatever it wants anyway. The problem is our government is full of people doing stupid and dangerous things.

  • I’m with Ted on this one. Organ donation should be, at the least, opt-out rather than opt-in.

    Unlike Ted I am a donor… system sucks but it’s all we got…

  • Ted,

    I’m quite shocked. Who exactly will determine which wills are not “reasonable”? What if someone leaves the money to the journalism department of a school? Or an art department? Journalism? Art? Those don’t make money. No. The Will Court has decided that the monies in question should be transferred to the Richard Cheney School of Business. The only exception? Being able to prove the deceased person was out of his or her mind, literally, incapable of making sound decisions, and lawyers do that already: When I made out my will (the only leaving my hundreds of dollars), I had to sit and talk to two of the lawyer’s admin staff for about 10 minutes, so they could see I wasn’t high or crazy.

    There are a small number of milestones in the law that must remain unmovable. Adulthood begins at 18. Not because it does but because you can’t give a different standard to every single person and hope to enforce it. Oh, you’re 16, and we’ll try you as an adult for this car theft, but this guy’s 22, and, same crime, but we’ll charge him as a juvenile.

    Look at the abortion debate. It’s a sideshow. Why? Because — going to your question of why the system kowtows to the superstitious and ignorant — the law is too chickenshit to simply say, “Hey, guess what? We have a good standard to follow. We arbitrarily set the border of adulthood at 18. So until the baby is actually born, the second the head appears outside of the mother, it’s not a person. The second the head starts coming out? It’s a person. We can arrest it, torture it, waterboard it, the works. If the mother wants to abort any time before that, even on her way into the delivery room, that’s no one’s call but hers.

    The crazies would go nuts. “You mean you’re letting that little slut decide what happens? What about my right to stick my nose wherever I want to? The Bible clearly says that I have the right to boss this dirty little whore around.”

    It’s the same with wills. You start tearing up “give it to Fido” wills and the next thing to be invalidated will be the wills giving money to art schools. Or to liberal causes. Or to conservative causes. Or to the environment (we all know global warming is a scam).

    It’s like going back to measurements based on body lengths. Can you imagine the drawing of a plot of land indicating that the property is a 30-by-80 cubit rectangle?

  • Ted, I suggest that there is a better and easier solution to the problem than mandatory harvesting of organs after death, which is hardly problem free. Rather, make the post-mortem harvesting of organs an opt-out, rather than at present, an opt-in procedure. Those utterly opposed to organ donations, for whatever reason there may be, can choose to opt out, while those who don’t care one way or another – which I suggest comprise the vast majority – will, when their time comes, contribute to the pool of organ donators. Of course, one disadvantage is that many of us have pretty well worn out our organs when we do shuffle off this mortal coil, but as the number of people who die annually due to gunshot wounds in the United States, which in 2011 amounted to more than 32 000 people – many of whom were presumably young enough to possess organs worth harvesting – that waiting list you show could probably be worked through in a few years time, even taking into account compatibility issues. The real problem would be in ensuring that organs are harvested soon enough after death as to be of use ; alas, few of those murdered or who commit suicide with the aid of firearms are surrounded by teams of transplantation surgeons at the time of their decease….


  • This being America and liberals empowering conservatives with horrible failed, stupid election strategies for for 40+ years, thus ensuring anything more progressive than the collected works of Ronald Reagan is off the table….

    Fixed that for you, Ted. Otherwise, well done.

  • If the government was not run by two rightwing parties and their rightwing trolls, granting more power to the government would be acceptable because the power would come with great responsibility and the populace wouldn’t need to fear that a privilege would be created. That’s not the case here. Our government is run by rightwingers, so any increase in its power creates an immediate moral harm. The amount of good needed to combat that harm is severe.

    That said, opt-out is an acceptable policy under the circumstances.

    Restrictions on property alienation after death have existed for centuries. There is no problem here. And all slippery slope arguments are complete bullshit.

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