Advanced Level Sept Oct 14 LD Brief

Foundation Briefs
Advanced Level September/October Brief
Resolved: A just society ought to presume consent

for organ procurement from the deceased.
September/October 2014
Table of Contents
Table of Contents
Table of Contents .................................................................................................................................................... 1
Defend Your Source ............................................................................................................................................. 10
Authors.......................................................................................................................................................... 10
Organizations ................................................................................................................................................ 19
Definitions............................................................................................................................................................. 20
Medical Definition of Death TF ............................................................................................................ 20
Definition of Presumed Consent TF...................................................................................................... 20
Definition of presumed consent. CFS ....................................................................................................... 21
Difference between an opt-in and opt-out system and hard and soft opt out systems. SBH. ................... 21
Topic Analysis One............................................................................................................................................... 22
Topic Analysis Two Tommy Fang Stanford University ................................................................................... 34
Pro Evidence ......................................................................................................................................................... 38
Opt-Out Systems have Higher Donation Rates ................................................................................................ 39
Countries with presumed consent have, on average, 25-30% higher cadaveric donation rates. SBH...... 39
A comparison of 5 studies show an increase in organ donation from country to country. SBH. ............. 41
Empirical evidence indicates that presumed consent is effective at increasing donation rates. Spain
proves. LZ. ................................................................................................................................................ 42
When the default assumption is donation, donations rates increase at a statistically significant level when
all other variables are controlled. LZ. ....................................................................................................... 43
When choosing between explicit and presumed consent, psychological research shows that having a
default of presumed consent increases donation rates. LZ. ...................................................................... 44
Austria has shown success with a true system of presumed consent. LZ. ................................................ 45
Presumed consent actually increases family consent and increases donation rates by up to 30%. CFS .. 46
Increasing organ donation also has massive financial benefits. CFS ....................................................... 46
A meta-study found presumed consent to increase organ donation rates. CFS ........................................ 47
All the studies in a European meta-study found presumed consent to increase organ donation rates. CFS
................................................................................................................................................................... 47
Before and after studies reveal an increased organ donation rate of 30%. CFS ....................................... 48
foundationbriefs.com
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Belgium increased its organ donation rates by 55% with presumed consent. CFS .................................. 48
Black Market..................................................................................................................................................... 49
The black market exists because there are strict restrictions on the provision and production of organs
and high demand and low supply for organs. SBH. ................................................................................. 49
Presumed consent diminishes the need for the black market through decreasing the demand and
increasing the supply of organs. SBH. ...................................................................................................... 50
Market regulation wont work because people will always search for a cheaper price. SBH. ................. 51
Legal organ market would fight the black market TF .............................................................................. 52
Forced Donations Necessary to Meet Demand................................................................................................. 53
There exists a large market for kidney transplants TF .............................................................................. 53
Wait times for kidney transplants are enormous TF ................................................................................. 53
The United States has an extremely slow kidney wait time TF ................................................................ 54
Organ donations are on the decline and are essential to saving lives. CFS .............................................. 54
The illegal organ trade is rising and needs to be combated. CFS ............................................................. 54
Mandatory procurement will close the gap between supply and demand for organs TF ......................... 55
Status Quo ......................................................................................................................................................... 56
Presumed consent means status quo is AFF TF........................................................................................ 56
Current system of organ donation TF ....................................................................................................... 56
Previous court cases justify presumed consent TF ................................................................................... 57
Many people are waiting for a kidney. Long wait times have serious consequences. SBH. ................... 58
The US has an opt-in system whereas Spain has an opt-out system. Spain still trumps the US high
numbers. SBH. .......................................................................................................................................... 59
The demand for organs is high while the supply is low leading to large waiting lists whose numbers
increase on a yearly basis. SBH. .............................................................................................................. 60
Thousands of people die a year. There are roughly 18 people that die a day. ......................................... 60
Definition of Death ........................................................................................................................................... 61
Death is simply a social construct TF ................................................................................................... 61
The deceased dont count under a system of utilitarianism. LZ. .............................................................. 61
Public Opinion .................................................................................................................................................. 62
Public opinion favors donating the organs of the dead TF ....................................................................... 62
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Polls of transplant professions support presumed consent legislation. SBH. ........................................... 63
There is public support for organ donation but few grant consent. Additionally, utilitarianism justifies
presumed consent. CFS............................................................................................................................. 63
An international survey shows that transplant professionals support presumed consent. CFS ................ 64
There has been an increased support for presumed consent. CFS ............................................................ 64
The public approval and utilitarianism justify presumed consent. CFS ................................................... 64
The US public strongly believes that presumed consent would increase organ donation rates. CFS ...... 65
According to a poll, the US public is willing to donate their organs. CFS ............................................... 65
Distributive Justice ........................................................................................................................................... 66
Distributive justice equal access justifies forced organ donation TF .................................................. 66
Distributive justice maximum benefit justifies forced organ donation TF ......................................... 67
Efficiency .......................................................................................................................................................... 68
Cadaveric donations are efficient TF ........................................................................................................ 68
Hard-Opt Out Systems Good ............................................................................................................................ 69
Policies should avoid asking the families about donation because it is difficult for doctors and nurses to
do. LZ........................................................................................................................................................ 69
It is more humane to not ask families. LZ. ............................................................................................... 69
Communitarianism............................................................................................................................................ 70
The communitarian approach would justify presumed consent as a way to give back to the community.
LZ.............................................................................................................................................................. 70
When the organs are no longer valuable to the dead, they should be used to help the living. LZ. .......... 70
Establishing presumed consent as the norm creates a civic duty. LZ. ...................................................... 71
Social Contract .................................................................................................................................................. 72
Tacit consent would justify presumed consent in traditional social contract theories. LZ. ...................... 72
Discrimination .................................................................................................................................................. 73
A disproportionate amount of black patients are on the waiting list. SBH............................................... 73
Racial bias is built into the organ donation and transplant system, leaving the poor and minorities to
suffer ultimately fatal disadvantages. SBH. .............................................................................................. 73
Even when minorities are on the waiting list, they are discriminated against. SBH. ............................... 74
Organ donation discriminates against individuals who identify as gay by not accepting their organs.
SBH. .......................................................................................................................................................... 75
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Medical Research .............................................................................................................................................. 77
Even when donated organs of the deceased are rejected for transplant, they go towards biomedical
research. SBH. .......................................................................................................................................... 77
Brains and other human tissues that are intact are necessary for research but low in supply. Opt-out
systems increase the supply. SBH. ........................................................................................................... 78
Increased Donation Saves Money..................................................................................................................... 79
An increased donation rate saves lives and money. Its been empirically proven in Spain. SBH. .......... 79
Con Evidence ........................................................................................................................................................ 80
Incentivize Live Transplants ............................................................................................................................. 81
Incentives for live transplants are needed TF ........................................................................................... 81
Live transplants have a greater success rate TF ........................................................................................ 81
Incentives arent used now because everyone is too focused on keeping organ donation altruistic.
SBH. .......................................................................................................................................................... 82
Permitting the sale of kidneys by live donor under strictly controlled conditions would be beneficial.
CFS ........................................................................................................................................................... 82
Deontology........................................................................................................................................................ 83
Primary reason for current kidney transplants is altruism TF................................................................... 83
Organ donations help the donors welfare TF .......................................................................................... 83
Presumed consent can lead to harmful erroneous donations that would be worse than under actual
consent. CFS ............................................................................................................................................. 84
Implied Consent Bad ........................................................................................................................................ 85
Implied consent has negative consequences TF ....................................................................................... 85
A system of presumed consent violates autonomy and presumed consent logically doesnt make sense.
LZ.............................................................................................................................................................. 85
Since presumed consent does not require informed consent, it compels people and violates their
autonomy. LZ............................................................................................................................................ 86
The current referral system is increasing family consent rates in the US. CFS........................................ 87
Different policies and legislation have worked in different countries. CFS ............................................. 88
Ethics ................................................................................................................................................................ 89
Ethics is based around consent TF ............................................................................................................ 89
Slippery Slope ................................................................................................................................................... 90
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Forcing mandatory organ donations can lead to a slippery slope TF ....................................................... 90
Forced Donations of Brain-dead Patients...................................................................................................... 91
Brain dead patients are not actually dead TF ......................................................................................... 91
Constitutionalism .............................................................................................................................................. 92
Presumed consent may violate property rights. CFS ................................................................................ 92
Legality ............................................................................................................................................................. 93
Previous court cases are against presumed consent TF ............................................................................ 93
Property interest of the dead denies forced organ donation TF ................................................................ 94
Reciprocity Plan ................................................................................................................................................ 95
Counterplan: Reciprocity proposal TF...................................................................................................... 95
Mandated Choice .............................................................................................................................................. 96
Counterplan: Use mandated choices for posthumous organ donations TF............................................... 96
A system of presumed consent explained and it has three benefits. LZ. .................................................. 96
Mandated choice helps families and preserves individual autonomy. LZ. ............................................... 97
Counterplan: Alternative Organ Sources .......................................................................................................... 98
Counterplan: Use alternative sources of organs TF .................................................................................. 98
Financial Incentives for Deceased .................................................................................................................... 99
Solvency advocate for giving financial incentives for cadaveric donation. SBH..................................... 99
Financial incentives increase human dignity. SBH. ............................................................................... 100
Justice requires incentives because it has the intention to help those in need. SBH. ............................. 101
Incentives arent used now because everyone is too focused on keeping organ donation altruistic.
SBH. ........................................................................................................................................................ 102
There are currently disincentives that discourage people from donating. CFS ...................................... 102
Ethical Incentives ............................................................................................................................................ 103
Ethical incentives remove autonomy violations. SBH. .......................................................................... 103
Examples of ethical incentives that could be given to cadaveric donors. SBH. ..................................... 104
Israeli System CP ............................................................................................................................................ 105
The Israeli system defined. LZ. .............................................................................................................. 105
The Israeli system has empirically been shown to increase donation rates at a statistically significant
level. LZ. ................................................................................................................................................. 106
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The Israeli system results in a decrease of transplant tourism, increases living kidney donations, and
decreases the number of people who die on waiting lists. LZ. ............................................................... 107
Discrimination ................................................................................................................................................ 108
Women give more organs and consistently receive fewer. Switching to an opt-out system would
intensify the already existent lack of trust for the system that women and others have. SBH. .............. 108
Opt-out systems increases disrespect for women who are living and deceased. SBH. .......................... 109
Women tend to identify with their bodies more than men making organ donation more intimately
violating than simply an easy rescue of giving up organs not needed postmortem. SBH. ................. 110
Presumed consent discriminates against minorities by placing a burden on them to opt-out when they
dont have the knowledge or access to opt-out. SBH. ............................................................................ 111
Minorities dont support presumed consent. CFS................................................................................... 112
Regulated Market ............................................................................................................................................ 113
Regulated organ markets are safer than the current system of living donations. SBH. ......................... 113
Its empirically worked in Iran. The US can learn from Iran with their organ market. SBH. ................ 114
A regulated market protects the vendors and buyers. SBH. ................................................................... 115
Futures Market ................................................................................................................................................ 116
Explanation of a futures market. SBH. ................................................................................................... 116
A futures market does not allow the rich to exploit the poor. SBH. ....................................................... 116
There arent organ allocation issues because organs go to the buyer not the most in need. SBH. ......... 117
There is no issue with selling what is not yours because you signed a contract to sell your organs in the
future. SBH. ............................................................................................................................................ 118
How a futures market works. SBH. ........................................................................................................ 119
A futures market proves the best, robust solution to the organ shortage problem. SBH. ....................... 119
Example of how much money would be given for an organ. SBH. ....................................................... 120
There would not be a significant increase in cost of organ donation and transplants to the buyer or seller.
SBH. ........................................................................................................................................................ 120
A futures market is cheaper than the alternatives. SBH. ........................................................................ 121
Public Support................................................................................................................................................. 122
In some countries presumed consent has been a disaster and strongly publically opposed. CFS .......... 122
Autonomy ....................................................................................................................................................... 123
Peoples bodies are used as a means to anothers ends violation their autonomy. SBH. ....................... 123
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Presumed consent leads to a loss of autonomy and mistrust in health care systems globally. SBH. ..... 124
Pro Counters........................................................................................................................................................ 125
AT - Autonomy Violations ............................................................................................................................. 126
Presumed consent and express consent both make assumptions about the choice of the deceased. The
only difference is an operational one. But, since the majority of populations say they would want to give
up their organs, presumed consent is the better of the two options. SBH. ............................................. 126
Presumed consent is the better system to ensure autonomy is protected. It presumes consent, something
that a rational person would chose and what the majority of society agree with. SBH.......................... 127
Presumed consent may better educate the patient. LZ. ........................................................................... 129
A system of presumed consent prevents the family from overriding the autonomous choices of the
individual. LZ. ........................................................................................................................................ 129
Presumed consent helps overcome psychological barriers when choosing. LZ. .................................... 130
As long as a system of education existed, it would be consistent with individual autonomy. LZ. ........ 131
Bodily autonomy is violated in both an opt-in and an opt-out system making the violations non-unique.
SBH. ........................................................................................................................................................ 131
AT Lose Control of Body ............................................................................................................................ 133
People shouldnt be afraid of losing control of their body because safeguards exist to protect against
that. LZ.................................................................................................................................................... 133
AT Religious Objections ............................................................................................................................. 134
Most religions encourage organ donation and exceptions can be granted on religious grounds. LZ. .... 134
As long as the opt-out system is responsive to religious objections, it is not an issue for presumed
consent. LZ. ............................................................................................................................................ 134
Islam in the majority of cases has supported organ donation. SBH. ...................................................... 135
The majority of Christians endorse organ transplantation. SBH. ........................................................... 136
Jehovahs Witnesses are allowed to have organ donation so long as there is no blood transfusion. SBH.
................................................................................................................................................................. 137
Organ donations is deeply rooted in the history of Hindus. SBH........................................................... 138
Sikhism as a religion and Sikhs have a positive attitude towards organ donation. SBH. ....................... 139
The Jewish faith has multiple prohibitions against organ donation. SBH. ............................................. 139
AT Free Market ........................................................................................................................................... 140
Moving to a market system exploits the poor. SBH ............................................................................... 140
AT - Rights of the dead ................................................................................................................................ 141
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Legal rights of the dead. TF .................................................................................................................... 141
Constitutional rights end once the citizen dies. CFS .............................................................................. 141
AT Preferred Status for Organ Donors CP .................................................................................................. 142
This is the same as paying for organs. LZ. ............................................................................................. 142
The assumption behind this claim is that people are only self-interested, but countries like Canada
disprove this. LZ. .................................................................................................................................... 142
This program has a high likelihood of decreasing organ availability and doesnt solve the real problem.
LZ............................................................................................................................................................ 143
There is a chance that such a program will encourage unhealthy behaviors. LZ. .................................. 144
This system doesnt necessarily result in any extra organs for transplantation. LZ. .............................. 144
AT Removal of Altruism ............................................................................................................................. 146
Presumed consent facilitates rather than reduces altruistic behavior. LZ. .............................................. 146
This argument is absurd. People shouldnt die because of a lack of altruism. LZ. ................................ 146
By helping individuals overcome psychological barriers, presumed consent can help individuals express
their actual desires. LZ. ........................................................................................................................... 147
AT Constitutionality .................................................................................................................................... 148
The Fifth Amendment doesnt negate because courts dont recognize organs as property. LZ. ............ 148
Even if organs were property, a presumed consent system does not constitute taking. LZ. .................. 149
AT Market Regulation ................................................................................................................................. 150
Market regulation wont work just as it hasnt worked in any attempts in the status quo. People will
always search for a cheaper price. SBH.................................................................................................. 150
AT Internet Organ Matching ....................................................................................................................... 151
Its unregulated, which leads to a host of problems. SBH. ..................................................................... 151
Con Counters ...................................................................................................................................................... 152
AT - Opt-Out Systems Increase Donation Rates ............................................................................................ 153
The difference between an opt-in and opt-out system is marginal. The real differences come from
things like differing mortality rates. SBH ............................................................................................... 153
Presumed consent does not increase donation rates. CFS ...................................................................... 154
It would be a poor use of the United States resources to implement presumed consent. CFS .............. 154
AT - Selling body parts immoral .................................................................................................................... 155
Selling body parts has historical and empirical roots TF ........................................................................ 155
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AT - Organ market would target the poor as donors ...................................................................................... 156
Turn, organ markets would actually target those in middle to upper class TF ....................................... 156
AT - Utilitarianism justifies mandatory organ procurement .......................................................................... 157
Utilitarianism works for the con respect for autonomy considered TF ............................................... 157
AT - Public Opinion ....................................................................................................................................... 158
Public support should not be a deciding factor in organ procurement policy. CFS ............................... 158
Cases ................................................................................................................................................................... 159
Affirmative Case ............................................................................................................................................. 160
Introduction:................................................................................................................................................ 160
Contention One: .......................................................................................................................................... 162
Contention Two: ......................................................................................................................................... 164
Contention Three: ....................................................................................................................................... 168
Negative Case ................................................................................................................................................. 171
Introduction:................................................................................................................................................ 171
Contention One: .......................................................................................................................................... 172
Contention Two: ......................................................................................................................................... 173
Contention Three: ....................................................................................................................................... 173
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Defend Your Source
Defend Your Source

Authors
Alberto Abadie and Sebastien Gay
Alberto Abadie is Professor of Public Policy at Harvard Kennedy School. His main research areas are
econometrics, labor economics, and public finance. Dr. Sebastien Gay is a Principal at Berkeley Research
Group, LLC and is on the faculty at the University of Chicago Department of Economics. He specializes in
health economics and financial services.
Alexander Powhida
Alexander Powhida is a lawyer of private practice. Powhida was named a Super Lawyer in 2013 in Business
Litigation. He also was Lecturer on Law and Risk Management for the Capital District Building Owners and
Managers Association
Amber Rithalia, Catriona McDaid, Sara Suekarran, Lindsey Myers,

and Amanda Sowden
Rithalia, Catriona, and Suekarran are research fellows for the Centre for Reviews and Dissemination. Myers is
an information specialist. Sowden is deputy director for the Centre for Reviews and Dissemination. The Centre
for Reviews and Dissemination is a department of the University of York and is part of the National Institute for
Health Research.
Benjamin Hippen
Hippen is a transplant nephrologist in private practice with Metrolina Nephrology Associates and the Carolinas
Medical Center in Charlotte, North Carolina. He is an at-large member of the United Network for Organ
Sharing/Organ Procurement and Transplant Network Ethics Committee and serves as an associate editor of the
American Journal of Transplantation.
Page 10 of 174
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Capt. Ajit Vadakayil

Capt. Ajit Vadakayil been in command of chemical tankers (mainly) for more than 6640 days -- spread over 30
years, which is a world record. In his free time, he likes to post about chemical reactors and problems that go
on in the world.
Carl Cohen
Cohen is Professor of Philosophy at the Residential College of the University of Michigan. In philosophy,
Cohens interests have focused on issues of practical importance; he has been prominently involved in
philosophical issues arising on the protection of humans, and especially prisoners, serving as voluntary subjects
in medical experiments.
Francis L. Delmonico, Robert Arnold, Nancy Scheper-Hughes, Jeffrey

Kahn, and Stuart J. Youngner
Francis L. Delmonico, MD, FACS is a surgeon, clinical professor and health expert in the field of
transplantation. He serves on numerous committees and is affiliated with various leading organizations and
institutions. Robert M. Arnold is the Centers Director of Clinical Training. He is a Professor in the Division of
General Internal Medicine, Department of Medicine. Nancy Scheper-Hughes is a professor of Anthropology
and director of the program in Medical Anthropology at the University of California at Berkeley. Laura A.
Simnoff, PH.D. Case Western Reserve University School of Medicine Cleveland. Simnoffs main content areas
include organ and tissue donation. Jeffrey Kahn, PhD, MPH, is the Robert Henry Levi and Ryda Hecht Levi
Professor of Bioethics and Public Policy and the Deputy Director for Policy and Administration at the Johns
Hopkins Berman Institute of Bioethics.. Stuart J. Youngner is Susan E. Watson Professor of Bioethics,
Professor of Psychiatry, Professor of Medicine, and Chair of the Department of Bioethics at Case Western
Reserve University School of Medicine.
Franklin Miller
Franklin G. Miller, Ph.D. is a member of the senior faculty in the Department of Bioethics, National Institutes
of Health (NIH) and Special Expert, National Institute of Mental Health Intramural Research Program. His
principal current research interest is examination of ethical issues in clinical research, including study design,
informed consent, and the ways in which clinical research differs from medical care.
Page 11 of 174
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Gary Becker
Gary Becker is a Professor of Economics at the University of Chicago and a Senior Fellow at the Hoover
Institute. He was awarded the Nobel Memorial Prize in Economic Sciences in 1992 and received the United
States Presidential Medal of Freedom in 2007.
James Lindemann Nelson

James Lindemann Nelson is a philosophy professor and bioethicist currently teaching at Michigan State
University. Nelson earned his doctorate in philosophy at the State University of New York. Nelson was an
Associate for Ethical Studies at The Hastings Center from 199095 and is both a Woodrow Wilson Visiting
Fellow and a Fellow of the Hastings Center. Nelson currently teaches courses on biomedical ethics, ethical
theory, moral psychology, feminist theory, and philosophy of language
Jennifer M Smith
Smith was formerly a partner and department chair of the South Florida Health Law Group of Holland &
Knight LLP. She was a federal judicial law clerk to the Honorable Joseph W. Hatchett, U.S. Court of Appeals
for the Eleventh Circuit. Currently, she is an associate professor of law, Florida Agricultural & Mechanical
University College of Law.
John M. Olin
Olin is a research Fellow in Law and Economics. University of Chicago Law School Associate Professor.
California Western School of Law.
John Robertson
John Robertson is an assistant professor at the University of Wisconsin Law School.
Kenneth Gundle
Kenneth Gundle is a junior majoring in Human Biology with an Area of Concentration in "Biological and
Social Issues in Organ Transplantation." He first became interested in organ donation policy during a class
entitled "The Nations Health." The research presented here was supported by a Chappell-Lougee Scholarship
and a Haas Summer Fellowship.
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Kristen Gwynne
Kristen Gwynne is a New Yorkbased journalist whose work has appeared on AlterNet, Salon and
RollingStone.com. She is an associate editor on AlterNet.
Laura Siminoff
Laura A. Siminoff, PH.D. Case Western Reserve University School of Medicine Cleveland. Siminoffs main
content areas include organ and tissue donation.
Lloyd R. Cohen
Cohen is Professor of Philosophy at the Residential College of the University of Michigan. He has published
scholarship on a variety of applications of economics to law, including a market in transplant organs, marriage
and divorce, wrongful death, tender offers, and free riders and holdouts.
Mark Nadel
Mark Nadel currently is an Attorney at the Federal Communications Commission. He graduated from Harvard
Law School, JD. He previously was a policy analyst for the US Congress Office of Technology Assessment
(OTA).
Maria N. Morelli
J.D. candidate, May 1996, Washington College of Law, The American University, B.A. 1992, Yale University.
Marie-Andree Jacob
Marie practiced law and worked as a clerk before becoming an academic. She is a senior lecturer at Keele
University. She writes on organ donations.
Michael Oliver, Alexander Woywood, Aimun Ahmed, and Imram Saif

Oliver and Alexander are from the Department of Nephrology, Lancashire Teaching Hospitals NHS Foundation
Trust, Preston, Lancashire, UK. Michael Oliver Krauthammer is Associate Professor of Pathology at the Yale
School of Medicine. Aimun and Imram are from the Department of Nephrology, Derriford Hospital, Plymouth
Hospitals NHS Trust, Plymouth, UK. Dr Aimun Ahmed is also a consultant physician, nephrologist, and
honorary senior lecturer.
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Peter Clark
Peter A. Clark, S.J., Ph.D. is a Professor of Medical Ethics and Director of the Institute of Catholic Bioethics at
Saint Joseph's University in Philadelphia. He is a Professor of Medical Ethics and Director of the Institute of
Catholic Bioethics and a bioethical consultant with hospitals in the Philadelphia and Baltimore areas.
Remco Coppen, Roland D. Friele, Richard L. Marquet, and Sjef KM

Gevers
Remco Coppen, Roland D. Friel, and Richard L. Marquet are from NIVEL (Netherlands Institute for Health
Services Research) in Utrecht, The Netherlands. Remco Coppen also was awarded the Public Health Prize in
2010 for his thesis on organ donation. Roland D. Friel is the Deputy Director Head of research department
Program Leader Laws. Sjef Gevers is from Academic Medical Center/University of Amsterdam, Amsterdam,
The Netherlands. He also has university degrees in law and sociology.
Roger L. Mendoza
Mendoze is an economist by training. He publishes refereed research, pursues teaching, and does actuarial work
in the field of welfare economics, particularly health care and retirement pensions. He has contributed to the
development and implementation of privatization strategies in the United States.
Sheri R. Glaser
Sheri Glaser is a Trial Attorney with the United States Department of Justice. She is is a J.D. candidate at the
Washington College of Law.
T. Millar, R Walker, JW Ironside, C Smith, JE Bell, JC Arango, DJ

Harrison, DJ MacIntyre, and D Blackwood
T. Millar, R Walker, JW Ironside, C Smith, and JE Bell work in the Neuropathology Unit at the University of
Edinburgh. JC Arango and DJ Harrison work in the Division of Pathology and Forensic Medicine Service at
the University of Edinburgh. DJ MacIntyre and D Blackwood work in the Division of Psychiatry at the
University of Edinburgh.
Danielle Hamm
Danielle Hamm is an ethics adviser for the British Medical Association.
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Juliet Tizzard
Juliet Tizzard is the deputy head of ethics for the British Medical Association.
Eric J Johnson
Johnson, Eric J is the Norman Fig Professor of Business Columbia Business School in Marketing.
Daniel G Goldstein
Goldstein, Daniel G. is the Principal Researcher at Microsoft Research New York City and an Assistant
Professor of Marketing at London Business School.
Maxwell J Mehlman
Mehlman, Maxwell J. is the Professor of Law and Director of The Law-Medicine Center at Case Western
Reserve University 'School of Law. He has a B.A. Reed College, 1970; B.A. Oxford University, 1972; J.D.,
Yale Law School, 1975.
Nicanor Pier Giorgio Austriaco

Rev. Nicanor Pier Giorgio Austriaco is an assistant professor of biology at Providence College in Rhode Island
Andrew D Lawson
Andrew D Lawson is a Consultant in Pain Medicine & Anaesthesia & Medical Ethicist at the Royal Berkshire
Hospital and is an Honorary Senior Lecturer in Medical Ethics at Imperial College, London.
Eike-Henner W. Kluge
Eike-Henner W. Kluge is a Professor and Chair in the Department of Philosophy at the University of Victoria,
Canada
Mitsuyasu Kurosu
Mitsuyasu Kurosu works in the Tokyo Medical Universitys Department of Bioethics
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Gil Segal
Gil Segal works for the Center for Health Law, Bioethics and Health Policy, Kiryat Ono College, Kiryat Ono,
Israel; the Gertner Institute for Epidemiology and Health Policy, Ramat Gan, Israel; and is a member of the
School of Law, University of Virginia, Virginia, USA
J. Lavee, T. Ashkenazi, A. Stoler, J. Cohen, and R. Beyar

J. Lavee [Israel National Transplant Center, Ministry of Health, Tel Aviv, Israel; Heart Transplantation Unit,
Sheba Medical Center, Tel Hashomer, Israel], T. Ashkenazi [Israel National Transplant Center, Ministry of
Health, Tel Aviv, Israel], A. Stoler [Department of Economics, DePaul University, Chicago, IL], J. Cohen
[Israel National Transplant Center, Ministry of Health, Tel Aviv, Israel; General Intensive Care Department,
Rabin Medical Center, Petah Tikva, Israe] and R. Beyar [Israel National Transplant Center, Ministry of Health,
Tel Aviv, Israel; Rambam Medical Center, Haifa, Israel]
Muireann Quiqley, Linda Wright, and Vardit Ravitsky

Quigley, Muireann works for the Centre for Social Ethics and Policy/Institute for Science, Ethics, and
Innovation, School of Law, University of Manchester, Manchester, United Kingdom; Wright, Linda is a part of
the Department of Surgery and Joint Centre for Bioethics, University of Toronto, Toronto, Ontario, Canada;
Ravitsky, Vardit is a part of the Bioethics Programs, Department of Social and Preventive Medicine, School of
Public Health, University of Montreal, Montreal, Quebec, Canada.
Paula Boddington
Dr Paula Boddington is a Stipendiary Lecturer in Philosophy at Hertford College of Oxford. BA in philosophy
and psychology from Keele University before coming to Corpus Christi, Oxford to take the BPhil and DPhil in
philosophy. She lectured at Bristol University and the Australian National University, and has held research
posts at Cardiff and in the Medical Sciences Division of Oxford University. She has worked extensively in
medical ethics, and took an LLM in Legal Aspects of Medical Practice at Cardiff University. She has been
teaching at Hertford since 2011.
Robert M. Veatch and Jonathan B. Pitt

Veatch is a Professor of Medical Ethics at the Kennedy Institute of Ethics. Pitt, Jonathan B is an Adjunct
Professor of Law, Georgetown Law School.
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Sally Satel
Sally Satel, is an American psychiatrist based in Washington, D.C. She is a lecturer at Yale University School
of Medicine, the W.H. Brady Fellow at the American Enterprise Institute, and author.
Sydney Lupkin
Sydney Lupkin is a health reporter for ABCNews.com. She was a data researcher at The Bay Citizen, a
nonprofit newsroom in San Francisco, where she wrote about accident deaths for The New York Times. She
previously worked as a computer-assisted reporting intern at ProPublica, where she worked on the Recovery
Tracker and wrote about a lapse in OSHA's death records.
Simon Bramhall
Simon Bramhall has been Consultant Surgeon at the Liver Unit, Queen Elizabeth Hospital, Birmingham since
2002.
Kenneth Gundle
Kenneth Gundle is a Resident Orthopaedic Surgeon at University of Washington School of Medicine. He went
to medical school at Harvard University.
Amber Rithalia
Amber Rithalia is a research fellow at the Centre for Reviews and Dissemination (CRD) at the University of
York.
Maryellen Liddy
Maryellen Liddy is a J.D. Candidate at Fordham University of School of Law.
Daniel Springer
Daniel Springer is a researcher at Oakland University.
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David Orentlicher
David Orentlicher is a Samuel R. Rosen Professor of Law and Co-director of the William S. and Christine S.
Hall Center for Law and Health.
Deborah Mitchell
Deborah Mitchell is a professional health writer who has authored, co-authored, and ghostwritten more than 45
books published by major houses in the areas of conventional and alternative health, wellness, and nutrition;
and a health news reporter, regularly contributing to various websites, including Emaxhealth and Prostate.net
Emily Bourke
Emily Bourke is a Journalist at Australian Broadcasting Corporation.
Alexander Kagan
Alexander Kagan is a professor in the Departmetnt of Nephrology and Hypertension at Kaplan Medical Center,
Rehovot, Israel. He attended Hebrew University Medical School.
Veronica English and Linda Wright

Veronica English is the deputy head of medical ethics of the British Medical Association, in London. Linda
Wright is a Clinical Social Work/Therapistand has been practicing for over 15 years.
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Defend Your Source
Organizations
Center for Bioethics. Ethics of Organ Transplantation
About: The Center for Bioethics & Human Dignity explores the nexus of biomedicine, biotechnology, and our
common humanity. Within a Judeo-Christian Hippocratic framework, we anticipate, interpret, and engage the
pressing bioethical issues of our day. As a center of rigorous research, theological and conceptual analysis,
charitable critique, and thoughtful engagement, we bring clarity to the complex issues of our day.
http://www.ahc.umn.edu/img/assets/26104/Organ_Transplantation.pdf
UW Organ and Tissue Donation.

Established in 1966, UW Organ and Tissue Donation is widely recognized as one of the most effective organ
procurement programs in the nation.
Page 19 of 174
Definitions
Definitions
Medical Definition of Death TF
Taylor, Robert (1997). Reexamining the Definition and Criteria of Death.
The whole-brain criterion of death was first formally proposed by the Ad Hoc Committee of the Harvard
Medical School to Examine the Definition of Brain Death in a Special Communication published in JAMA
in 1968. Since then, all states in the United States and many western countries have endorsed this definition of
death. The strongest defense of the concept of brain death was provided by Bernat, Culver, and Gert in a
series of papers published in the early 1980s, emphasizing the important distinctions between the definition and
the criteria of death and the tests for death. Careful analysis, however, demonstrates that brain-related criteria of
death are inconsistent with traditional concepts of death. Thus, although death is properly understood as a
biological phenomenon, brain death is a social construct created for utilitarian purposes, primarily to permit
organ transplantation. The best definition of death is the event that separates the process of dying from the
process of disintegration and the proper criterion of death in human beings is the permanent cessation of the
circulation of blood. Nevertheless, because brain-related criteria of death have been widely accepted, and
because our society has demonstrated a strong commitment to organ transplantation, abandoning the concept of
brain death would create serious political problems. Abandoning the dead donor rule would solve the problem
of obtaining organs for transplantation, but would create different, equally serious, political problems.
Preserving the concept of brain death as a social construct, as a legal definition of death, but distinct from
biological death, is also problematic, but may be our most acceptable alternative.
Definition of death/consent to procure organs will be a big issue early in the round to establish ground.
Definition of Presumed Consent TF

Pierscionek, Barbara (2008). What is presumed when we presume consent?
Any action or decision made on a presumption is accepted in law and science as one based on judgement of a
provisional situation. It should therefore allow the possibility of reversing the action or decision. Presumed
consent to organ donation will not permit such reversal. Placing prime importance on the functionality of body
organs and their capacity to sustain life rather than on explicit consent of the individual will lead to further
debate about rights of ownership and potentially to questions about financial incentives and to whom benefits
should accrue. Factors that influence donor rates are not fully understood and attitudes of the public to
presumed consent require further investigation. Presuming consent will also necessitate considering how such a
measure would be applied in situations involving children and mentally incompetent adults.
Presumed consent will determine to what extent AFF must prove to win the ground.
Page 20 of 174
Definitions
Definition of presumed consent. CFS

Simon Bramhall Presumed consent for organ donation: a case against Annals of The
Royal College of Surgeons of England. May 2011.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3363073/
Presumed consent is alternatively known as an opt-out system and means that unless the deceased has
expressed a wish in life not to be an organ donor then consent will be assumed. This can be divided into what is
known as a hard opt-out where the family are not consulted or a soft opt-out when the family's wishes are
considered in the same manner as with the current opt-in system.
This definition explains the difference between a hard opt-out and soft opt-out systems.
Difference between an opt-in and opt-out system and hard and soft opt out systems. SBH.
James Lindemann Nelson. Donation by default? Examining feminist reservations about
opt-out organ procurement International Journal of Feminist Approaches to
Bioethics, Volume 3, Number 1, Spring 2010, pp. 23-42
Broadly, an opt-in system requires positive evidence that the recently dead person who is a potential provider of
transplantable organs has explicitly agreed to provide them, or that those recognized as her appropriate proxy
decision makers have so agreed. Opt-out systems, in contrast, will retrieve organs unless the potential organ
provider had decided to withhold them. Further distinctions pivot on the role that the surviving bonded
intimates may play: in France, for example, the opt-out policy is referred to as soft, which means that
survivors may effectively object to organ provision on behalf of someone whose objections were not recorded
when alive; in Austria, the opt-out system is hard, and survivor objections are not generally regarded as
sufficient to halt procurement. Opt-in systems may also defer to, or resist, the judgment of a potential donors
survivors.(pg. 25)
There is a difference between a hard and soft opt-out system. This might be a potential topicality debate
so it would be good to know what as the affirmative you defend.
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Topic Analysis One
Topic Analysis One

Lawrence Zhou
This topic analysis will be primarily geared towards stock/traditional approaches to the resolution, Resolved: A
just society ought to presume consent for organ procurement from the deceased. I believe that this is a fairly
balanced topic with good literature and arguments for each side and can handle both traditional and progressive
approaches to the topic well.
Breakdown of the resolution.

Just society.
What does it means for a society to be just? I believe that there are two valid approaches to this. The first
approach is to assume a hypothetical just society exists. This approach seems the most textually grounded, but
also seems to leave some questions unanswered. If this society is just, then what does it mean for the society to
be just in the first place. And if a just society is merely hypothetical, will one ever exist? This approach seems
best for very philosophical approaches to the topic, but also seems to leave a lot of questions unanswered. The
second approach is to frame the resolution as a question of what a society ought to do to become just. This
approach seems to have better debates in terms of real world applicability because debaters can now point to
empirical examples of what has happened in the real world and explain why those policies make a society just
or unjust. While I do feel that this approach is probably not the most textual, I believe it makes for the best
debates.
Both of these approaches have positives and negatives, you pick which one you believe in and defend it. While
I dont believe that this question will become relevant in most debates, it does have some bearing on what
framework you pick and how you approach your cases.
Is there a difference between a just government and just society? Yes. Is it relevant? Probably not.
Presume consent.
What is presumed consent? According to Simon Bramhall:
Simon Bramhall [Consultant Liver Transplant Surgeon, Liver Unit, Queen Elizabeth Hospital, Birmingham] Presumed consent for organ donation: a case against
Annals of The Royal College of Surgeons of England. May 2011; 93(4): 270272. doi: 10.1308/147870811X571136b
Presumed consent is alternatively known as an opt-out system and means that unless the deceased has
expressed a wish in life not to be an organ donor then consent will be assumed. This can be divided into
what is known as a hard opt-out where the family are not consulted or a soft opt-out when the
family's wishes are considered in the same manner as with the current opt-in system.
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Topic Analysis One
It is a shift from what is happening in most societies, like the United States, because in the status quo, the
default assumption is that consent is not assumed. In the United States, we assume that the deceased are not
organ donors unless they have specifically indicated somewhere that they wish to have their organs donated.
Under a system of presumed consent, the assumptions are flipped where the deceased are assumed to be donors
unless they have specifically indicated somewhere that they do NOT wish to have their organs donated.
Organ procurement.
According to the World Health Organization, procurement is:
Global Glossary of Terms and Definitions on Donation and Transplantation. World Health Organization. Geneva, November 2009.
http://www.who.int/transplantation/activities/GlobalGlossaryonDonationTransplantation.pdf
The process that includes donor identification, evaluation, obtaining consent for donation, donor
maintenance and retrieval of cells, tissues or organs.
Stock aff positions

Utilitarian affs
The most common affirmatives on this topic will adopt some sort of utilitarian approach to the resolution, which
argues that what a just society ought to do is to benefit the most people. Utilitarian frameworks are particularly
good on this resolution because most of the relevant empirical evidence is biased towards the affirmative. The
advantages of using this type of framework is that it is easily debatable, easy to defend, and highly intuitive. It
is debatable because it makes the round extremely clear: the better debater is the one who shows that his or her
side is the one that comparatively is better in terms of minimizing suffering or maximizing happiness.
Utilitarianism is easy to defend because most people believe utilitarianism to generally be true. And it seems
that intuitively, a just society should take steps that maximize happiness and/or minimize suffering, which
requires adopting a utilitarian approach. This also makes it easy to contextualize a just society: a just society is
one that benefits its people. A disadvantage to using this type of framework is that negative debaters will
frequently choose to not answer the contentions, and instead answer the util framework with their generic dump
of eight util bad answers. To avoid this, make your criterion more specific and less generalized. Another
disadvantage is that evidence about why presumed consent does not work exists and requires debaters be very
prepared to answer such negative evidence.
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Topic Analysis One
The most common argument is that a system of presumed consent would solve for the current shortage of organ
donors. An average of 18 people die each day because of the lack of organ donations1. Presumed consent would
seem to be an effective method of remedying such a problem and saving lives. Many studies indicate that
policies of presumed consent could raise organ donation rates by up to 30%2. This is seems to be the most basic
argument and one of the toughest arguments to answer. It is also highly intuitive and functions under any
utilitarian framework.
However, even independent of organ shortages, a system of presumed consent would still seem to have many
benefits. One organ donor can save or improve the lives of up to 50 people3, and medical advances will surely
bring this number higher. Any system of utilitarianism that looks to benefit the majority of people would
definitely agree that if an organ can benefit 50 people, then a just society ought to presume consent for organ
procurement and benefit the majority. This argument doesnt even fall prey to the classic hospital counterargument about sacrificing one healthy patient to save five sick patients as this is a case that concerns the
deceased. A dead persons organs clearly doesnt benefit anyone inside the dead persons body, but it does
benefit people who are in need of organs. Even if organ procurement benefitted just one living person, it would
still make sense to affirm under a utilitarian framework since a dead person cannot contribute to utility whereas
a live person can.
Another type of utilitarian affirmative approach would be to look at the medical benefits from researching a
donated organ as opposed to transplanting it. Several articles mention specific advantages to researching organs,
including better understanding particular medical conditions. Researching these organs can help medical
experts better treat ailments such as diabetes, liver damage, and heart problems, all of which are real problems
that impact real people.
http://www.organdonor.gov/about/data.html
Alberto Abadie Harvard University and NBER, Sebastien Gay University of Chicago. "The Impact of
Presumed Consent Legislation on Cadaveric Organ Donation: A Cross Country Study" December 2005
http://www.hks.harvard.edu/fs/aabadie/pconsent.pdf
3
"Organ Donation: MedlinePlus." U.S National Library of Medicine. U.S. National Library of Medicine, n.d.
Web. 18 Aug. 2014. <http://www.nlm.nih.gov/medlineplus/organdonation.html>.
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Topic Analysis One
When competing in front of flow judges, dont forget to weigh, weigh, weigh. If the accepted framework in
round becomes utilitarianism, always remember to explain why your side is COMPARATIVELY better. No
matter what the negative claims, it can hardly outweigh saving lives at the cost of a dead persons organs that
they dont need anymore. The negative will always try to weasel their way out of this, but the affirmative has
the better evidence and better results.
In front of lay judges, you want to also weigh. Explain in simple terms that there is no way that a dead persons
organs outweigh the life of a living person. Bringing this issue close to home is an effective way at persuading
lay judges. Bringing up stories or hypotheticals about how organ donations are key to saving lives and the effect
that presumed consent has on benefitting people will sway many lay judges to your side.
The final thing to mention when running utilitarian positions is to be wary about negative counterplans. While
most negative disads and utilitarian arguments are probably empirical claims that are defensive in nature, the
one thing the negative has a lot of on this topic is counterplan ground. In order to run these utilitarian arguments
well, there must be reasons why only a system of presumed consent can derive these unique advantages. If you
claim that affirming raises donation rates, you need reasons why this happens only when you affirm, or at least
show why it works best when affirming. When affirming, you must be prepared on many negative counterplans
with arguments showing both why affirming produces better advantages than negating and why the particular
negative counterplan isnt effective.
Social contract affs

Social contract affs will also be very popular approaches to the topic when affirming. These frameworks argue
citizens formed a society for the protection of their natural rights and that there exists a contract between society
and the people. The advantage of adopting a social contract approach is that it appeals to Western political
thought. We, as Americans, typically believe that a social contract approach to society is what determines the
legitimacy of a society. A disadvantage to the social contract approach is that this approach is very open to a
variety of common negative responses.
I believe that there are two plausible social contract approaches to the resolution when affirming. The first is to
adopt a primarily utilitarian approach and claim that society has a contractual obligation with its citizens to take
steps to maximize societal welfare. This would claim that the social contract mandates that a just society look to
the good of the society and if presumed consent for organ procurement would benefit society in some way, it
seems that a just society ought to take such an approach. This approach has the benefit of accessing
consequentialist impacts while avoiding a strictly utilitarian debate. While this approach works well in front of
many lay judges, it has its disadvantages. It seems unnecessary to begin with. If you want to argue about
societal welfare, you should just use utilitarianism and not disguise it as the social contract. It also opens the
door to many more negative attacks. Not only can the negative now make utilitarian arguments that now link
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Topic Analysis One
into your framework, they also can make contractual arguments that also could link turn the affirmative case,
essentially doubling your opponents strategic options.
The second is to adopt a balanced rights approach. This approach would claim that a just society exists to
balance between competing rights claims, which is the purpose of the social contract. Such an approach makes
sense intuitively because many people agree and believe that society does exist for such a purpose. This
approach argues that when rights come into conflict, a just society would have to prioritize a right. In this case,
the rights that would be in conflict are the rights of the recipient to an organ, and the right of the deceased.
There are other possible rights that could be claimed by either side. The affirmative could claim a right by
society to the organ for research, a right by an individual to a lifesaving organ transplant, a right to life, etc. You
want to make the negatives right claim look as trivial as possible, especially compared to the rights the
affirmative is claiming. Who cares about the rights of a dead person when there are people who have the right
to life? There are a couple reasons why the rights to the organs precedes the rights of the deceased. The first is
obvious, a dead person really doesnt have many rights, and even if they did, they certainly would not be given
priority in any just society over the rights of a living person. Second, a right to a lifesaving organ is more
important than a lesser right to, say, respect the autonomy of the dead person, which means that even if the
negative did have a legitimate rights claim, it would not occupy the same primary status as the right to life.
Third, the right to a lifesaving organ is also necessary for other rights, such as a healthy, meaningful, and free
life. Any just society must look at securing basic rights and providing lifesaving organs is undoubtedly one way
of securing many basic rights. Fourth, the moral logic that dictates that we respect the rights of the deceased
comes from a notion of human dignity, but any notion of human dignity would also recognize that stopping
suffering and violations of dignity of a living person is a higher moral priority than stopping possible violations
of dignity of the deceased. Finally, no rights are being lost by affirming. Any system of soft consent would still
respect the rights of the family and those who do not wish, for religious or personal reasons, to have their organs
procured can easily opt out of such a system, which means that violations of rights dont really exist in the
affirmative world. I believe that this system is probably the best way to approach the social contract. This
approach, I believe, is also one of the most reasonable, topical, and intuitive affirmative cases that has the
potential to work well in front of both lay and progressive judges.
Rawls affs
While Rawls is more of a hypothetical contractualist, his position would work well here. Hippen et al explains:
Hippen B [Metrolina Nephrology Associates and Carolinas Medical Center, Charlotte, North Carolina], Ross LF [Departments of Pediatrics, Medicine, and Surgery,
MacLean Center for Clinical Medical Ethics, University of Chicago], Sade RM [Department of Cardiothoracic Surgery and Institute of Human Values in Health Care,
Medical University of South Carolina]. Saving lives is more important than abstract moral concerns: financial incentives should be used to increase organ
donation. Ann Thorac Surg. Oct 2009; 88:10531061.doi:10.1016/j.athoracsur.2009.06.087.
One widely accepted theory of egalitarian justice was developed by John Rawls. It would permit policies
that increase organ transplantation using living vendors if this policy would be accepted behind a veil of
ignorance where one was not aware of ones personal traits but did have knowledge of the social and
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Topic Analysis One
political state of affairs. Behind the veil of ignorance, an individual would know that demand for organs
greatly outstripped supply. Behind the veil, the rational Rawlsian individual would adopt policies to
increase organ transplants provided that the new policies were not harmful to those who are already
worse off.
The Rawls approach, I believe, has the potential to be an effective approach for both progressive and lay judges.
It makes sense, it is easy to explain, and there are few good responses against the framework. It also allows for a
variety of different affirmative claims to link under a single framework. This approach would allow for a rights
based approach under a social contract view as well as utilitarian arguments about saving lives.
However, I believe that the Rawlsian approach is open to a few problems. The first issue is that the arguments
that justify a Rawlsian approach would justify other counterplans that also promote organ procurement using
different methods. For example, the evidence above is actually about using financial incentives to increase
organ donation. This means that using a Rawlsian approach opens you up to some utilitarian arguments. In
order to combat this, you will have to do a decent amount of work to answer counterplans. Another problem
with a Rawlsian approach is that because it allows different affirmative arguments to link to a single framework,
it also opens yourself up to many different negative arguments to also link. While those arguments arent
necessarily the best, it means that the affirmative does have to be prepared to deal with those arguments.
Other aff arguments.

One somewhat interesting aff argument is that autonomy seems to demand that we affirm. This is because most
people actually believe that they should have their organs donated, but this doesnt end up happening, so in
order to rectify this situation, we should adopt a system of presumed consent to ensure that more peoples
wishes are being respected. This is known as the fewer wrongs argument. Michael B. Gill explains:
Michael B. Gill [Professor of Philosophy at the University of Arizona.] Presumed Consent, Autonomy, and Organ Donation. Journal of Medicine and Philosophy. 2004,
Vol. 29, No. 1, pp. 37-59. http://www.u.arizona.edu/~gillm/media/articles/presumedconsent.pdf
Cohen has given the following argument for the claim that presumed consent would do a better job than
the current system at respecting peoples wishes (Cohen, 1992, p. 2169).2 About 70% of Americans
would prefer to donate their organs for transplantation after their death. But fewer than 70% of the
organs suitable for transplantation are donated. This is because many people who want to donate their
organs do not leave indications of their desires that are clear enough to overcome the current systems
initial presumption against removing organs for transplantation. As a result, many who wanted to donate
their organs after death are buried with all their organs intact inside their bodies. This violates their
wishes about what should happen to their bodies after death. A policy of presumed consent, however,
would result in peoples wishes being respected at least 70% of the time, and probably much more than
that, so long as the policy includes a well publicized opt-out opportunity. This would almost certainly
constitute an increase over the current system in the number of decedents whose wishes are respected.
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Topic Analysis One
This argument is slightly counter intuitive and, as such, might not be the best suited to run in front of lay judges.
However, this is an important argument because it turns most negative autonomy based positions. Debaters
should strongly consider putting this argument in their case as a preempt against common negative cases, or
reading this as a turn in the 1AR.
A type of nailbomb affirmative case could also be run, claiming that there is no morally relevant distinction
between organ procurement in general and a system of presumed consent. The Stanford Encyclopedia of
Philosophy explains:
Wilkinson, Martin [Associate Professor at Auckland University, MA, DPhil (Oxon), Deputy Head of Department | Political Studies] and Wilkinson, Stephen [Professor
of Bioethics at Lancaster University], "The Donation of Human Organs", The Stanford Encyclopedia of Philosophy (Fall 2014 Edition), Edward N. Zalta (ed.),
forthcoming URL = <http://plato.stanford.edu/archives/fall2014/entries/organ-donation/>.
The proposal envisages taking organs without the explicit consent of the deceased. One may object that
people's rights over their bodies establish a duty of non-interference which can be lifted only with the
consent of the rightholder (Kluge 2000). A different objection points out that taking organs without
consent will sometimes be against the wishes of the deceased; and while not taking will be against the
wishes of the deceased who had wanted to donate, taking in error is a worse mistake than not taking in
error, because people have a right not to have their organs taken but no right to have their organs taken
(Veatch 2000). As against these views, we must dispose of the bodies of the dead in some way, even if
not consented to; and we give unconsented medical treatment to the unconscious even though some
would have opposed treatment (Gill 2004; Wilkinson in press).
Using the bodies of the deceased without either their consent or knowing that they had wanted the use
raises an important and difficult ethical question. It is very important to note, however, that this question
is raised by virtually all existing organ procurement systems (see above on organ retrieval in practice).
Moreover, the simple inertia argument for shifting defaults cannot be right as it stands because there is
no default of non-retrieval in the absence of the deceased's consent. Other arguments for variations of
opting out turn on the empirical question of effects on retrieval. Since many different factors affect
retrieval rates, it is often hard to be confident about the difference that changes to consent would make.
With this evidence says is that any arguments again a system of presumed consent would ultimately be no
different from current medical practices that the vast majority of people, including some of those who raise
these objections, find to be justified. For example, arguments that we must treat the dead as they wouldve
wished in life makes no sense because we have defaults on how we treat the dead. We still have to treat the
dead in some way, even if they did not explicitly consent; and if they have strong objections against a system of
treatment, they can always opt-out.
Finally, a note to affirmative debaters. One major disadvantage that the aff has to face is the fact that negatives
can beat you by out-righting or by out-lefting you. If you, as the affirmative, place too much emphasis on just
saving lives and argue that autonomy doesnt really matter, then the negative is free to out-left you and read a
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Topic Analysis One
myriad of counterplans including a counterplan that advocates for required organ donation no matter what. That
counterplan probably produces more organ donations even though it clearly disrespects autonomy. If that
happens, and you have already read a ton of reasons for why autonomy is not important, its going to be very
difficult to leverage affirmative offense against that position. However, if you make autonomy an important
issue, and read reasons for why you have to respect autonomy, then the negative is going to out-right you and
read a position that says that autonomy comes first and a system of presumed consent disrespects that. If you go
too far in either direction, the negative can simply co-opt the arguments that you read and use them for their
advantage. In order to avoid this problem, you can either bite the bullet and just answer the negative positions
head on, or you can strategically craft your case so as to not go too far to the left or the right. I think the
affirmative is going to have to find that happy medium that takes into account autonomy and the consequences
of a system of presumed consent.
Stock neg positions

So it seems that the affirmative has a lot of good arguments, but where does that leave the negative? Actually,
the negative has plenty of good arguments.
Autonomy/Kant negs
This seems to be the most intuitive. Many philosophers make the argument that it violates individual autonomy
to presume ownership over the deceaseds organs. Consent is an integral part of autonomy. If one does not fully
consent, then one has overridden a persons autonomy. However, one cannot presume consent. Consent is a
deliberate action. Thus, presumed consent violates autonomy because it isnt a system of actual consent.
Presumed consent is also a bit troublesome because the logic behind it is faulty. Not saying no is not the same
thing as saying yes. Just because someone didnt say no as you robbed them doesnt mean they consented to
being robbed. This is the moral logic that justifies a system of presumed consent and simply doesnt make any
sense.
Another problem with consent is that to consent, you have to be informed about an issue, however, it doesnt
seem like a system of presumed consent informs patients sufficiently to consider it real consent. Andrew
Lawson explains:
Andrew D Lawson [Consultant in Pain Medicine & Anaesthesia & Medical Ethicist, Royal Berkshire Hospital; Honorary Senior Lecturer, Medical Ethics, Imperial
College, London]. Presumed consent for organ donation in the United Kingdom. Journal of the Intensive Care Society. Volume 9, Number 2, July 2008.
http://journal.ics.ac.uk/pdf/0902116.pdf.
One of the fundamental problems about the concept of presumed consent is whether such consent can
actually be considered consent in the real sense of the word. The process of consent hinges on patients
being fully informed. In deciding not to opt out, how fully informed would people be? Even if a person
was informed when deciding not to opt out, how could that decision be said to still be informed some
years later?
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Topic Analysis One
My recommendation when writing this position is to take your own nuanced approach to it. This is probably
going to be the most common stock negative argument, so it will be heavily prepped out by good affirmatives.
Find your own little spin on it. If you run this type of negative position, you need to have a more specific
argument than just the generic autonomy argument. You also need a good response to the fewer mistakes
argument as that is a very popular affirmative response to autonomy-based positions.
Libertarianism/Locke negs
While Locke seems to go aff because of his social contract position, a good argument can be made in favor of
Lockean positions favoring the negative. This comes from the Lockean argument about private property and
owning yourself. Lockes argument is that an individual owns themselves, including their body, and ones
property cannot be violated without an individuals consent. This is very similar to the autonomy argument. The
only real difference is that this argument focuses on property rights and self-ownership as opposed to individual
choice.
Utilitarian negs
Despite a lot of literature going affirmative in terms of utilitarianism, there are still several routes to take using a
utilitarian approach.
First, there is a lot of literature indicting that systems of presumed consent are not particularly effective at
increasing organ donation rates. As a study from Johns Hopkins shows:
Johns Hopkins Medicine "Presumed Consent Not Answer to Solving Organ Shortage in U.S., Researchers Say" November 29, 2011.
http://www.hopkinsmedicine.org/news/media/releases/presumed_consent_not_answer_to_solving_organ_shortage_in_us_researchers_say
Segev and his team conducted in-depth interviews with transplant experts in 13 European nations with
presumed consent legislation. They found that, despite the laws, the process of organ donation in those
countries does not differ dramatically from the process in countries, such as the United States, that
require explicit consent. They also found that the United States ranked third among the nations surveyed
in rates of organ donation from the deceased, with 26.3 deceased donors per million population. Only
Spain (34.1) and Portugal (26.7) did better.
Other studies come to the same conclusion, and even studies that claim that presumed consent will raise
donation rates concede that multiple other factors are probably more responsible for the increased donations as
opposed to the law itself. One reason this is true is not that many organs can be used for transplant in the first
place. However, this argument is not particularly strong. It is not offense, or a reason to vote for the negative. It
just indicates that there is not a particularly good reason to affirm. This argument is just pure defense.
Furthermore, many judges and people intuitively believe that this system would probably raise donation rates.
There is no reason to fight against common intuitions if you dont have to.
Another utilitarian approach is run a counterplan. There are many viable counterplans in the relevant literature
that are worthy of examination.
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Topic Analysis One
NOTE: For traditional debaters, this does not mean that you cannot run these arguments. Just make sure to call
this an argument, and not a counterplan. Avoid the jargon.
One counterplan is to advocate that doctors should instead offer financial incentives for people to donate
organs. There are many philosophers who have advocated for paying for organs. The empirical evidence on this
question is mixed and is itself a major source of controversy, so this may not be the best approach as it invites a
whole other topic into the debate.
Another method is public awareness campaigns. There is evidence indicating that simply informing the public is
enough to raise donation rates. Make sure when running this argument though, to be clear about why this
counterplan is competitive. There has to be a reason why doing this counterplan alone is better than doing either
the affirmative plan or the affirmative plan and the counterplan together.
The next counterplan is known as mandated choice. Daniel Springer explains what mandated choice is:
Daniel Springer [Oakland University]. Organ Donation: Autonomy, Presumed Consent, and Mandated Choice.
http://www.oakland.edu/upload/docs/Philosophy/Springer_Essay.pdf
What both proponents and opponents of presumed consent often overlook is the individuals choice
prior to death. Mandated choice is a prime example of how to transform the ineffective system we
currently have while simultaneously avoiding much of the controversy between presumed refusal and
presumed consent. By eliminating the presumed nearly every individual could explicitly state their
wishes prior to death. Under mandated choice, individuals would be required to state their preferences
regarding organ donation when they renew their drivers licenses, file income tax forms, or perform
some other task mandated by the state. (p. 809) By enacting mandated choice, it removes the barrier of
presumption, and requires that citizens consider their own death and how they feel about organ donation.
Often in the cases of presumed refusal and in proposed models of presumed consent, it is the family of
the individual that must decide whether or not to donate their organs. Amid the chaos and anxiety that
engulfs the family during the death of a loved one, it seems unfair to ask them whether they wish to
donate their loved ones organs. By mandating that each person decide for themselves, it spares the
family the agonizing decision while simultaneously bolstering the individuals autonomy.
This counterplan has fairly good support in the literature and avoids the common affirmative arguments against
the opt-in system.
A method implemented by Israel has proven to be successful at increasing organ donation rates. The Israeli
system says that when two otherwise equally deserving patients are in need of organ transplants, then the one
considered an organ donor will be given priority. Danielle Ofri explains:
Ofri, Danielle, Associate Professor of Medicine at the New York University School of Medicine; Editor Chief, Bellevue Literary Review. "In Israel, a New Approach to
Organ Donation." New York Times Blog. The New York Times Company, 12 Feb. 2012. Web. 20 Aug. 2014. <http://well.blogs.nytimes.com/2012/02/16/in-israel-anew-approach-to-organ-donation/?_php=true&_type=blogs&_r=0>.
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Topic Analysis One
So Israel has decided to try a new system that would give transplant priority to patients who have agreed
to donate their organs. In doing so, it has become the first country in the world to incorporate
nonmedical criteria into the priority system, though medical necessity would still be the first priority.
This system has also proven to be extremely successful at raising donation rates. Ofri continues:
The consent rate from families has already increased, and the number of organs available for patients
has increased in parallel. Transplants have so far increased by more than 60 percent over all this year.
This counterplan is clearly competitive because you cant presume consent in this system. This system requires
that organ donors register themselves. While the system has clearly been effective, it is not without its
detractors, so be careful when running this type of argument.
I believe a solid negative counterplan is to out-left the affirmative. If they read a ton of reasons why autonomy
doesnt matter and that the only thing we care about is raising donation rates, then I believe a strategic option is
to advocate that organ procurement become mandatory. This type of system would definitely raise donation
rates because problems with system of presumed consent where the donation rates may or may not increase do
not apply to a system of mandatory procurement. If the procurement is mandatory, then donation rates will
skyrocket because everyone will have to donate.
As a final note about utilitarian positions, it is not necessary to only run these against utilitarian affirmatives.
Most, if not all, affirmative claims assume that a system of presumed consent raises, or has the potential to
raise, organ donation rates. If the counterplan shows that negating actually better increase organ donation rates,
then you can make the counterplan link into most affirmative frameworks.
Other neg arguments

The affirmative will generally say that it is not a violation of autonomy because people can opt out. However,
this logically doesnt make sense. Silence does not imply consent. For example, just because someone asks you
a whole list of things and you dont respond to one of them doesnt imply that you consented to that practice.
Furthermore, this approach seems extreme. No one should be expected to have to fill out a list of options that
they dont want done to them. The whole concept of consent is that people have to actively give consent. This
argument can be used to respond to affirmative arguments about autonomy, or it can be used on its own as a
reason why presumed consent doesnt logically make sense.
A risky approach is to argue that organ donations in general are impermissible because they violate the sanctity
of the body, violate a religious belief, or some other reason. This is generally considered to be an untenable
position and very few people actually believe that organ donations in general are wrong.
There are some arguments that claim that a system of presumed consent will lead to less trust between the
doctor and the patient, however, this is generally only mentioned in passing in the relevant academic literature
and has little to no empirical support.
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Topic Analysis One
Conclusion
This may not be the best topic ever, but I think it is a balanced topic that has good arguments from both the
affirmative and the negative and can be approached successfully with both traditional and progressive
techniques. I also believe it to be a very relevant topic with many real world impacts. I look forward to judging
some high quality rounds on this topic.
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Topic Analysis Two
Topic Analysis Two

Tommy Fang Stanford University
Resolved: A just society ought to presume consent for organ procurement from the deceased.
This brief will be very heavily framework/big picture focused. Although there is some side analysis, if you are
looking for specific case positions and examples of arguments for either side, look at Lawrence Zhous topic
analysis listed in this brief above.
General Overview
At first glance, I thought initially that this was a PF topic. That being said, it is an excellent LD topic that keeps
up with current issues. Certainly, PF arguments can be applied, and these will be addressed later in this topic
analysis.
The obvious dilemma in this resolution is whether the act of presuming consent, that is, assuming that those
that have died and not explicitly stated that they do not want their organs donated, are ok with such an act.
The implied result of this act would be a huge increase in the number of available organs, although the exact
number would remain in contention. Empirical examples from several countries that have adopted this practice
can be used to justify numbers for either side. The rise in supply is positive, as its purpose is to meet the even
larger demand of people needing organs. The organs donated by those under the presumed consent principle are
particularly valuable, as many of these are harvested immediately after death, where organ donations have the
highest rate of success, as they are less likely to be rejected by their hosts. This is the gist of the affirmative
argument, and the purpose of the affirmative in this round is to reason as to why this logic will trump anything
the negative can bring.
The purpose of the negative in this round then, is to provide any reason that there exists logic more important to
trump the affirmatives very consequentialist argument. There are two routes to this. First is the deontological
route. I would say use this route. There are many, many ethical and moral reasons why we cannot simply just
assume people would be ok with taking organs upon time of death. These will be discussed specifically in the
Message to NEGs section of this topic analysis. The second route that the negative can take is that of
consequentialism, directly challenging the affirmative in either their effectiveness, or stating negative
repercussions of allowing the affirmative to proceed with their plans. At this point Id also like to mention the
possibility of the negative to use a counterplan approach theres plenty cards in this brief to suggest the
possibility of solving for the affirmative without using the affirmatives plan. If you dont know what the
previous sentence means, then do not use a counterplan its simply a strategy for more progressive debaters
and fits this topic well.
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Topic Analysis Two
Starting Off
I would start off research with this topic by looking at some recent news articles/blogs on the issue. Medical
ethics has been a huge sector of philosophy for centuries, but the specific issue of harvesting organs, the
technology of which has only become available in the past century, is new. Theres a lot of topic literature and
as a researcher, you should be able to find a lot of current evidence (post-2012). I would look at some
.government pages for both presumed consent and organ procurement. If you want a general overview of
the topic, search the entire topic wording in Google Scholar and you should be presented with plenty of research
papers on the topic. Quantity of evidence will not be an issue for the topic; whats more important is that you
understand the situation and are able to come up with a unique justification for whatever side it is that you are
debating. Center your cases and your arguments around logic, not around cards, as those are aplenty. In fact, I
would use fewer cards for this topic, and in most cases, rely more on pre-written logical arguments.
Affirmative and Negative Burdens

The two sides for this topic are relatively well aligned. Really the only wording in the topic that can be debated
is the practice of presumed consent. It will be extremely difficult for the negative to be against organ
procurement or any other words in the resolution.
The ground for the affirmative then is to prove that presumed consent is the best policy for solving the
current problem of a supply and demand gap in the legal organ market. Keep in mind that unless the affirmative
is able to squirrel away with some framework, presumed consent must not only be effective, but better to other
alternatives, as the possibility of a negative suggesting a different policy (for example, funding research of
animal organ donation) is very high for this topic and the negative can win in this way. The affirmative ground
in this debate is not extremely broad and somewhat predicable, so to make the use of the most of what they
have, good framework is a must for the affirmative.
That said, the ground for the negative is much larger. The negative can win the round either by proving
presumed consent is a bad policy for whatever reason x, or by providing a better solution that not only
solves for everything the affirmative is presenting, but does more, perhaps without leading to the same harms to
which the affirmative falls victim. The first piece of negative ground mentioned requires a lot more on the
spot card cutting and thinking, as the affirmative determines ground by going first. The second can be read in
whatever situation. As mentioned above, a lot of the negatives ground is only found in challenging the words
presumed consent, and not elsewhere in the resolution.
General Framework/Definitions
The definition of organ procurement is relatively standard across the medical community, so there is not a
huge amount of debate here. I think what will be an interesting argument is the case of the word deceased.
Researching the topic, many articles attempt to delineate when a patient dies at several stages. Is a patient on
life support dead? Do we require absence of a pulse? If so, for how long? These questions may seem trivial, but
will determine a lot for the round. You may be surprised to learn that in many countries, patients on life support
are assumed to be medically dead, which means their organs fall under the policy of presumed consent. The
negative in this round thus has much larger access to morality arguments, as this action seems inherently more
Page 35 of 174
Topic Analysis Two
immoral than harvesting the organs of someone that has passed away from natural causes. In addition, the
magnitude of the affirmatives impacts may increase/decrease.
The only other issues I can think of with framework are with framing what ground is what. If the negative wants
to propose another alternative to presumed consent that will be equally effective in solving the supply and
demand gap, they will likely have to justify why this wins them the round in the framework debate. As
mentioned before, the affirmatives ground in this debate is a lot more constricted, so affirmatives might want to
consider expanding their ground through framework. I doubt framework will be a huge issue in this debate
period, as most cases will be topical and clearly defending one side or another.
Value/Criterion Pairs
The obvious values in this round are societal justice, justice, societal welfare, and morality. Theres not a
huge debate here as to whether justice is better than societal welfare.
The criterions for this round get a lot more interesting, especially depending on what cases you choose to cover.
For affirmatives, I suggest going with either upholding consequentialism, upholding utilitarianism,
protecting the living, or upholding social good. The last two require some explanation. Although both fall
under the grand scheme of consequentialism, which I expect most affirmative cases to do so (to be talked about
in the next section), they are more specific. If the affirmative can win the protecting the living criterion, it
takes away almost all negative ground for disproving the affirmative. Now, the negative must itself provide
an option that protects the living better than the affirmative. Look for cards along the lines of death bad and
philosophical arguments about duty to society if you choose to go along with this criterion. Similarly, upholding
social good speaks to treating those current members of society (excluding the deceased) above all other moral
gains. Look for cards that defend societal justice and societal welfare.
For negatives, I suggest either upholding deontology, upholding procedural justice, upholding
governmental legitimacy (based off of a slippery slope argument), upholding autonomy, or upholding
constitutionalism. The first two arguments are simply ethical theories and can be explained with a quick
Google search of each. Upholding governmental legitimacy is an argument that if we allow the government this
seemingly insignificant step of allowing forced organ donations, it can lead to bigger problems and larger
violations of power. The exact logic for this argument is similar to other slippery slope arguments and can be
found in the cards included in this brief. Upholding autonomy is popular with authors like Ayn Rand, and
stresses individualism as the moral epitome. There is a lot of topic literature on this criterion. Finally, upholding
constitutionalism would be a good match with several cards listed in the brief, referring to the rights of the
dead and universal human rights. As you can see, the negative positions on criterion are much more varied,
and range from consequentialist to deontological frameworks.
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Topic Analysis Two
Message to AFFs
For affirmatives, the central argument I propose is that, plain and simple, adopting a policy of presumed
consent will save _____ (get exact number from statistic) number of lives each year, and the only cost is that
we are harvesting organs from those that are already did, a common medical practice. This argument, no matter
how simple, is very solid, and centering a case with good analysis and meticulously selected cards will be
enough to win a lot of rounds if constructed correctly. The problem with this argument is that ninety percent of
people on the circuit will be reading the same argument. That being said, there doesnt exist a lot of other
affirmative arguments. Look in the cards for specific arguments, but the next best alternative I suggest is a case
centered around duty to society. The exact flow of the case would use this duty to justify any actions that as
a whole, will benefit society in a measureable (and thus utilitarian) way. A warning for affirmatives is not to fall
into the trap of making defensive arguments, where affirmatives will pre-emptively try and defend against
arguments they think the negative will say. Defensive arguments will not win rounds. Make every contention
in the affirmative case something that by itself can win you the round something that the negative has to
address and directly attacks their side, no matter the individual specific case.
Message to NEGs
The central argument Im proposing to the negative can be best explained by a theoretical question, one of
which Im sure some of you have heard. A train is coming down the tracks at full speed. It is on track to hit
three young children playing on the tracks who do not hear the train in time. If you however, push a man
standing by the tracks onto the train, killing him, the three children will hear in time and run off the tracks, thus
living (sorry for the bad logic, but its a story). The point is, most people will agree that this is not moral
because the man did not himself jump onto the tracks. A similar argument can be made for presumed consent
in organ donations. Although the patient is deceased, violating rights and assuming wishes for someone that did
not explicitly say so is a very dangerous path. Most of the arguments I suggest for the negative are
deontological and center around ethical theories. Most of the cards that I put into the brief are centered around
different authors and how they justify this scenario, but specifically for the case of presumed consent. Unless
you plan on writing a counterplan, as mentioned before, I suggest taking the path of simply disproving the
affirmatives actions, instead of providing an alternative, as this is sufficient to win the negative the round,
given that framework is set up correctly.
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Pro Evidence
Page 38 of 174
Pro: Higher donation rates
Opt-Out Systems have Higher Donation Rates

Countries with presumed consent have, on average, 25-30% higher cadaveric donation rates.
SBH.
Abadie, Alberto, and Sebastien Gay. 2006. The impact of presumed consent legislation on
cadaveric organ donation: A cross-country study. Journal of Health Economics
29.4: 599620.
On the whole, our empirical results suggest that presumed consent laws may greatly increase the supply of
cadaveric organs for transplantation. However, it would be erroneous to interpret our results as evidence that
presumed consent is the sometimesportrayed silver-bullet for organ shortage. First, it is unlikely that a 25% to
30% increase in cadaveric donation would eliminate completely the organ shortage problem in some countries,
like the U.S., although it would help considerably to alleviate [the organ shortage problem.] it. To see this
assume that percentage increases in cadaveric donations translate roughly to percentage increases in cadaveric
transplantation. Table IV in column (1) shows the range for the number of additional transplantations that a
25% to 30% increase in cadaveric transplantations would have represented in the U.S. for the period of 19952002. For the same period, columns (2) and (3) show the yearly change in the number of patients on waiting
lists and the yearly number of deaths on the waiting list, respectively. Columns (4) to (6) show the same
variables for the U.K. and the period 1994-2001. The figures in Table IV suggest that a 25% to 30% increase in
cadaveric transplantation could potentially close the gap between the demand and the supply of organs in the
U.K., but not in the U.S. Moreover, it seems likely that an increase in the supply of cadaveric organs would be
followed by a reduction in the supply of organs from living donors. Substitution of organs from living donors
would attenuate the effect of an increase in cadaveric organs on the size of the waiting lists.29 Finally, many
questions remain unanswered about how to implement a legislative change of this type. Although recent studies
have reported successful transitions to a presumed consent default (see, for example, Michielsen, 1996), it
seems likely that in some countries the imposition of a presumed consent law, without building first sufficient
social support, could generate an adverse response towards organ procurement efforts. V. Conclusions Previous
studies have pointed out that, on average, presumed consent countries do not produce significantly higher organ
donation rates. Moreover, several authors have hypothesized that this lack of correlation is produced by the fact
that presumed consent laws are rarely enforced and that, in practice, family consent is always required before
organs are extracted. In this article, we argue that legislative defaults on organ donation may affect the consent
decisions of the families, even if they are not enforced. First, we use a simple model to illustrate how presumed
consent laws may affect organ donation rates. In addition, using a panel of countries, we show that, once other
determinants of organ donation are accounted for, cadaveric donation rates are 25% to 30% higher in
presumed consent countries. The magnitude of this estimate does not vary much across the different
Page 39 of 174
specifications of our empirical model. Furthermore, using the panel structure of our data we are able to reject
the presence of additive fixed effects. Health professionals and organ donation activists in the U.S., Great
Britain, and several other countries have proposed changing legislative defaults on organ donation to presumed
consent. The results of this article suggest that presumed consent laws may alleviate organ shortages. Further
research is needed, however, to understand better how societies perceive and respond to legislative changes of
this nature.(pg. 17)
This evidence can be used to show that opt-out systems (presumed consent) work. It can be a link to a
larger impact that says increasing donations leads to less people on the waiting list and thus less people
who die on the waiting list or something similar. Here are a few reasons that the methodology for this
study is good.
1. It shows that when other determinants of cadaveric donation rates are accounted for, the coefficient
on the presumed consent variable is still large and significant even if Spain is excluded from the sample.
(They take out Spain from their analysis because Spain's system has had an outlier effect on other
studies.)
2. There are multi-variables that measure potentially relevant country characteristics, for example,
religious beliefs, whether the country has a common law or a civil law system, and the number of deaths
caused by motor vehicle accidents and cerebrovascular diseases.
3. The study was conducted over a 10 year period which is good to ensure there are no year by year
fluctuations.
4.
The study had a sample size of 22 countries which accounts for country by country variation.
5.
Its statistically significant, which means it checks for random fluctuations.
Page 40 of 174
A comparison of 5 studies show an increase in organ donation from country to country.

SBH.
Rithalia, Amber, Catriona McDaid, Sara Suekarran, Lindsey Myers, and Amanda
Sowden. "Impact of Presumed Consent for Organ Donation on Donation Rates: A
Systematic Review." National Center for Biotechnology Information. U.S. National
Library of Medicine, 14 Jan. 2009. Web. 20 Aug. 2014.
<http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2628300/#__ffn_sectitle>.
Results Twenty six studies met our inclusion criteria (see figure). Of these, five assessed organ donation rates
before and after the introduction of presumed consent legislation in a single country,w1-w5 eight compared
organ donation rates in countries with presumed consent systems with rates in countries with explicit or
informed consent or similar systems,w6-w13 and 13 surveys addressed attitudes towards presumed
consent.w14-w26 Of the 13 surveys identified, full details were obtained for nine. Impact of presumed consent
on organ donation rates in before and after studies Before and after studies have the benefit of exploring the
experience of individual countries but, because it is an uncontrolled study design, it is not possible to rule out
the influence of other known or unknown factors influencing donation rates. All five studies, which represented
the experience of three countries, found an increase in organ donation rates following the introduction of
presumed consent legislation (table 1). In Austria the 4.6 donors per million population per year before
legislation increased to 10.1 per million in the four years after the introduction of presumed consent and to
27.2 per million in the five years after introduction of infrastructure changes including full time transplant
coordinators.w1 In Belgium kidney donation increased from 18.9 to 41.3 per million population per year
over a three year period,w3 and in Singapore kidney procurement increased from 4.7 to 31.3 per million
population, also over a three year period.w4 However, there was limited exploration of other changes such as
increased publicity and organisational and infrastructure changes that might have taken place at the same time
as the change in legislation. As such factors are likely to influence donation rates, it is unclear to what extent the
increases found were directly attributable to the change in legislation.(pg. 6)
This evidence is an analysis of multiple studies and gives results from country to country that uses an optout system. This is a starting place to see multiple countries that have good models for affirmative plans
for opt-out systems that include other legal procedures and incentives that make their policy so effective.
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Empirical evidence indicates that presumed consent is effective at increasing donation rates.
Spain proves. LZ.
Danielle Hamm [ethics adviser, British Medical Association], Juliet Tizzard [deputy head
of ethics British Medical Association]. Presumed consent for organ donation. BMJ
2008; 336 doi: http://dx.doi.org/10.1136/bmj.39475.498090.80 (Published 31 January
2008)
A key question is whether such a system would increase organ donation rates; a growing body of evidence
indicates that it would. The relation between presumed consent and donation rates is notoriously hard to
understand because of other determinants that affect donation rates. A study in 2006 compared 22 countries
over 10 years; it took account of determinants that might affect donation rates, such as health expenditure and
number of deaths from road crashes. It concluded that When other determinants of donation rates are
accounted for, presumed consent countries have roughly 25-30% higher donation rates than informed consent
countries. A study in 2003 found similar results.
Spain consistently has the highest donor rate in Europe. One major difference between Spain and the UK is that
it has an exceptionally highly organised and well funded system. The recent report of the UK Organ Donation
Taskforce has drawn on the experience of Spain and has centered its recommendations on increasing organ
donation rates through improved infrastructure, coordination, and funding. The other major difference with
Spain is that it has a system of presumed consent. Although relatives are still consulted, the system of presumed
consent, which presents a very positive view of donation, has resulted in a decrease in the number of relatives
refusals.4 The UK can learn two lessons from Spain, one regarding improvements to infrastructurewhich the
BMA welcomes government commitment toand the other regarding presumed consent.
This evidence cites multiple studies, including one that looks at 22 countries over a long period of time. It
cites the same study as above, but does so it a clearer way, which makes this more cardable. It also gives
an analytic reason for why Spain has a lower rate of relative refusal which answers back a lot of neg
counterstudies that claim that presumed consent isnt effective because relatives still often refuse
donation.
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When the default assumption is donation, donations rates increase at a statistically

significant level when all other variables are controlled. LZ.
Johnson, Eric J [Norman Fig Professor of Business Columbia Business School
Marketing] and Goldstein, Daniel G. [Principal Researcher at Microsoft Research
New York City and Assistant Professor of Marketing at London Business School],
Defaults and Donation Decisions (December 2004). Transplantation, Vol. 78, No. 12,
pp. 1713-1716. Available at SSRN: http://ssrn.com/abstract=1323508
Could changes in default have an effect on the actual number of donations in a country? We examined the
actual number of cadaveric donations made per million on a slightly larger list of countries, here using a time
series of data from 19912001. We used a regression analysis that controlled for other differences in countries
propensity toward donation, transplant infrastructure, educational level, and religionall variables known to
affect donation rates, see Gimble et al. (24). While there are no differences across years, there is a strong effect
of the default. Figure 3 shows that when donation is the default, there is a significant (P_0.02) increase in
donation, increasing from 14.1 to 16.4, a 16.3% increase. Using similar techniques, but looking only at 1999 for
a broader set of countries, including many more from Eastern Europe, Gimbel et al. (24) report an increase from
10.8 to 16.9, a 56.5% increase also plotted in Figure 3.
This evidence shows a specific methodology and gives the level of significance and is clear about
controlling for differences between countries that might affect donation rates.
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When choosing between explicit and presumed consent, psychological research shows that
having a default of presumed consent increases donation rates. LZ.
Johnson, Eric J [Norman Fig Professor of Business Columbia Business School
Marketing] and Goldstein, Daniel G. [Principal Researcher at Microsoft Research
New York City and Assistant Professor of Marketing at London Business School],
Defaults and Donation Decisions (December 2004). Transplantation, Vol. 78, No. 12,
pp. 1713-1716. Available at SSRN: http://ssrn.com/abstract=1323508
Over the course of the last two decades, a number of European countries have been running similar natural
experiments with organ donation. Different countries have chosen different default options for the decision to
become organ donors. Some countries require explicit consent and opting- in to become a donor, while others
presume consent and require opting-out for those who do not want to be donors (21). We first examined the
role of defaults using an online experiment. We asked 161 respondents whether they would be donors
using one of three questions with varying defaults. In the opt-in condition, participants were told to
assume that they had just moved to a new state where the default was to not be an organ donor and they
were given a choice to confirm or change that status. The opt-out condition was identical, except the
default was to be a donor. The third, neutral condition simply required them to choose with no prior
default. In all conditions, respondents could at a mouse click change their choice, largely eliminating
effort explanations. The default had a dramatic impact, with revealed donation rates being about twice as
high when opting-out as when opting-in. As can be seen in Figure 1, the opt-out condition did not differ
significantly from the neutral condition, which required a choice without a default option. Only the opt-in
condition, the current practice in the United States, was significantly lower. Because there are many factors that
might produce different effects in the real world, we examined the rate of agreement to become a donor
across European countries with explicit and presumed consent laws. With data reported in Gabel (22),
which we supplemented by contacting central registries for several countries, we estimated the effective
consent rate, that is the number of people who had opted in (in explicit consent countries) or the number
who had not opted out (in presumed consent countries). If preferences concerning organ donation are
strong, defaults should have little or no effect. However, as can be seen in Figure 2, defaults make a large
difference, with the four opt-in countries on the left having lower rates than the six opt-out countries on
the right. The result is surprisingly strong: the two distributions have no overlap and nearly 60
percentage points separate the two groups. We think these effects are larger than those in our questionnaire
because the cost of changing from the default is higher, involving filling out forms, making phone calls, or
sending mail.
The best psychological evidence on this question clearly shows that changing the default to donation will
increase donation rates. Even if every study is tainted by confounding variables, psychological analysis
shows that it increases donation rates. Their empirical evidence at best demonstrates weaknesses in the
present system, but doesnt answer the fact that a system of presumed consent, when done correctly, will
result in increased donations.
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Austria has shown success with a true system of presumed consent. LZ.
Mehlman, Maxwell J. [Professor of Law and Director, The Law-Medicine Center, Case
Western Reserve University 'School of Law. B.A. Reed College, 1970; B.A. Oxford
University, 1972; J.D., Yale Law School, 1975.], "Presumed Consent to Organ
Donation: A Reevaluation" (1997). Faculty Publications. Paper 542.
http://scholarlycommons.law.case.edu/faculty_publications/542
One true presumed consent system in Europe is found in Austria. A patient who does not wish to donate
organs must state his objection in writing. Donation is not discussed with families unless they raise the issue.
The only exceptions are cases involving pediatric patients and foreigners. It is therefore noteworthy that the
latest data from Eurotransplant on the availability of kidneys for transplantation show that Austria not
only has a significantly higher rate than the Federal Republic of Germany, Luxemburg and the
Netherlands, all of which have voluntary donation systems, but also a rate more than 11 percent higher
than Belgium, which, despite its de jure presumed consent system, operates de facto on the basis of encouraged
voluntarism or routine request. The Austrian data on heart and liver donation are not as clear. If presumed
consent provided more organs than other donation approaches, it would be expected that, as a percentage of the
population, more hearts and livers would be donated in Austria not only in comparison with countries that have
de jure and de facto voluntary systems, like the United Kingdom, Germany and The Netherlands, but also in
comparison with Belgium and France. According to Roels and his colleagues, Austria, Belguim and France all
have much higher numbers of hearts and livers available for transplantation per million inhabitants than the
United Kingdom, the Federal Republic of Germany and The Netherlands. But while Austria has a somewhat
higher rate for livers than either France or Belgium, it has a lower rate for hearts. The Austrian experience
therefore provides some support for the notion that adopting presumed consent increases the supply of
donor organs over other donation approaches, but the data are incomplete, and a number of questions remain
unanswered.
Even though Austria has a slightly lower rate of heart donation, it seems more than enough to make up
for the other organs that are donated at a higher rate.
Page 45 of 174
Presumed consent actually increases family consent and increases donation rates by up to
30%. CFS
Alberto Abadie Harvard University and NBER, Sebastien Gay University of Chicago.
"The Impact of Presumed Consent Legislation on Cadaveric Organ Donation: A
Cross Country Study" December 2005
In this article, we argue that legislative defaults on organ donation may affect the consent decisions of the
families, even if they are not enforced. First, we use a simple model to illustrate how presumed consent laws
may affect organ donation rates. In addition, using a panel of countries, we show that, once other determinants
of organ donation are accounted for, cadaveric donation rates are 25% to 30% higher on average in presumed
consent countries. The magnitude of this estimate does not vary much across the different specifications of our
empirical model. Furthermore, using the panel structure of our data we are able to reject the presence of additive
fixed effects.
Increasing organ donation also has massive financial benefits. CFS

Kenneth Gundle. "Presumed Consent for Organ Donation Perspectives of Health Policy
Specialists" Spring 2004. http://web.stanford.edu/group/journal/cgi-
bin/wordpress/wp-content/uploads/2012/09/Gundle_SocSci_2004.pdf
Higher rates of organ donation not only result in saved lives, but frequently in saved financial resources. Spain
estimates that its 10,000 renal transplants save approximately $207 million every year (Lpez-Navidad et al.,
2002). Compared to dialysis, transplanting a kidney is beneficial both in quality of life for the patient and in
money spent. In the United States, there are currently over 50,000 people on the waiting list for kidney
transplants, which potentially represents a large savings in healthcare expenditures.
Gives an additional unique benefit to higher organ donation rates.
Page 46 of 174
A meta-study found presumed consent to increase organ donation rates. CFS

Rithalia Amber, McDaid Catriona, Suekarran Sara,Myers Lindsey, Sowden Amanda.
Impact of presumed consent for organ donation on donation rates: a systematic
review BMJ 2009;338:a3162 http://www.bmj.com/content/338/bmj.a3162
Before and after studies have the benefit of exploring the experience of individual countries but, because it is an
uncontrolled study design, it is not possible to rule out the influence of other known or unknown factors
influencing donation rates. All five studies, which represented the experience of three countries, found an
increase in organ donation rates following the introduction of presumed consent legislation (table 1). In
Austria the 4.6 donors per million population per year before legislation increased to 10.1 per million in the four
years after the introduction of presumed consent and to 27.2 per million in the five years after introduction of
infrastructure changes including full time transplant coordinators.w1 In Belgium kidney donation increased
from 18.9 to 41.3 per million population per year over a three year period,w3 and in Singapore kidney
procurement increased from 4.7 to 31.3 per million population, also over a three year period.
A great meta-study that evaluates results from multiple countries.
All the studies in a European meta-study found presumed consent to increase organ donation
rates. CFS
We conducted a systematic review investigating the impact of presumed consent legislation on organ donation
rates; to our knowledge this is the first review to address this question. We found four good quality studies
comparing organ donation rates between countries with and without systems of presumed consent. Each study
examined the association between presumed consent and organ donation rates in mainly European countries
between 1990 and 2002. All four found an association between presumed consent legislation and higher organ
donation rates, and in three this was statistically significant.
Page 47 of 174
Before and after studies reveal an increased organ donation rate of 30%. CFS
Estimates of the size of the effect varied: two studies reported a 20-30% increase in organ donation, one
reported 2.7 more donors per million population, and one reported 6.1 more donors per million population.
There was evidence that factors other than presumed consent contributed to the variation in organ donation
rates. In at least one study, mortality from road traffic accidents, the number of transplant centres, gross
domestic product per capita, and health expenditure per capita were found to be important. Five before and after
studies also showed an increase in organ donation rates following the introduction of presumed consent.
Belgium increased its organ donation rates by 55% with presumed consent. CFS
Maryellen Liddy. "THE NEW BODY SNATCHERS: ANALYZING THE EFFECT OF
PRESUMED CONSENT ORGAN DONATION LAWS ON PRIVACY,
AUTONOMY, AND LIBERTY" Fordham Urban Law Journal Volume 28, Issue 3
2000 Article 4.
http://ir.lawnet.fordham.edu/cgi/viewcontent.cgi?article=1817&context=ulj
Presumed consent systems have varying degrees of support in other nations. Countries with presumed consent
laws include Austria, Belgium, France, Italy, Norway, Sweden, and Switzerland. In particular, Belgium has
utilized a presumed consent model for more than ten years. In the Belgian system, people may exercise their
right to opt out by filing an objection at any local town hall. These individual donation decisions are then
registered in a centralized database and made accessible only to transplant officials. However, despite the
existence of the registry, doctors are still encouraged to discuss organ and tissue removal with the decedent's
relatives. Moreover, physicians are not compelled to harvest any organs under the presumed consent scheme if
they are uncomfortable doing SO. Overall, presumed consent is credited with increasing organ donation in
Belgium by fifty-five percent within a five year period, even though traffic fatalities (a major source of organ
donations) decreased over that same time. Presumed consent supporters point out that only two percent of the
Belgian people have opted out of the system, implying that near-unanimous support for presumed consent exists
within that country.
Good long term study of Belgiums presumed consent system that has great results.
Page 48 of 174
Pro: Black Market
Black Market
The black market exists because there are strict restrictions on the provision and production
of organs and high demand and low supply for organs. SBH.
Mendoza, Roger L. "Price deflation and the underground organ economy in the
Philippines." Journal of Public Health 33.1 (2011): 101-07. Price Deflation and the
Underground Organ Economy in the Philippines. 22 Mar. 2010. Web. 20 Aug. 2014.
<http://jpubhealth.oxfordjournals.org/content/33/1/101.full>.
An underground economy refers to profitable exchanges and transactions involving illegal commodities.
Studies show that a combination of high levels of demand for these commodities and stiff government
restrictions on their provision (legality, financing and pricing) and/or production (service delivery,
operations and management) encourages the growth of underground economies or black markets.9 Broad
consensus on the part of the government and the people, as to which commodities should be traded legally and
how, as well as an overall change in public responsiveness, is critical since underground economies cannot be
eradicated by government action alone.10
The current academic and policy debate centers on the legitimacy (or at least permissible extent) of the profitmotive behind kidney transplantation. Black market kidney (or organ) trading is illegal because governments
consider it to be repugnant.11,12 It also leads to negative/harmful behavior among individuals,13 such as cashstrapped hospitals and facilities selling operations that they are ill-equipped to perform.14 As several studies
show, these behavioral and ethical implications (policy costs) outweigh from the standpoint of most
governments the benefits to be derived from a legally constituted, compensation-basedalbeit regulated
kidney market.1517 Other studies further stress the indirect or spillover effects of legalizing compensated
kidney donations (e.g. health inequities and unfair access to required medical care).14,18,19(pg. 1)
It's important to show reasons why the black market exists because that's how you can garner a link.
Argue that the affirmative through presumed consent for organ procurement increases the supply of
organs and thus diminishes the need for the black market.
Page 49 of 174
Pro: Black Market
Presumed consent diminishes the need for the black market through decreasing the demand
and increasing the supply of organs. SBH.
Glaser, Sheri R. "Formula to Stop the Illegal Organ Trade: Presumed Consent Laws and
Mandatory Reporting Requirements for Doctors." Http://www.wcl.american.edu.
N.p., Winter 2005. Web. 17 Aug. 2014.
<http://www.wcl.american.edu/hrbrief/12/2glaser.pdf>.
Presumed consent, when the state strictly follows it, is the best-practice method of legally obtaining
organs. In countries with presumed consent laws, there is a higher procurement rate for organs than in
countries without these laws. Many argue that if the demand for organs were met legally, then people
would have less incentive to illegally obtain organs and the black market would eventually diminish. On a
more basic level, if there were more organs available for transplant, then more peoples lives would be
saved.
In addition, presumed consent leads to improvements in tissue matching between donor organs and recipients,
and it allows surgeons to be more particular about which organs are selected. Furthermore, these laws allow for
more careful application of brain-death criteria because the increased supply of donor organs diminishes
incentive to obtain organs through inappropriate means. For example, there have been cases in Russia and
Argentina where organs were removed from comatose patients who were pre- maturely declared brain-dead.
Presumed consent also ensures that organs are fresher because it eliminates the doctors need to contact the
deceaseds next of kin, thus shortening the time between death and determination of consent. Lastly, the
decision as to whether or not to donate organs is not made during the grieving period immediately following
someones death.
Financially, presumed consent lowers costs on the part of the government. For example, in the United States,
with a federally funded dialysis program, the cost of a kidney transplant, taking into account the cost per year
after the transplant for further medical care, is less than the yearly cost of dialysis. One could reasonably argue
that, as kidney transplants become even more commonplace, the costs will continue to fall. If a nation has a
system of presumed consent and has more organs available for transplants, then that nation will presumably be
performing more transplants and will have fewer patients on dialysis, thus lowering government costs.(pg. 22)
This can be used as a link to say that the affirmative begins to get rid of the black market on organs.
This can have lots of impacts such as, but not limited to, decreasing diseases spread through unclean
manners of removing and receiving organs, decreasing organ theft, decreasing buying organs from
people in poorer countries for little to no money, etc.
Page 50 of 174
Pro: Black Market
Market regulation wont work because people will always search for a cheaper price. SBH.
Delmonico, Francis L., Robert Arnold, Nancy Scheper-Hughes, Jeffrey Kahn, and Stuart
J. Youngner. "Ethical Incentives - Nor Payment - For Organ Donation." New
England Journal of Medicine 346.25 (2002): n. pag. Web. 17 Aug. 2014.
<http://www.hods.org/pdf/Ethical%20Incentive.pdf>.
Since the current system of altruistic organ donation has not met the demand for organs, some critics suggest
that the way to resolve this problem is to turn to a market approach that would permit the sale of human
organs.41-44 However, the ethical principle that one should not sell ones body applies whether the market is
regulated or left to the vicissitudes of capitalism.45 A system regulated by a government agency (e.g., the
Department of Health and Human Services) would probably not be the only source of organs for sale. In fact,
the futility of trying to regulate payments to donors is suggested by worldwide experience. In the current global
market, prices vary depending on the region and the social status and sex of the donor. For example, in
Bombay, India, the current price for a womans kidney is said to be $1,000; in Manila, the Philippines, the price
for a mans kidney may be closer to $2,000; and in urban Latin America, a kidney can be sold for more than
$10,000. Such are the payments allegedly made to the vendor; payments to the broker are an additional expense
that can drive the cost of the organ even higher. Payments have allegedly exceeded $200,000 for arrangements
in which the financial transaction occurred in another country and the transplantation was performed in the
United States.18
Brokering in the United States according to market criteria of donor suitability would probably be no different.
If the current prohibition against the sale of organs were rescinded, there would be little legal or ethical
justification for preventing persons from bypassing the regulated system and using other means to obtain a
better price for an organ from a more medically suitable donor. The Internet can be used to secure the best price
for any commodity. A federally regulated system would have to outlaw Internet bidding and set a controlled
price for certain types of donors or continuously modify the price.(pg. 2004)
Since regulating the market will not resolve the illegal trade of organs in the black market, this means
one of the few solutions to the black market trade of organs is reducing the incentive to sell illegally. One
reason we reduce the incentive to sell illegally is because an opt-out system reduces the demand for
organs by increasing the supply. This could also answer a negative position that argues that we ought to
have market regulations and should sell our organs.
Page 51 of 174
Pro: Black Market
Legal organ market would fight the black market TF

Becker, Gary (2007) Introducing Incentives in the Market for Live and Cadaveric Organ
Donations
The long wait for organs under the present system has encouraged the development of a black market in live or
cadaveric organs, where donors or their heirs get paid. These transplants are available only to wealthier
individuals who usually must bear the total expense themselves. They are also often much riskier because
organs are not screened as carefully for disease, are not matched as closely to recipients, and operating
conditions and the quality of surgeons tend to be inferior. Allowing the purchase of organs would essentially
knock out the black market in organs, and all its problems of quality control. The purchase of organs would also
reduce the advantages of wealth in getting organs since poorer individuals in need of organs who cannot afford
the black market would no longer have to wait so long before getting their organs through the Medicaid or
Medicare payment system. But above all, the most effective answer to the critics of paying for organs is that the
present system imposes an intolerable burden on many very ill individuals who cannot afford to wait years until
suitable organs become available. Increasing supply through payment would largely eliminate this wait and thus
enormously improve the efficiency of the transplant market.
Similar to cards above, establishing a legal organ market will fight black market deals.
Page 52 of 174
Pro: Necessary to meet demand
Forced Donations Necessary to Meet Demand

There exists a large market for kidney transplants TF
Donations
We can tell the story of the market for organ transplants through figures. Figure 1 presents, from 1990 to 2005
the total number of kidney transplants, the number with live donors, and the number of persons waiting for
kidney transplants in the United States. The number of kidney transplants grew slowly over the period from
about 10,000 in 1990 to over 13,700 in 2005. The number of live donors grew rapidly over the same
period, so that by the beginning of this century, almost half of all kidney transplants used live donors.
Part of this increase can be attributed to the growing use of laparoscopic nephrectomy, a minimally-invasive
procedure with equivalent recipient outcomes and lower donor morbidity than traditional open nephrectomy.
However, most of the increase can be attributed to the sustained increase in waiting times to receive an
organ due the inability of the current system to procure enough organs, imposing an increasing pressure
among family members and other relatives to donate their organs. Almost 17,000 persons were already
waiting for a kidney transplant in 1990. But this number grew rapidly, so that about 65,000 persons were
on this waiting list by the beginning of 2006. The ratio of this number to the annual number of transplants is a
little below five years, which is an estimate of the average waiting time to get a kidney in 2005.
Can be used in concurrence with argument that demand justifies procedures.
Wait times for kidney transplants are enormous TF

Donations
During the 1990s, reported median waiting times for kidneys and livers grew over time, but they were much
longer for kidneys. The median waiting time to get a kidney transplant increased from 1 year in 1990 to 3.2
years in 2001, which is a little lower than the 3.3 years wait in 2001 estimated from the ratio of the number
waiting to the annual number of transplants. Part of the discrepancy results from exits from the organ queue due
to deaths of some of those waiting, some of them become too sick to go through transplant surgery (in 2001
over 850 persons left the kidney waiting list, or 1.7% of the kidney waiting list, because they became too sick to
undergo transplant surgery), some purchase organs in the black market, some decide to remain on dialysis, and
some exit for other reasons. But waiting times and the number waiting both increased sharply over time, and
both indicate that persons who need a kidney transplant must wait a long time before they get one.
Add-on card in addition to demand. Longer wait times mean more deaths.
Page 53 of 174
The United States has an extremely slow kidney wait time TF

Donations
Moreover, live donors constitute a much smaller fraction of all transplants in other nations than in the United
States. Perhaps then it is not surprising that the average waiting time in Germany for a kidney transplantestimated at about five years from the ratio of the waiting list to the annual number of kidney transplants -is
longer than that in the United States. However, average waiting times in other nations, including Spain and UK
and Ireland, are smaller than in America. This may be because governments and private insurance companies in
these nations impose harsher eligibility conditions for publically subsidized or insurance-paid transplant
surgery.
Organ donations are on the decline and are essential to saving lives. CFS
Deborah Mitchell. March 22, 2010. Organ Donations Decline as Need Increases
http://www.emaxhealth.com/1275/24/36134/organ-donations-decline-need-
increases.html
More than 100,000 people need life-saving organ transplants in the United States, and an additional million
need life-saving and life-improving tissues, eyes, and corneas. Yet every day, an average of 18 people die
because there are not enough organ donations to meet the need, according to the Organ Procurement and
Transplantation Network. The seriousness of the lack of organ donations has been highlighted in a new study[s]
conducted by investigators at Cedars-Sinai Medical Center. The studys authors found that the gap between the
number of organs available for transplant and the number of patients waiting for a donor organ is widening. The
number of organs from living donors has declined progressively since 2004, and for the first time, the number
of organs from deceased donors has declined.
The illegal organ trade is rising and needs to be combated. CFS

Emily Bourke. Alarming Rise in Illegal Human Organ Trade Australian Broadcasting
Corporation Fri, 22 Jun 2012. http://www.abc.net.au/news/2012-06-22/an-illegal-
organ-trading/4086096
The World Health Organization is warning of an alarming rise in the illegal trade in human organs, saying
around ten percent of transplant procedures involve organs that have been bought on the black market. The
latest estimates show that organ traffickers are exploiting poor people in China, India and Pakistan to cash in on
the rising international demand for replacement kidneys.
Page 54 of 174
Mandatory procurement will close the gap between supply and demand for organs TF
Donations
The present legal market for kidney transplants can be represented by the supply curve SS and the demand
curve DD in Figure 5, where the horizontal axis measures the number of kidney transplants, and the vertical
axis the total cost of a typical kidney transplant. In most nations, the cost of transplant surgery is mainly
borne either by governments or by private health insurance companies. Their willingness to qualify
individuals for this expensive surgery increases as its cost declined. This is the main reason why the
effective quantity demanded, given by the curve DD, increases as costs fall. Demand by wealthy individuals
who finance much of their own transplant costs clearly also tends to be negatively related to costs. However,
under the present system, it appears that some of the people use the black market to pay either for live donors or
for organs from cadavers in order to reduce their waiting times. When donors or their heirs receive no
compensation for their organs, one would not expect the supply of organs to depend much on the price above
the cost of the surgery. This is why the supply curve for either live or cadaver legal transplants is L- shaped,
where the horizontal segment correspond to the average cost of kidney transplants and then it becomes vertical,
or independent of price, at the number of total altruistic donors. The gap plotted in Figure 4 measures the
horizontal distance between the demand and supply curves in Figure 5 at the cost of transplants- we assume in
Figure 5 that the average cost of a kidney transplant is $160,000. The gap would be smaller at higher costs
because quantity demanded is reduced by a rise in cost, but the technological progress that reduced the cost of
organ transplants and made them safer during the past 15 years raised excess demand and waiting lists by
encouraging greater demand. Monetary payments to donors or their heirs would increase the total cost of
transplants since costs would include such payments. But since higher payments would elicit a larger number of
organs, they would rotate the supply curve clockwise, from SS to S*S*, and thereby increase its elasticity. If
government subsidies or private insurance cover payments to donors, a legal market would affect the location of
demand functions only by redistributing some demand from the black to the legal sector, and by encouraging
more patients in need of organs to apply since the wait would be sharply reduced. But still, monetary
incentives would help close the gap between supply and demand both by increasing the number of organs
available and by raising the total cost of transplant surgery. In fact, monetary incentives should change
the supply of organs from being completely inelastic with respect to costs to being highly elastic. The
reason is that the number of potential useable organs from live donors and cadavers, especially live
donors, is very large compared to the number of transplants. But the present system ignores almost all of
this potential supply by disallowing payments for organs. We provide rough estimates of what it would cost
to attract enough live donors with financial incentives to close the gap between supply and demand.
Can be used in a plan AFF or just as a card explaining solution formed by AFF.
Page 55 of 174
Pro: Status quo
Status Quo
Presumed consent means status quo is AFF TF
Powhida, Alexander (1999). Forced Organ Donation: The Presumed Consent to Organ
Donation Laws of the Various States and the United States Constitution.
The state presumed consent statutes that fall into three distinct categories. The first deals with organ shortages
most effectively by setting forth a strict system in which the consent of the deceased is presumed and the family
of the deceased is not informed or consulted. These are commonly referred to as "organ conscription laws. More
moderate laws, referred to as "routine request laws," require every citizen to elect whether to donate or to
withhold consent. The final and perhaps least effective presumed consent law creates a presumption of consent
to organ donation. However, the presumption can be defeated before death by the donor, or after death by
surviving family members, who, by law, must be informed of their right to refuse consent. This last type of
presumed consent law is referred to in this Comment as the "shifting presumption law."
Establishes status quo current effects seen are thus by AFF.
Current system of organ donation TF

Nadel, Mark (2005). Using Reciprocity to Motivate Organ Donations.
To better understand policies for increasing organ donations, it is useful to consider the current organ allocation
system. Those requiring an organ from a cadaveric donor must be listed on the United Network for Organ
Sharing (UNOS) waiting list. This generally requires that they meet the medical suitability standards of a
transplant center and demonstrate their ability to finance the transplant. Medicare generally covers the bulk of
the costs of kidney transplants for its beneficiaries, and Medicaid may cover some transplants for the poor in
some states. Some patients, however, are forced to pursue loans, grants, or donations, and many, like Denzel
Washington's character's son in the 2002 film John Q fall short and are thus excluded by this so called "green
screen." The allocation of organs among those on the UNOS waiting is based, to a large degree, on
compatibility.
Card can also be used for NEG establishes status quo either way.
Page 56 of 174
Pro: Status quo
Previous court cases justify presumed consent TF

Harvesting cornea tissue under presumed consent laws has provided the stimulus for challenging the
constitutionality of these laws. In a number of cases, the state courts first found that the laws were valid under
the state constitutions and second, that there was no property interest in the deceased person's body. The courts
in Tillman v. Detroit Receiving Hospital, Georgia Lion Eye Bank, Inc. v. Lavant, and State v. Powell held that
the next of kin of the deceased has no property right in the dead body." In Tillman, the court faced a challenge
to the constitutionality of a Michigan presumed consent law. The court rejected the petitioner's argument that
the statute invades a fundamental privacy right in a person's body. The court held that a right of privacy deals
with the right to make decisions about one's own body and that right dies with the person. In addition, the court,
in dicta, wrote that there is no property right to be had in a dead body. The courts in Georgia Lion Eye Bank,
Inc. and Powell agreed with the Tillman decision's dicta that there was no full property right in a dead body.
Both courts, however, acknowledged a quasi-property right in the surviving relatives of the decedent to
possession of the body for purposes of burial. This "right" was not a full property right, but rather a quasiproperty right creating an interest which "did not rise to the constitutionally protected interest included in the
due process clause." In essence the courts held that "rights in a dead body exist ordinarily only for purposes of
burial and no other purpose;" therefore the rights were not substantial enough to warrant further due process
procedures . Overall, the foundation of the decisions rest in a uniform conclusion that there is no
constitutionally protected property right in a dead body. Nonetheless, the courts have recognized a quasiproperty right for certain dispositional purposes. This "quasi- property right" would encompass actions, "'for the
purpose of burial, sepulture, or other lawful disposition. However, as the next section will discuss, more recent
decisions have provided legal reasoning that may draw the previously noted decisions into dispute.
Justifies legally the arguments for AFF.
Page 57 of 174
Pro: Status quo
Many people are waiting for a kidney. Long wait times have serious consequences. SBH.
Benjamin Hippen. Saving Lives Is More Important Than Abstract Moral Concerns:
Financial Incentives Should Be Used to Increase Organ Donation October 2009.
Annals of Thorasic Surgery 88(4): 10531061.
The number of people with kidney failure in the United States is increasing. By 2010 it is expected to be
591,000, with more than 80,000 patients waiting for a kidney transplant [2]. Incremental improvements in
immunosuppression have rendered kidney transplantation a superior therapeutic modality for more and more
patients with kidney failure. Unfortunately, despite our best efforts, the supply of transplantable kidneys has
not and will not keep up with the growing demand.
The current state of affairs is responsible for several unintended, but foreseeable, consequences. Longer
waiting times for transplant candidates result in patients who are sicker at the time of transplantation.
This factor, combined with an increased reliance on extended criteria donors (ie, marginal donors),
results in inferior graft survival. Longer waiting times also serve to increase emotional pressure on any
available living donor. Longer waiting times and few available options have contributed to an upsurge in
international organ trafficking. This combination of factors erodes trust in the transplant community as
a whole. In 2006, the federal government spent $22.7 billion dollars on end-stage renal disease, of which only
$2.2 billion was spent on kidney transplantation, yet the 5-year survival with a successful kidney transplant is
more than double the survival conferred by dialysis.(pg. 4)
Page 58 of 174
Pro: Status quo
The US has an opt-in system whereas Spain has an opt-out system. Spain still trumps the
US high numbers. SBH.
Lupkin, Sydney. "Organ Donation Rates: How the US Stacks Up." ABC News. N.p., 18
June 2013. Web. 28 Aug. 2014.
Some countries have opt-out systems in which citizens are presumed organ donors unless they formally
opt not to donate their organs when they die. Other countries even offer incentives such as payment for
living kidney donations or preferred treatment for donors if they ever need to become a transplant recipient.
Read on to learn how organ donation practices differ around the world. United States Although t[T]here are
more than 118,000 people on the organ transplant waiting list in the United States, only 8,143 underwent
transplants from deceased donors in 2012, according to the Organ Procurement and Transplantation
Network, which allocates organs as a result of the National Organ Transplant Act of 1984. With its opt-in
program, the United States has the fourth-highest organ donor rate, with 26 donors per million people in the
population, according to data from the National Transplant Organization in Spain, which compiles organ
donation rates annually. The United States, however, leads the world in actual transplant rates, which Dr. Tom
Mone, a past president of the Association of Organ Procurement Organizations, says means doctors can use
more of the organs they harvest. "It's fair to say we're doing as well or better than anyone else," said Mone, who
is now the CEO of One Legacy, a nonprofit organization focused on organ donation. "But we have such a large
number of people and a very good chronic care system, so they can wait longer as the waiting list grows."
Registration is different in each state, and a few have proposed opt-out systems in which people are
automatically assumed to be consenting donors unless they opt out. However, this has never gotten far in state
legislatures, said OPTN spokesman Joel Newman. "Once these bills are introduced, concerns arise about
individual rights, rights to make an individual decision," Newman said. Colorado tried to get an opt-in law
passed a few years ago, but the lawmaker who introduced the bill pulled it in 2011 because the reaction was so
negative, according to the Denver Post. Mone said about 75 percent of the people who are brain dead and could
donate organs actually wind up donating them. That's not bad, considering that of all people who are eligible to
donate blood, only 7 percent do so, he said. "The bad news is even if they donated 100 percent of the time, we
would not wipe out our list," he said. Spain is widely considered the gold standard in organ donation
because it has had the highest organ donation rate of any other country in the world, with 35.3 organ
donors per million people. (This compares with 26 organ donors per million people in the United States.)
Unlike the United States, which has an opt-in policy, Spain has an opt-out policy, meaning citizens are
automatically organ donors unless they opt out.(pg. 1)
Prefer this evidence because its comparative and shows the clear delineation between the numbers of
organ donors in an opt-in system to an opt-out system.
The implication of this evidence is that the waiting list grows every year in many countries, but especially
the US. This proves we need to change something now otherwise the number of lives lost will increase.
Even though the US has the highest numbers of an opt-in system in the world, Spain still trumps the US
with the highest organ donation numbers through an opt-out system.
Page 59 of 174
Pro: Status quo
The demand for organs is high while the supply is low leading to large waiting lists whose
numbers increase on a yearly basis. SBH.
Kenneth Gundle.Presumed Consent for Organ Donation Perspectives of Health Policy
Specialists2004. Medical Anthropology. SURJ.
Every day in the United States, 17 people die waiting for an organ transplant. The number of people on
the waiting list for an organ has more than tripled over the last ten years and now exceeds 82,000
individuals; at the same time, the number of donors has remained relatively stagnant (OPTN, 2004). In 2001,
6,439 people died while waiting for a transplant, nearly double the 3,916 candidates who died while
waiting just five years earlier in 1996 (OPTN, 2004; The Lewin Group, 2000; Wright, 1998). Neither the
waiting list nor the number of patients who are dying each year is showing any sign of decrease instead,
there is only an increasing organ shortage crisis in the United States.(pg. 1)
The implication is that the waiting list and number of people dying waiting for an organ every year is
increasing, making it imperative that we change the system now.
Thousands of people die a year. There are roughly 18 people that die a day.
29(4): 599620
In 2002, 6,679 patients died on the U.S. organ waiting lists before an organ became available, roughly 18 per
day (OPTN, 2003). In spite of media campaigns and other attempts to promote donation, the supply of organs
cannot keep up with the demand, and the number of patients on waiting lists has been growing steadily during
the last decade (see Figure 1). One of the most frequently quoted explanations of the gap between the supply
and demand of organs is that the number of families that refuse to grant consent to donation is still large.
Approximately half of the families that are approached to request donation refuse it in the U.S. and Great
3
Britain, compared to around 20% in Spain and around 30% in France. The U.S. and Great Britain are informed
consent countries; Spain and France are presumed consent countries.(pg. 1)
Roughly 18 patients die per day on an organ waiting list. Organs are high in demand but low in supply.
Families in opt-in systems more often restrict organ extraction from deceased relatives than in opt-out
systems.
Page 60 of 174
Pro: Definition of death
Definition of Death
Death is simply a social construct TF
Siminoff, Laura (2004). Death and organ procurement: public beliefs and attitudes.
More recently, several bioethicists have argued that death is neither a scientific nor a philosophical truth to
be discovered or proved (Lock, 2001; Youngner & Arnold, 1993, 2001). Rather, it is a social construct whose
cultural and normative aspects areas important as its biologic and rational ones. They argue that brain death
was constructed by the Harvard Ad Hoc Committee to facilitate two behaviors allowed only after a
determination of deathdiscontinuation of mechanical ventilation and organ retrieval (Pernick, 1999;
Youngner, 1992). In 1968, when the Harvard Committee published its report, our society had little clinical and
legal experience with allowing patients to die by discontinuing mechanical ventilation. Now, many patients are
allowed to die by turning off their ventilators. However, a declaration of death remains a prerequisite for organ
procurement.
Can also be used as an AT card downplaying the importance of death in organ procurement.
The deceased dont count under a system of utilitarianism. LZ.

Dr Paula Boddington [Stipendiary Lecturer in Philosophy at Hertford College of Oxford.]
(1998), Organ Donation After Death Should I Decide, or Should My Family?.
Journal of Applied Philosophy, 15: 6981. doi: 10.1111/1468-5930.00074
On a utilitarian stance, the welfare of others may be appealed to only in exceptional cases for medical treatment,
but more often in cases of organ donation, and there is an obvious reason for this difference: the organ donor is
dead. On a straightforward utilitarian position, the dead person can experience no happiness or unhappiness, and
has no welfare needs. So, although there may be utilitarian reasons for respecting the wishes of individuals
regarding organ donation, the interests of others may outweigh this consideration relatively commonly; in any
case, assessing these interests will always be relevant to a complete assessment of what to do.
Page 61 of 174
Pro: Public opinion
Public Opinion
Public opinion favors donating the organs of the dead TF
Siminoff, Laura (2004). Death and organ procurement: public beliefs and attitudes.
The data in this survey reveal three characteristics about public attitudes and knowledge in regard to the
relationship between death and organ retrieval. First, there is evidence that the actions most people say they
would take with regard to organ donation are consistent with the dead donor rule. When presented with
three case scenarios of severely brain-damaged patients (ranging from brain dead to PVS), most people
were unwilling to violate the dead donor ruleat least in accordance with their own beliefs about who is
dead and who is alive. In other words, most people who said that the patient was dead were willing to donate
the patients organs and those who said the patient was alive were not willing to donate the patients organs.
Moreover, a significantly higher percentage of respondents who were confused about death were willing to
violate the dead donor rule than those who were not. Second, the public remains considerably unaware or
misinformed about the medico-legal definition of brain death and its implications for organ retrieval.
Although the vast majority of the people surveyed had heard of the term brain death (98%), only onethird knew that brain-dead patients were legally dead in Ohio, the state where they lived. Moreover, a
significant minority (28%)believes that brain-dead patients can still hear and nearly 60% mistakenly think that
the respirator is stopped before, rather than after, organs are taken. Third, the general public holds varying
personal beliefs about when a patient is dead. These differences cannot be attributed solely to ignorance or
confusion, although lack of knowledge certainly played a role in the answers we recorded. While brain death is
the accepted legal and medical standard in the US, it does not represent a universal vision of what it means to be
dead. A majority of subjects (57.2%) personally considered a ventilator-dependent, brain damagedbut
not brain- deadpatient (scenario 2) to be dead and a sizable minority (34.1%) considered a patient with
PVS (scenario 3) to be dead. Additionally, while a majority of respondents had opinions about deaths that
were inconsistent with legal and medical standards (70.5%), only 9.8% of these had internally inconsistent
patterns of classification that indicated they were confused.
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Pro: Public opinion
Polls of transplant professions support presumed consent legislation. SBH.

29(4): 599620.
However, increasing donation consent rates from families is still viewed as the most promising route to increase
organ donation (UNOS, 2002). Many analysts and health professionals believe that presumed consent
legislation may play an important role in shaping the decision of the families. In an international survey
of transplant professionals, 75% of the respondents supported presumed consent legislation, and 39%
identified this type of legislation as the most effective measure to increase donation rates, the highest
percentage among all measures considered in the survey, followed by improved education with 18% (Oz
et al, 2003).(pg. 1)
There is public support for organ donation but few grant consent. Additionally, utilitarianism
justifies presumed consent. CFS
From an economists point of view, the shortage of cadaveric organs for transplantation is an intriguing
phenomenon. First, from a purely utilitarian perspective, it represents the routine disposal of a highly valuable
commodity, with the potential to save lives. Moreover, survey data indicate a significant disagreement between
preferences for donation and donor card registration. In particular, results from a well-known survey (Gallup,
1993) indicate that while most Americans favor organ donation (85%), and would like to donate their
organs after death (69%), only a few grant permission for organ extraction on their drivers license or an
organ donor card (28%). Finally, in recent years the question of how defaults influence economic choices has
become an issue of great interest among economists.
Page 63 of 174
Pro: Public opinion
An international survey shows that transplant professionals support presumed consent. CFS
However, increasing donation consent rates from families is still viewed as the most promising route to increase
organ donation (UNOS, 2002). Many analysts and health professionals believe that presumed consent
legislation may play an important role in shaping the decision of the families. In an international survey of
transplant professionals, 75% of the respondents supported presumed consent legislation, and 39%
identified this type of legislation as the most effective measure to increase donation rates, the highest percentage
among all measures considered in the survey, followed by improved education with 18% (Oz et al., 2003).
There has been an increased support for presumed consent. CFS

We investigated public attitudes towards presumed consent through surveys carried out in the UK and
elsewhere. The eight UK surveys suggest variation in the level of support for presumed consent, with earlier
surveys finding lower levels of support. The most recent survey reported that 64% of respondents supported a
change to presumed consent. The findings across the three surveys that investigated variation in attitudes by
demographic characteristics were equivocal, but the groups surveyed, the questions asked, and the analyses
conducted were dissimilar.
The public approval and utilitarianism justify presumed consent. CFS

Daniel Springer. "Organ Donation: Autonomy, Presumed Consent, and Mandated
Choice". Oakland University.
The proponents of presumed consent argue that acting on the presumption that people would desire to donate
their organs for transplantation after death better respects most individuals autonomy rather than the
presumption underlying the current presumed refusal system, namely that individuals would prefer not to
donate their organs. Numerous studies and surveys have been conducted that suggest about, 70 percent of
Americans would be willing to have their organs removed postmortem for transplantation if they were suitable
for this... (p. 383) Contrast this with the 30 percent of people who would not choose to have their organs
donated. It seems that presumed consent would be better suited to respecting peoples desires than presumed
refusal. Cohen3 , a biomedical researcher in support of a presumed consent policy, argues that this is the case,
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Pro: Public opinion
because very few people adequately indicate that they wish to donate their organs postmortem, and so their
ante mortem wish to do so is not considered. What Cohen wishes to argue is utilitarian in nature, maximize the
good for the most people possible.
The US public strongly believes that presumed consent would increase organ donation rates.
CFS
David Orentlicher. "PRESUMED CONSENT TO ORGAN DONATION: ITS RISE AND
FALL IN THE UNITED STATES". RUTGERS LAW REVIEW.
http://pegasus.rutgers.edu/~review/vol61n2/Orentlicher_v61n2.pdf
Public views can help us decide whether presumed or actual consent better serves the interests of patient
autonomy. How, then, do people feel about presumed consent versus actual consent to organ donation? Polling
data sends a mixed message. In a 2005 national survey, 85.9% of the public thought that presumed consent
would increase the organ supply, but only 43.2% supported a system of presumed consent. On the other hand,
only 31.3% said they would opt out of a presumed consent system.
According to a poll, the US public is willing to donate their organs. CFS

Under this approach, it appears that presumed consent is the better policy. Public opinion surveys consistently
find that a majority of people say they want to have their organs used for transplantation after death. More than
70% of the public states that they are somewhat or very likely to donate, and about 53.2% of people have
documented their willingness to donate. It makes sense to base the laws default rule according to the
majoritys preference. That is, if 70% of people want to donate organs and only 30% do not want to donate, the
law should assume that people want to donate, thereby satisfying 70% rather than 30% of the population.
Page 65 of 174
Pro: Distributive justice
Distributive Justice
Distributive justice equal access justifies forced organ donation TF
Center for Bioethics (2004). The ethics of organ transplantation.
The concept of distributive justice how to fairly divide resources arises around organ transplantation
because there are not enough organs available for everyone who needs one. Distributive justice theory
states that there is not one right way to distribute organs, but rather many ways a person could justify
giving an organ to one particular individual over someone else. This list of possible distributive justice
criteria comes from the University of Washington School of Medicine website: 1. To each person an equal
share 2. To each person according to need 3. To each person according to effort 4. To each person
according to contribution 5. To each person according to merit 6. To each person according to freemarket exchanges. One distributive justice criteria is equal access. Organs allocated according to equal
access criteria are distributed to patients based on objective factors aimed to limit bias and unfair distribution.
Equal access criteria include: Length of time waiting (i.e. first come, first served) Age (i.e. youngest to
oldest) Equal access supporters believe that organ transplantation is a valuable medical procedure and worth
offering to those who need it. They also argue that because the procedure is worthy, everyone should be able to
access it equally. To encourage equality in organ transplantation, the equal access theory encourages a
distribution process for transplantable organs that is free of biases based on race, sex, income level and
geographic distance from the organ. Some who believe in equal access distribution would also like to have an
organ distribution process free of medical or social worthiness biases. Medical worthiness biases could
exclude patients from reaching the top of the transplant waiting list if lifestyle choices like smoking and alcohol
use damaged their organs. Social worthiness biases would factor in a patients place in society or potential
societal contribution before giving them an organ. This would affect, among others, prisoners being punished
for offenses against society. The primary reasons for wanting to prevent individual worth from factoring into
organ distribution include: a) the argument that individual worth does not determine medical need; b) the
dilemma involved in deciding who will make decisions of who is worthy or not worthy to receive an organ, and;
c) the slippery slope of determining an individuals worth and whether or not it is fair to label someone worthy
of a medical procedure.
Explains equal access principle as justifying the ethical reasons behind organ donations for society as a
whole.
Page 66 of 174
Pro: Distributive justice
Distributive justice maximum benefit justifies forced organ donation TF

A second type of distributive justice criteria is maximum benefit. The goal for maximum benefit criteria
is to maximize the number of successful transplants. Examples of maximum benefit criteria include:
Medical need (i.e. the sickest people are given the first opportunity for a transplantable organ) Probable
success of a transplant (i.e. giving organs to the person who will be most likely to live the longest) People
who support the maximum benefit philosophy believe organ transplants are medically valuable
procedures and wish to avoid the wasting of organs because they are very scarce. To avoid waste, they
support ranking transplant candidates by taking into account how sick the patient is and how likely it is that the
patient will live after he or she receives a transplant. Successful transplants are measured by the number of
life years gained. Life years are the number of years that a person will live with a successful organ transplant
that they would not have lived otherwise. This philosophy allows organ procurement organizations to take into
account several things when distributing organs that the equal access philosophy does not like giving a second
organ transplant to someone whos already had one or factoring in the probability of a successful medical
outcome. Three primary arguments oppose using the maximum benefit distribution criteria. First, predicting
medical success is difficult because a successful outcome can vary. Is success the number of years a patient
lives after a transplant? Or is success the number of years a transplanted organ functions? Is success the level of
rehabilitation and quality of life the patient experiences afterward? These questions pose challenges to those
attempting to allocate organs using medical success prediction criteria. The second argument against maximum
benefit distribution is that distributing organs in this way could leave the door open for bias, lying, favoritism
and other unfair practices more so than other forms of distribution due to the subjective nature of these criteria.
Third, some ethicists argue against using age and maximizing life years as criteria for distributing organs
because it devalues the remaining life of an older person awaiting a transplant. Regardless of how old someone
is, if that person does not receive a transplant they will still be losing the rest of his or her life, which is
valuable to everyone.
Similar to the card above, this card takes a consequentialist approach, arguing for the greater benefit of
society.
Page 67 of 174
Pro: Efficiency
Efficiency
Cadaveric donations are efficient TF
Currently, once a person dies, his or her organs may be donated if the person consented to do so before they
passed away. A persons consent to donate their organs is made while still living and appears on a drivers
license or in an advance directive. After consenting to donate organs, nothing happens with that information
until the person dies. A person is considered dead once either the heart stops beating or brain function ceases
(called brain death). After death, the organs are taken from the deceased persons body. If possible, the
deceased person may be kept on life support once they have died until the organs can be taken, in order to
preserve the organs until they are removed. If the deceased persons organ donation wishes are unknown, the
hospital, physician, or organ procurement organization will approach a family member to obtain consent to
remove the organs. The family members with the authority to do so is generally determined by this hierarchy:
Spouse. If no spouse, then Adult child. If no adult children, then Parent. If no parents, then Adult
sibling. If no siblings, then Legal guardian. One cadaveric donor can provide organs for several different
people. Which organs and tissues can be recovered may depend on the cause of death or damage to an organ,
but typically several organs can be recovered from a single cadaver. In 2002, more than 22,000 organs were
recovered from 6,182 cadaveric donors.
Can also be used as a counter in terms of consequentialist debates.
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Pro: Hard opt out
Hard-Opt Out Systems Good

Policies should avoid asking the families about donation because it is difficult for doctors and
nurses to do. LZ.
Required request was devised to deal with what were believed to be the underlying reasons for the failure of
encouraged voluntarism. Opinion polls showed that few people voluntarily donated their own organs or those of
members of their own families. Yet the polls also showed that an overwhelming majority approved of organ
donation in principle, and hospitals found that, when asked, most families consented to removing the organs of
dead relatives. Asking families rather than the donors themselves therefore seemed the best approach to
increasing the supply of organs. The problem was that, under encouraged voluntarism, the families were not
being asked. Physicians and nurses were reluctant to ask families to consent to donation while their loved ones
were still alive, and, once death had occurred, caregivers did not like to interrupt families during their time of
grief. Physicians were also reported to be held back from discussing donation by the notion that the death of the
patient was a medical failure. The typical separation of treatment and transplant teams within the hospital
community also reduced structural incentives for establishing effective request procedures.
Since asking families is difficult for hospital staff to do, we should not ask the families.
It is more humane to not ask families. LZ.

While the prospect of increasing the supply of organs for donation is the major benefit anticipated from a shift
to presumed consent, there may be other important benefits as well. To begin with, since presumed consent
would eliminate the need to confront bereaved relatives with requests for donation, it may be more humane than
required request. "To someone whose relative is about to die," wrote Dukeminier and Sanders, "asking for the
kidneys may seem a ghoulish request." The same may be true for relatives whose loved one has just been
declared legally dead.
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Pro: Communitarianism
Communitarianism
The communitarian approach would justify presumed consent as a way to give back to the
community. LZ.
Andrew D Lawson [Consultant in Pain Medicine & Anaesthesia & Medical Ethicist, Royal
Berkshire Hospital; Honorary Senior Lecturer, Medical Ethics, Imperial College,
London]. Presumed consent for organ donation in the United Kingdom. Journal of
the Intensive Care Society. Volume 9, Number 2, July 2008.
Perhaps a way around the autonomy, rights and utilitarian conflict is to consider a communitarian response.
This model suggests organ donation not as a gift, but as an act of giving back to the community, the paying
back of an obligation. Communitarian philosophy stresses the common good. According to communitarian
theorists, all of our norms, theories, principles and virtues can be traced to distinct ethical traditions and ways of
life. The good society focuses both on individual rights and the good of the larger community.
Communitarianism might entail a persisting obligation after death to benefit other members of the community.
This obligation may not be absolute; consideration may also be given to individual autonomy. One problem
with a communitarian solution is how one defines a community and how society deals with differing
perceptions of a community.
When the organs are no longer valuable to the dead, they should be used to help the living.
LZ.
Marie-Andree Jacob [LL.B. University Laval; LL.M. York University, J.S.D. in progress,
Cornell University; Research Associate, Gertner Institute for Epidemiology and
Health Policy Research], On Silencing and Slicing: Presumed Consent to PostMortem Organ Donation in Diversified Societies, 11 Tulsa J. Comp. & Int'l L. 239
(2003). Available at: http://digitalcommons.law.utulsa.edu/tjcil/vol11/iss1/7
Presumed consent can be justified by a communitarian vision of the world. Communitarianism rejects a liberal
construction of the individual as an "unencumbered self."' Communitarianism focuses on the interconnection,
interdependence, and community-orientation of beings. Following the Aristotelian tradition, Communitarian
theory suggests that ethics is "the exercise of a set of spatially and temporally bound virtues that we may regard
as our primary defense system against the destruction or erosion of that human community without which our
lives would be aimless." According to a communitarian, her organs might well belong to her during her life, as
they are essential in that lifetime; but when no longer needed by or useful to her they are properly shared with
Page 70 of 174
Pro: Communitarianism
the other community members. This "sharing of the goods" is required, according to Aristotle. "[T]o be
[human] is to fill a set of roles each of which has its own point and purpose: member of a family, citizen,
soldier, philosopher, servant of God."1 To this list, "organ supplier for your sick fellows" can be added. Sharing
is a higher value than an individual's wish to preserve the integrity of a dead body.
Establishing presumed consent as the norm creates a civic duty. LZ.

Communitarians would approve of an across-the-board presumed consent rule because the donation of organs
would be the norm. As reported by Nora Machado, "[n]ot to donate is a negative deviation from the norm. Since
the norm is viewed as a positive act, the deviation becomes a negative and egoistic act," thus fulfilling the
educational purpose of the law. Moreover, in order to effect the deviation, steps must be taken; contrasted with
the passive obedience of the moral norm. Is it possible that a law or policy presuming consent will facilitate
altruistic behavior, as it becomes easy to donate organs?
There are practical advantages to this method. If more organs are desirable, people are more likely to passively
concur (the "status quo bias") and obey established routine. Without presumed consent, they must perform an
active, and to some extent, energy-consuming altruistic act. In a world of presumed consent, "[i]nstead of
altruism, one articulates a notion of quasi-civic duty in donating organs, grounded on notions of social solidarity
in society," writes Machado. Another author speaks about presumed consent as being an expression of
"presumed solidarity.'' The assumption is that current human ethical behavior of lower priority between
individual selfdevelopment and solidarity, or freedom and responsible involvement. As such, building a
presumption of solidarity into the law would be ethically justifiable."
Page 71 of 174
Pro: Social contract
Social Contract
Tacit consent would justify presumed consent in traditional social contract theories. LZ.
In The Leviathan, contractarian theorist Thomas Hobbes suggests that signs of contract and consent are either
express or by inference.' Hobbes therefore validates tacit consent as a standard paradigm for consenting to
contracts. Hobbes defines acts that signify consent, either tacit or express, as distinct from acts implying
consent. An act signifying consent is a medium for a specific message, consent. It is a sign, a signal, a
representation that expresses and transmits from one person to another the content of the message of consent. It
is distinct from an act implying consent; the latter being more like a hint that opens the door for the deduction,
the inference, and the drawing of conclusions by the observer. Acts implying consent are the source of John
Locke's conception on tacit consent. For Locke, consent to political and social obligations can be inferred by the
observer, regardless of the potential consentor's intentions or even awareness that she or he is consenting.
Locke's notion of tacit consent is hypothetical, or rather, conditional, in the sense that consent exists and binds
automatically if it is given to good government. In this sense, Locke stresses that the quality of the government
is a source for the quality of the consent towards obligations. Following his reasoning, the fact that donating
cadaveric organs to others is good policy would of itself be a ground for validating people's tacit consent to
make such gifts. This argument does not go on to imply that if donating cadaveric organs is good, it justifies
automatic removal regardless of people's consent. Rather, Locke is saying that if such donations are good, there
are grounds to assume people's tacit consent to do it.
This argument justifies presumed consent and also answers back autonomy-based positions.
Page 72 of 174
Pro: Discrimination
Discrimination
A disproportionate amount of black patients are on the waiting list. SBH.
Gwynne, Kristen. "How the Organ Transplant System Is Stacked Against the Most
Needy, and Why You Should Be a Donor." Alternet. N.p., 19 Aug. 2011. Web. 26
Aug. 2014.
<http://www.alternet.org/story/152074/how_the_organ_transplant_system_is_stacke
d_against_the_most_needy%252C_and_why_you_should_be_a_donor?page=0%2C
4>.
More than 100,000 Americans are waiting for lifesaving operations. Unfortunately, organ donation rates do not
match organ demand. Each year 6,000 or more people die waiting for organ transplants. What's more, because
the organ transplant system operates with a built-in bias against the poor, minorities are nearly half as likely to
receive organs, even though they are more likely than whites to need them. In 2008, 7,182 people died waiting
for organs; 4,638 people died waiting for kidney transplants, and 1,542 of them were black. In other words, 64
percent of deaths on waiting lists are for kidneys, and 33 percent of deaths on the kidney waiting list are black
patients. Blacks in America donate organs ( 13 percent of donors) at about the same rate they make up the
population ( 14 percent), but they represent a disproportionate 35 percent of the kidney waiting list. More
problematic is the fact that many in need of an organ do not even make the lists, or not in time, stymied by a
complex patchwork system that discriminates against poor and minorities in any number of ways, many of
which can be fixed.(pg. 1)
Racial bias is built into the organ donation and transplant system, leaving the poor and
minorities to suffer ultimately fatal disadvantages. SBH.
Aug. 2014.
4>.
Racial Bias in the Organ Transplant Process Minority populations are disadvantaged in organ transplantation in
several ways. Three key factors prevent African Americans from receiving kidneys at rates equal to whites.
First, African Americans exhibit higher rates of diseases that cause kidney failure, like hypertension and
diabetes. Five percent of people on wait lists died in 2008 and, more specifically, 4.6 percent of people on
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Pro: Discrimination
kidney wait lists perished. Second, the African-American population has a high prevalence of type B blood,
which is more rare in the general population (and a problem because blood type matching is necessary for a
successful transplant). Third, race-linked poverty and socioeconomic issues make it much harder to navigate the
organ transplant system. The race wealth gap is now at its highest in 25 years - by 2009, median wealth of
whites was 20 times that of minorities - since the Census began collecting data. The disparity between African
Americans and whites waiting for an organ (or death, whichever comes first) is yet another example of the
challenges of poverty. Studies show African Americans, and minorities in general, are referred to the wait list
for a kidney transplant later, and once on the list, take longer to finally obtain a lifesaving organ. What's
interesting is that a 2009 study showed that this race gap does not exist in Canada, where, presumably, the same
genetic factors affect African Americans. The researchers conclusion? [O]ur results raise potentially
important questions about whether better access to health services for African Americans would improve
outcomes following kidney transplantation in this population. (pg. 1)
Minorities are denied organs at disproportionate rates. Their deaths are almost entirely preventable, yet
almost entirely ignored. The system is ridden with discriminatory procedures from getting dialysis, to
getting on wait lists, to the actual transplants.
Even when minorities are on the waiting list, they are discriminated against. SBH.
Aug. 2014.
4>.
On the List? Race and Poverty [are] Still a Problem[.] Once on a wait list, people with poor access to care are
again disadvantaged. In all but three states - Michigan, California and Iowa - a patients time on the wait list
starts when a transplant center deems him or her a candidate for transplantation. Because African Americans,
and anyone with limited access to health care, are referred to a transplant center later, the amount of wait time
they have under their belts will often be significantly lower than wealthier patients who started dialysis later
(and are less sick) but were referred earlier. In Ml, CA and IA, however, wait time is counted more fairly - from
the day of approval (assuming kidney functioning is less than 20 percent) or from the start of dialysis, which
often occurs at 10-15 percent of kidney function, Norman explained. For the system to be more equitable,
Nonnan and Callender both advocate counting wait time from the start of dialysis or kidney failure. If you
place a person on the waiting list at 19 percent (of kidney function), they may have enough waiting time that
they get an offer of a deceased donor transplant before ever having to go on dialysis, which is ideal, said
Nonnan. Again, getting patients on the wait list early is just another example of why early referral and access
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Pro: Discrimination
to health care - is crucial. And still, inequitable counting procedures are not the only systemic issues affecting
minorities. Once on the waiting list, blood type and geographic region play crucial roles in the delay of minority
transplantation, according to the University of Washington study. The Problem With Regional Allocation For
organ transplants, the country is divided into 11 allocation regions. In each region, an organ procurement
organization (OPO) oversees the selection of organ transplant patients. Some regions have more donors or
transplant centers than others, making the regional list lengths unequal. OPOs give first priority to patients in
their region. For many organs, time "on ice, or between bodies, is crucial. Thus, organs are allocated
regionally, with the sickest, best-matched patients receiving organs available within their region. Only after a
region's transplant list yields no viable matches will the organ move on to a nearby location, where the same
matching process is applied. Here, a serious flaw is built into the system: Rich people can afford to fly out to an
available organ or "multi-list," putting their names on several waiting lists, so that they have a better chance of
finding a donor match. What minorities could do - had they the information necessary - is multi-list on regions
close by. Karen Cummings, a public and professional education specialist reaching out to Dominican and
African-American communities at NYODN (New York Organ Donation Network), said the issue for minorities
is "making sure they know that, for example, Pennsylvania, Connecticut, those are areas in your region. But
educating minorities on the issues surrounding organ transplantation does not stop there. As Cummings,
Callender and Norman all noted, education and communication are vital.(pg. 1)
Minorities are denied organs at disproportionate rates. Their deaths are almost entirely preventable, yet
almost entirely ignored. The system is ridden with discriminatory procedures from getting dialysis, to
getting on wait lists, to the actual transplants.
Organ donation discriminates against individuals who identify as gay by not accepting their
organs. SBH.
ABC15. "Teen's Organ Donation Denied Because He Was Gay." KNXV. N.p., 16 Aug.
2014. Web. 21 Aug. 2014. <http://www.abc15.com/news/local-news/watercooler/teens-organ-donation-denied-because-he-was-gay>.
AJ's mom, Sheryl Moore, said even through the bullying, AJ wanted to help others. Soon after his death last
month, she received a letter saying what had become of her son's organs and as it turned out, AJ's wish was
not fully granted. Although his heart and other organs were able to save lives, AJ's eyes were rejected because
he was gay.
That's due to this Food And Drug Administration regulation, created decades ago. It says any donor believed to
have a risk for communicable diseases, like HIV, can not donate his or her eyes along with other tissue,
specially pointing to men who have sex with other men.
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Pro: Discrimination
Moore could not confirm whether AJ was sexually active, so he was deemed ineligible. But the ban doesn't just
stop at tissues.
"Gay men are banned for life from donating blood. She believes it's a regulation that needs updating. The FDA
does allow donations from heterosexuals who have slept with an HIV positive person ... after one year. ...
experts says that's a contradiction."
Experts like Glenn Cohen, a director at Harvard Law School. He told HealthDay, "We think it's time for the
FDA to take a serious look at its policy, because it's out of step with peer countries, it's out of step with modern
medicine, it's out of step with public opinion, and we feel it may be legally problematic."
This is how the FDA explains its regulation. "FDA's deferral policy is based on the documented increased risk
of certain transfusion transmissible infections, such as HIV, associated with male-to-male sex and is not based
on any judgment concerning the donor's sexual orientation."(pg. 1)
An opt-out program would necessarily remove those regulations to allow anyone who does not say that
they do not want to donate their organs to donate.
This section is an interesting take on the resolution looking at what a just society ought to be. A just
society ought not discriminate against certain members of that society for arbitrary reasons out of those
members control (race, sexual orientation, etc). A just society requires levels of equality. The key to
using this evidence is to find a way to argue that presumed consent would lessen such discrimination.
Hopefully, with more organ donation, there would be less pressure to prioritize one patient over another.
Page 76 of 174
Pro: Medical research
Medical Research
Even when donated organs of the deceased are rejected for transplant, they go towards
biomedical research. SBH.
UW Organ and Tissue Donation. "Donate Organs for Research: The Future Depends on
It." UWHealth.org. N.p., n.d. Web. 26 Aug. 2014. <http://www.uwhealth.org/organdonation/donate-organs-for-research-the-future-depends-on-it/20613>.
When people donate their organs, they generally think they'll be saving someone's life through transplantation.
But what happens when an organ isn't suitable for transplant? If you think those organs are still saving lives,
you're right.
For a number of reasons, not all organs are viable for transplant. Issues such as a donor's age or medical history,
or an organ abnormality, might limit their feasibility. However, these organs are often very practical for use in
research. "People need to understand that these organs will still be used in a way that saves lives and
advances medicine," says Roni Lawrence, clinical manager at the UW Health Organ Procurement Organization.
"The future of transplant medicine really depends on research, and organs are imperative to that research."
Groundbreaking treatment options, such as islet cell transplantation, rely on organs donated to research. What
was once a theory - that the islet cells could be secured from the pancreas and inserted into the liver to
reproduce - is now an applied treatment for Type 1 diabetics who suffer unawareness episodes.
At UW Hospital and Clinics, several islet cell transplant recipients have effectively been cured of their Type I
diabetes and no longer require insulin. Without years of research, and the numerous pancreata donated, this
treatment would not exist. "Just about any organ can be used for research, if it is deemed suitable by the
research agency," adds Lawrence. "The priority is always for transplantation, but research creates opportunities
to use more donated organs. People appreciate knowing they are still giving an important gift." Studies such
as lung rejection management, heart transplant using cardiac death donor hearts and improving the viability of
organs in transit are ongoing, and rely heavily on donated organs. The UW Health Organ Procurement
Organization is meeting national performance measure goals for research organs per donor, having doubled
their efforts in the last six months. Adds Lawrence, "When people donate organs, they're helping both the
patient who receives their live-saving transplant right away, and the next generation of recipients who will
recover sooner and live longer because of the research happening today."(pg. 1)
This could be a part of an affirmative advantage that has an impact in decreasing diseases by increasing
medical research opportunities.
Page 77 of 174
Pro: Medical research
Brains and other human tissues that are intact are necessary for research but low in supply.
Opt-out systems increase the supply. SBH.
T. Millar et al. Tissue and organ donation for research in forensic pathology: the MRC
Sudden Death Brain and Tissue Bank July 31, 2007. J Pathol 2007; 213: 369375
Brain banking over the decades has provided essential support for the investigation of human brain disorders
but control cases are generally in short supply. Brains that are devoid of pathological changes are a truly
precious resource. Our study seeks to meet the needs both of researchers wishing to acquire human tissue
samples and of the public who are pressing for research progress, within a changing social climate in which
there is reluctance to discuss death and post mortem issues. Even in hospital when death is not unexpected it can
be difficult for medical personnel to initiate a sensitive conversation with families about what is to happen to the
body of their loved one after death [4,8,9]. Little is known about how newly bereaved families might feel if they
were given the opportunity to donate tissue samples and/or organs specifically for research, although a previous
study published in 2003 showed that of 106 families asked for research access to tissue samples from forensic
PMEs, two-thirds gave consent [10]. A recent study in Australia reported that following a high profile publicity
campaign, consent for research donation of the whole brain was provided by 58% of bereaved families who
were approached on the day of post mortem examination [11].
Media attention focusing recently on historical research undertaken on tissue samples and organs from
Sellafield workers again suggests negative attitudes among relatives [3] and might further discourage
researchers from attempting to access post mortem tissues. However, the subtext of families distress has
always been the lack of information and consultation. While it has been claimed that most families would have
consented to retention and research use of organs if asked, the question arises as to whether this is actually the
case. Only a small number of individuals take active steps at present to arrange for their body to be used after
their death for educational or research activities.(pg. 375).
Not many people actually allow for their organs, brains, and tissues to be used post-mortem for research.
An opt-out system would allow it.
Page 78 of 174
Pro: Saves money
Increased Donation Saves Money

An increased donation rate saves lives and money. Its been empirically proven in Spain.
SBH.
Kenneth Gundle. Presumed Consent for Organ Donation Perspectives of Health Policy
Specialists2004. Medical Anthropology. SURJ.
Higher rates of organ donation not only result in saved lives, but frequently in saved financial resources.
Spain estimates that its 10,000 renal transplants save approximately $207 million every year (LpezNavidad et al., 2002). Compared to dialysis, transplanting a kidney is beneficial both in quality of life for
the patient and in money spent. In the United States, there are currently over 50,000 people on the
waiting list for kidney transplants, which potentially represents a large savings in healthcare
expenditures.
Prefer my impacts for (_) reasons:
Timeframe: My arguments outweigh on timeframe because the first piece of Kenneth Gundel evidence
explains how the waitlist and waitlist deaths are skyrocketing every year making is an imperative now to
take actions to change that.
Probability: There is a very clear link from step to step about how there is a shortage of organs now and
how empirically in the past opt-out systems have increased organ donation and saved countries lives and
money.
Qualitatively: the quality of life goes up when someone can get a transplant quicker due to a shorter
waiting list because they can sooner get off of medical procedures such as dialysis with kidney
transplants.
Page 79 of 174
Con Evidence
Page 80 of 174
Con: Live transplants
Incentivize Live Transplants

Incentives for live transplants are needed TF
Donations
Live transplants already account for almost half the kidney transplants in the United States, and for almost 8%
of liver transplants. Live transplants would be much more important if individuals had greater incentive to take
the risk involved in donating one of these organs. Some of the issues involved in using monetary incentives for
live and cadaver transplant surgery are similar, but others are very different. It might appear that incentives to
increase cadaver transplants raise fewer difficult issues, especially since they involve no risk to the already
deceased donors. However, we will show that in several respects live donations are less subject to abuse and
corruption, and they have several other advantages that have received insufficient attention. In any case,
reasonable estimates indicate that the market equilibrium price for kidneys, and perhaps also for livers, will be
determined by live donations even though most organs would come from cadavers.
Alternative solution to the AFF can be coupled with cards stating the effectiveness and solving for AFF.
Live transplants have a greater success rate TF

Donations
In addition, live transplants give much greater flexibility on timing of transplants than with cadaver organ
transplants. So transplant surgery with live donors can take place when both the donor and recipient are in the
best possible condition. In particular, live transplants can occur when recipients are in relatively good health.
Partly for reasons of match and timing, the long-term success rate of live organ transplants is generally greater
than for cadaver organ transplants. The renal graft survival rate at one year are 89.2% for cadaveric donor
transplants and 94.7% for living donor transplants, while the renal graft survival rate at ten years are 35.8% for
cadaveric donor transplants, and 55.8% for living donor transplants. For liver, the graft survival rate at one year
are 80.3% for cadaveric donor transplants and 71.9% for living donor transplants, but the graft survival rates at
ten years are 43.7% for cadaveric donors and 53.3% for live transplants.
Additional reason to prefer the NEG under this plan.
Page 81 of 174
Con: Live transplants
Incentives arent used now because everyone is too focused on keeping organ donation
altruistic. SBH.
Satel, Sally "Test Incentives for Organ Donations Theres No Reason Not To." The
New York Times. The New York Times, 22 Aug. 2014. Web. 22 Aug. 2014.
<http://www.nytimes.com/roomfordebate/2014/08/21/how-much-for-a-kidney/testincentives-for-organ-donations-theres-no-reason-not-to>.
Why are such trials not being run at this time? Several reasons. The transplant community is too complacent,
too wedded to the notion that only altruism is a legitimate motive for donating an organ. Its a romantic
conceit, but a lethal one too. The gift of life is precious; I received it from a friend in 2006. But altruism, as a
strategy, is simply not producing enough organs. It needs to be supplemented with compensated donation.
To be fair, there is some promising movement afoot as the American Society of Transplant Surgeons and the
American Transplantation Society collaborate on a position paper that has been previewed as favoring pilot
trials of incentives. But we need patients to speak out too.(pg. 1)
Permitting the sale of kidneys by live donor under strictly controlled conditions would be
beneficial. CFS
Alexander Kagan M.D. and Michael M. Friedlaender. Legalizing the sale of kidneys for
Transplantation: Suggested Guidelines. Departmetnt of Nephrology and
Hypertension, Kaplan Medical Center, Rehovot, Israel. Hebrw University Medical
School. 2002. http:// www.ima.org.il/imaj/ar02dec-10.pdf
We believed that society has an ethical obligation to perform transplants in as many dialysis patients as possible
because this treatment greatly improves their life expectancy. Furthermore, it is what most dialysis patients
fervently desire. Society would gain the large reduction in treatment costs of end-stage renal disease, and also
by returning younger patients to work and productivity. It seems clear at the present time that the only way to
substantially increase the number of kidney transplants is to permit sale of kidneys by live donor. We contend
that this should be allowed, under strictly controlled conditions. Such a scheme should also help to counteract
the ugly international black market (with its almost inevitable exploitation of donors) that has developed in the
past few years. Since this is a national and ethical problem, in addition to being a medical one, we believe the
matter should be carefully considered by a committee convened by the Ministry of Health, consisting of
doctors, ethicists, dialysis patients, jurists, and clergy.
Page 82 of 174
Con: Deontology
Deontology
Primary reason for current kidney transplants is altruism TF
Donations
In 2004, about 80 per cent of living donors and recipients in the United States were related, either as parents,
children, siblings, spouses, or other relatives. The first live liver transplant in the United States involved a
mother who donated part of her liver to her young daughter. A professional basketball player who earns
millions of dollars per year, Gregg Ostertag of the Utah Jazz, possibly jeopardized the duration of his basketball
career by donating a kidney to his sister. It is not surprising that family members supply the overwhelming
number of live organ donations when payment to donors is illegal. Then the motive for giving has to be caring
or altruism, and it is well known that this is typically much stronger within families than between persons
unrelated either by blood or by marriage. The evidence on the relation between living donors and donor
recipient for the United States in 2004 demonstrates powerful within-family altruism and caring, at least for the
small number of families involved in live transplants. However, those individuals in need of transplants who do
not have sufficiently altruistic relations, or who do not belong to a numerous family, are out of luck under the
present system. They must wait years until they become eligible for a useable organ from a cadaver.
Reasons for donating organs are often more important to donors than anything else forcing donations
defeats ethics.
Organ donations help the donors welfare TF

Robertson, John (1976). Organ Donations by Incompetents and the Substituted Judgment
Doctrine
It is useful to think of the decision to donate organs in terms of its effect on the donor's welfare. As
Kenneth Arrow points out, one's welfare may depend on his enhancing some other person's welfare.
Kidney donors, for example, report heightened self-esteem, renewed meaning in life, and other positive
feelings including transcendental or peak experiences from their gift of life to another. Their decision to
donate brings praise from the recipient, family, friends and even the public. Often it enhances their status in the
family, as occurs with adolescent donors and those who offer to donate as a way of being reaccepted after a
previous rejection by the family. Indeed, there may be competition among family members to give. Gift giving
norms also involve obligations to repay the satisfaction of which the donor will enjoy in various forms possibly
over many years. Thus, whatever the complicated motivations of the donor, his altruism seldom has a zero
or negative return. If a competent organ donor will often experience an increase in personal welfare from
Page 83 of 174
Con: Deontology
donating his organ, could not the utility of an incompetent person in this situation also be enhanced
sufficiently that a reasonable person with his present and future preferences might choose to undergo the
pain and risks of a transplant?
Follow along with previous card. Forcing donations decreases morality of donors.
Presumed consent can lead to harmful erroneous donations that would be worse than under
actual consent. CFS
There are two important reasons why we might view the harm from an erroneous donation under presumed
consent as worse than an erroneous non-donation under actual consent. First, religious beliefs may be more
important in decisions not to donate than in decisions to donate. Some people may have strong religious
objections to being an organ donor, but other people may not have a strong religious desire to be an organ
donor. On the other hand, the religious argument may not be insurmountable. While it is commonly believed
that orthodox religious doctrine rejects organ donation, this is not actually the case. Indeed, organ donation is
permitted by many mainstream religious denominations. Orthodox Judaism, for example, permits organ
retrieval after death, as long as physicians can demonstrate that a specific person stands to lose his or her life or
an entire physical ability (e.g., the ability to see) without the donation. At the same time, religious doctrine may
even impose a duty to donate ones organs. In short, it does not appear that religious considerations should
doom presumed consent, but other considerations might.
Page 84 of 174
Con: Implied consent bad
Implied Consent Bad

Implied consent has negative consequences TF
Donations
Some nations use the principle of implied consent, so that organs from cadavers can be harvested unless
individuals prior to death expressly indicated that they did not want their organs harvested. We believe that
implied consent is a dangerous principle that denies heirs full control over the human capital remains of loved
ones. It would be comparable to requiring that all assets of deceased persons automatically go to governments,
or to particular private organizations or other purposes, unless wills stipulated otherwise. But what is more
important the implied consent organ procurement approach does not eliminate the long queues for transplants.
Many persons advocate greater use of implied consent as a way to increase the number of organ donations. We
have various doubts about the use of implied consent if children do have the last word. In addition, Gays
theoretical and empirical study (2006) indicates that implied consent systems may reduce rather than raise the
number of organs donated compared to systems of presumed consent.
Consequentialist argument for the AFFs implied concert argument.
A system of presumed consent violates autonomy and presumed consent logically doesnt
make sense. LZ.
EIKE-HENNER W. KLUGE [Professor and Chair, Department of Philosophy, University
of Victoria, Canada]. Improving Organ Retrieval Rates: Various Proposals and
Their Ethical Validity. Health Care Analysis 8: 279295, 2000. 2000 Kluwer
Academic Publishers. Printed in the Netherlands.
http://download.springer.com/static/pdf/195/art%253A10.1023%252FA%253A1009
496002775.pdf?auth66=1409091433_76769d54f2d220d20b496c3e766cb2bd&ext=.pd
f
The presumed consent approach would go contrary to this social recognition of the right of informed consent. It
may well be asked, whether matters that touches ones personal identity as an embodied being deserve less
careful treatment and consideration than matters of merely commercial concern. Prima facie, at least, it would
seem that the ethical scruples that validate the objection to the above-mentioned marketing practices should
apply with full force to the case of organ donation.
Page 85 of 174
Moreover, the presumed consent approach commits a basic logical error: It confounds the failure to
exercise ones autonomy in a positive fashion i.e., failing to exercise the right to say No! with having
given permission.
Furthermore, the very concept of presumed concept is fundamentally misguided: It undermines the principle
that unless we have given explicit consent to interference with our person, our body remains inviolate.
This is what underlies the right to freedom from non-consensual interference with ones person. Therefore if the
logic of the presumed consent option were to be applied consistently, it would mean that someone who
did not want to be interfered with physically, whether that be sexually or in any other fashion, would
have to inform potential trespassers to the individuals person of that fact. That would reverse the polarity
of the right to inviolability. The individuals body would become public property unless a right of
dominion was claimed by the individual person. It would thus destroy the very notion of a person as an
embodied entity.
As well, if the right to self-determination is accepted as a central social value, then every effort should be made
to safeguard it. One of the foreseeable consequences of a presumed consent approach would be that there
would be false positives i.e., situations where the individual did not know about the option and
therefore had not refused, situations where the individual in fact had objected but for some practical reason
the refusal was never processed, the refusal was not available at the time of death, etc. The Principle of NonMalfeasance is a fundamental ethical principle of most modern societies. It entails that foreseeable harms
should be minimized. False positives are a foreseeable and avoidable harm. Consequently presumed
consent is not an ethical option.
This is a fairly self-explanatory argument and shows multiple logical reasons for why presumed consent
is nonsense.
Since presumed consent does not require informed consent, it compels people and violates
their autonomy. LZ.
Mitsuyasu Kurosu [Tokyo Medical University, Department of Bioethics] Ethical Issues of
Presumed Consent in the Use of Patient Materials for Medical Research and the
Organ Donation for Transplantation. Scientific Contribution. Journal of Philosophy
and Ethics in Health Care and Medicine, No.3, pp.64-85, July 2008. http://pemed.umin.ac.jp/kokusaishi/no_3/kurosu.pdf
Is the presumed consent system ethical? In the presumed consent system, a patient is assumed to accept the
situation that his/her biological materials will be used for medical research, unless he/she specifically refuses. If
a patient refuses or is hesitant, he/she must express their will, otherwise the patient materials will be used for
medical research.
Page 86 of 174
In such a case, the presumed consent system compels a patient to express his/her will with regard to the
use of his/her materials for medical research. The donation of a patient material for medical research whose
object is not medical treatment of the patient is not directly beneficial to the patient. Therefore, it is important
for such medical research that physicians obtain voluntary consent from each patient. However the
presumed consent system on use of patient materials for medical research does not require informed
consent for a specific medical research. This system functions as one of specific methods of a comprehensive
consent system.
The concept of informed consent is to respect an individuals autonomy. This is emphasized in the Declaration
of Helsinki (WMA) and the Universal Declaration on Bioethics and Human Rights (UNESCO). To compel a
patient to express his/her will, will be violation of an individual autonomy and an outrage against
informed consent.
Compelling patients is unethical. Donations should not be forced but should be voluntary. The presumed
consent system is not adopted in the Human Tissue Act 20045 in the UK and in the Research Involving Human
Biological Materials, which is a report of National Bioethics Advisory Commission in the USA.
The current referral system is increasing family consent rates in the US. CFS
In the US the Surgeon General introduced new legislation on to the US Federal Register that meant that each
hospital had a legal duty to identify and refer every potential donor to the organ donor organisation (ODO).
Potential donors are identified using clinical triggers that are very often present in patients who are likely to be
diagnosed as brain-stem dead (BSD). Hospitals failing to comply are financially penalised. The US already had
a well-staffed and extensive network of organ donor coordinators and systems in place to reimburse hospital
costs. In addition to the improvement in referral arrangements the ODOs around the US invested heavily in
training of coordinators in consent processes that are very specific to families of potential organ donors. The
coordinators in the US approach families to obtain consent and this has led to a significant increase in family
consent rates.
Page 87 of 174
Different policies and legislation have worked in different countries. CFS

A number of countries have a system of presumed consent, including Spain, but very few use the system in
practice. In Spain presumed consent had been part of statute for 10 years prior to the organisational changes
without any effect on rates of donation. The US does not have presumed consent legislation. Both have
impressive rates of organ donation and both have seen a rapid increase in a relatively short period of time.
Sweden switched to a presumed consent system in 1996 but continues to have very poor rates of organ donation
(10 PMP) and attempts to introduce presumed consent legislation in Brazil and France led to a backlash against
organ donation.
Page 88 of 174
Con: Ethics
Ethics
Ethics is based around consent TF
Doctrine
Traditionally, the device that adjusts our knowledge to our ethics has been the concept of consent. The free,
knowing and intelligent consent of a competent person to participation in the development or use of biomedical
knowledge appears prima facie to satisfy the requirement of respect for persons, since respect for persons means
respecting a person's autonomy. The problem of euthanasia may be seen in this light. In general, we feel
revulsion at involuntary euthanasia, and most doubts about voluntary euthanasia involve ascertaining the
validity of the subject's consent, such as whether a living will executed at a prior date is sufficient evidence of
present consent. Similarly, the ethical and legal issues in genetic screening and counseling revolve around
questions of disclosure and full consent to procedures that may reveal genetic data that stigmatize or restrict a
person's later choices." In general, the major thrust of public policy toward research with human subjects has
concerned the development of institutional mechanisms for assuring that competent adults participating in
research have given their informed consent.'
Very strong offensive argument around the definition of a just society and prioritizing process of
actions above consequences.
Page 89 of 174
Con: Slippery slope
Slippery Slope
Forcing mandatory organ donations can lead to a slippery slope TF
Doctrine
A final policy concern is that any deviation from a requirement of actual consent could open the door to
social worth or utilitarian assessments in non-transplant situations of incompetents and competents alike,
leading to further and massive incursions on the autonomy and dignity of individuals. This "slippery
slope" or "entering wedge" argument pervades medical ethical debates. Does the substituted judgment
indeed propel us down a "slippery slope"? Despite social tendencies to deny to the institutionalized and
mentally disabled adequate treatment, civil rights and dignity, recent recognition of the rights of incompetent
persons, particularly their right to respectful care and treatment, has been a major step toward a more humane
and dignified treatment of the mentally handicapped. Much of this progress has resulted from an emphasis on
the similarities as human beings between incompetent and competent persons. One might argue that if the law
recognizes a class of situations in which actual consent required of competent persons is waived for
incompetents, leading to highly intrusive and dangerous surgery for the benefit of others, then support
would be given to common notions that incompetents, are second class citizens. Yet if such an impact is
possible at all, it could occur only by a misunderstanding or misinterpretation of substituted judgment. For the
substituted judgment doctrine is explicitly non-utilitarian, and makes no claim that the rights of incompetents
may be overridden to advance the interests of others, where the rights of competents may not be similarly
overridden. Rather than detract from respect for the persons of incompetents, the substituted judgment doctrine,
properly understood, actually fosters such respect. For it seeks to treat incompetents as competents are treatedas creatures of choice, with the autonomy and dignity of choice, and whose choices as best as we can ascertain
them are to be respected. It thus stands as a further elaboration of the personhood of incompetents.
The slippery slope referred to in the card is the ability of the government to expand into other sectors,
forcing citizens through similar harmless actions.
Page 90 of 174
Con: Brain-dead patients
Forced Donations of Brain-dead Patients

Brain dead patients are not actually dead TF
Miller, Franklin (2014). Rethinking the Ethics of Vital Organ Donations.
We contend that the proposition that brain death constitutes death of the human being is incoherent and,
therefore, not credible. To be sure, brain death is a valid diagnosis of irreversible coma. No one who
satisfies the criteria for brain death regains consciousness. Contrary, however, to the Uniform Determination
of Death Act developed by a presidents commission in 1981, many patients properly diagnosed as dead under
whole brain death criteria do not have irreversible cessation of all functions of the entire brain. For example,
the brains of many patients retain a variety of homeostatic functions, from regulation of temperature to
control over salt and water balance. James Bernat and colleagues have responded that brain death
should not require the loss of literally all functions of the entire brain, but only those that preserve the
functioning of the organism as a whole. According to Bernat, the diagnosis of brain death signifies the
loss of those critical brain functions that maintain the integrity of the body as a living organism. The loss of
these functions causes the body to disintegrate, leading over a period of days to cardiac arrest. This
deterioration is claimed to be inevitable, regardless of whether the patient is on life support.
Good segue card into arguments of human rights.
Page 91 of 174
Con: Constitutionalism
Constitutionalism
Presumed consent may violate property rights. CFS
2000 Article 4.
As previously discussed, most state and federal courts address presumed consent organ donation controversies
by examining the dead body as property. A review of these cases illustrates the problems inherent in analyzing
the ramifications of presumed consent organ harvesting within a restrictive property framework. First, it
demeans human dignity to treat a person's body as a sack of flesh and bone awaiting assignment to an owner.
Surely the family members do not view their deceased loved one as a mere piece of property, no different from
a house or car. Second, as in Brotherton, courts often must resort to a liberal construction of contrary precedent
and/or unwarranted extrapolations from procedural law in order to manipulate a dead body case to fit within the
legal constructions of property. Moreover, courts seeking to compensate decedent's relatives for the pain and
anguish of unauthorized organ harvesting must at least address the grotesque and farcical practice of placing a
dollar amount on the human body. In the end, as shown by Bauer's nominal award for extra burial costs, even
when a court recognizes that presumed consent harvesting has infringed upon a quasi-property right in the dead
body, it can only provide a very limited and ultimately unsatisfactory remedy to compensate damages.
Therefore, recognizing the artificial restrictions of the property context, this Note analyzes presumed consent
organ donation laws within the constitutional framework of individual and family-based privacy, autonomy, and
liberty, with the goal of providing a more reasonable resolution to this problem.
Page 92 of 174
Con: Legality
Legality
Previous court cases are against presumed consent TF
Two recent cases in the Sixth Circuit have reconsidered the constitutionality of presumed consent laws.
The first decision, Brotherton v. Cleveland, is the first to question the constitutionality of presumed
consent statutes. The second case, Whaley v. County of Tuscola, followed the lead of Brotherton ruling,
that a widow could sue under the Due Process Clause of the Fourteenth Amendment for denial of fair
procedures before the harvesting of her deceased husband's corneas. In this decision, the Sixth Circuit held
that the next of kin of a deceased person has a constitutionally protected property interest in the body of the
deceased. These cases, when read together with those cases that established the quasi-property right, present a
two-part foundation for overturning the constitutionality of the presumed consent laws. First, the Sixth Circuit
has found a property right, which satisfies the property component of the Fourteenth Amendment's Due
Process Clause. Second, as suggested in Tillman, there may be a constitutional challenge under the liberty
interest component of the Fourteenth Amendment based upon the interest in individual autonomy. The
findings of the Sixth Circuit necessitate review by the United States Supreme Court. The reasons for this are
twofold. First, there is obviously a brewing controversy concerning these laws in both public opinion polls and
in the courts. Second, with the Sixth Circuit beginning to develop a body of case law upon which to base future
decisions under the principle of stare decisis, it will eventually be necessary for the Supreme Court to decide the
issue in order to provide definitive law for the other circuits to follow.
Establishes precedent for illegality of the AFF actions.
Page 93 of 174
Con: Legality
Property interest of the dead denies forced organ donation TF

Applying the standard set forth in Board of Regents v. Roth, there should be no debate that the state has vested
a property interest in the family of a decedent. All fifty states provide that family members may take possession
of a decedent's body following death. Since the state has vested a class of persons with an interest in a
decedent's body, a property interest has been established.' Once the property interest has been established,
constitutional procedures are due. Importantly, the standard rule is that pre-deprivation hearings are required.
Only where there are "'extraordinary situations where some valid governmental interest is at stake that justifies
postponing the hearing until after the event,"' may a pre-deprivation hearing be dispensed with. This quoted
language seems to open a door for presumed consent laws based on the urgent need of those dying for want of
organs for transplantation. However, it has been noted that "it is fundamental that except in emergency
situations . . . due process requires that when a State seeks to terminate [a protected] interest.., it must afford
'notice and opportunity for hearing appropriate to the nature of the case' before the termination becomes
effective.""' Certain persons will die without access to organs, but this is not an emergency of the kind that
would permit dispensing with a pre-deprivation proceeding. Since presumed consent laws do not provide the
surviving family members, who have the property right, with pre-deprivation process, the statutes should fail.
List specific law to be applied that is relevant to cadavers.
Page 94 of 174
Con: Reciprocity
Reciprocity Plan
Counterplan: Reciprocity proposal TF
Nadel, Mark (2005). Using Reciprocity to Motivate Organ Donations.
Fortunately, a relatively simple adjustment to the organ donation rules would likely alleviate the two central
problems with the current system by inducing many more commitments to donate and deterring families from
challenging those wishes. Instead of asking individuals to act purely altruistically, UNOS/OPTN 95 should
formally recognize those who commit to donate organs at death by significantly increasing such
individuals' chances of receiving an organ should they later need one. Variations of this idea have been
proposed periodically over the last twenty years, apparently beginning with Jonathan Kaufelt's 1986
letter in the Wall Street Journal. One version of this proposal was adopted by Singapore in 1987. Although a
1993 UNOS Committee Report recommended wider discussion of a priority program," it has generally been
overlooked by policymakers. The idea was never raised during either the 1999 or 2003 hearings in the House of
Representatives on increasing organ donations, nor was it identified in either the 1993 General Accounting
Office (GAO) review of alternatives for achieving this goal' or the June 2004 Joint Committee on Accreditation
of Healthcare Organizations (JCAHO) report entitled Strategies for Narrowing the Organ Donation Gap and
Protecting Patients.
An alternative NEG solution that also solves for the NEG.
Page 95 of 174
Con: Mandated choice
Mandated Choice
Counterplan: Use mandated choices for posthumous organ donations TF
A second potential strategy to increase organs from cadaveric donors is mandated choice. Under this
strategy, every American would have to indicate their wishes regarding organ transplantation, perhaps
on income tax forms or drivers licenses. When a person dies, the hospital must comply with their written
wishes regardless of what their family may want. The positive aspect of this strategy is that it strongly
enforces the concept of individual autonomy of the organ donor. A mandated choice policy would require
an enormous level of trust in the medical system. People must be able to trust their health care providers to care
for them no matter what their organ donation wishes. A 2001 survey of 600 family members who had
experience donating organs from a deceased loved one, found about 25% of respondents would be concerned
that a doctor wouldnt do as much to save their loved ones life if they knew they were willing to donate their
organs. A mandated choice policy was tested in Texas during the 1990s. When forced to choose, almost 80%
of the people chose NOT to donate organs, which was not an increase in the number of available organs. The
law enacting mandated choice for Texans has since been repealed.
Mandated choice places a slight twist on most AFF plans.
A system of presumed consent explained and it has three benefits. LZ.

Rev. Nicanor Pier Giorgio Austriaco, O.P., Ph.D., S.T.L., [assistant professor of biology at
Providence College in Rhode Island]. Presumed Consent for Organ Procurement A
Violation of the Rule of Informed Consent? The National Catholic Bioethics Center.
Summer 2009. http://ncbcenter.org/document.doc?id=119
In lieu of presumed consent, several authors have proposed another option, the option of mandated choice.
Mandated choice requires all competent adults to decide whether they wish to donate their organs after death.
With this system, individuals are free to choose whether to donate, and even which organs they would like to
donate. However, they are not permitted to fail to register their wishes. Individuals could also choose to let their
relatives have the final say in organ donation. Unless they are granted this right, however, immediate family
members and other relatives have neither the power nor the opportunity to veto the individuals decision,
whether it is for or against donation.
A system of mandated choice could be accomplished by asking about organ donation on drivers license or state
identification card applications, tax returns, or similar civil documents. The system of registration would have to
Page 96 of 174
Con: Mandated choice
be as inclusive as possible so that it can reach every adult member of a given population. An application or tax
return would not be accepted until the question of organ donation is answered. The individuals decision would
then be included in a database that would be accessible to individuals involved in organ procurement. A change
of mind could easily be communicated at any time using a written directive. Finally, a system of mandated
choice would have to incorporate safeguards that protect the confidentiality of the decisions made by each adult
citizen to protect him or her against the possibility of coercion from family members, employers, or others.
Can the Catholic moral tradition endorse a system of mandated choice for organ procurement? It appears so.
First, mandated choice respects the dignity of the human person as charitable gift giver. Each individual is still
given the opportunity to give or withhold his or her organs for donation and transplantation. Second, procured
organs would retain their formality as gift since they would be obtained with the explicit and informed consent
of the donor, who has decided to give his or her organ to another. Finally, a system of mandated choice would
serve the common good by increasing the supply of organs available for patients who need them. As such, a
system of mandated choice can be justified within the Catholic moral framework.
Even though this evidence is about the Catholic moral tradition, it still has good arguments about why a
mandated choice system still helps people and is a moral choice.
Mandated choice helps families and preserves individual autonomy. LZ.

Daniel Springer [Oakland University]. Organ Donation: Autonomy, Presumed Consent,
and Mandated Choice.
What both proponents and opponents of presumed consent often overlook is the individuals choice prior to
death. Mandated choice is a prime example of how to transform the ineffective system we currently have while
simultaneously avoiding much of the controversy between presumed refusal and presumed consent. By
eliminating the presumed nearly every individual could explicitly state their wishes prior to death. Under
mandated choice, individuals would be required to state their preferences regarding organ donation
when they renew their drivers licenses, file income tax forms, or perform some other task mandated by
the state. (p. 809) By enacting mandated choice, it removes the barrier of presumption, and requires that
citizens consider their own death and how they feel about organ donation. Often in the cases of presumed
refusal and in proposed models of presumed consent, it is the family of the individual that must decide
whether or not to donate their organs. Amid the chaos and anxiety that engulfs the family during the death of
a loved one, it seems unfair to ask them whether they wish to donate their loved ones organs. By mandating
that each person decide for themselves, it spares the family the agonizing decision while simultaneously
bolstering the individuals autonomy.
Mandated choice also has the benefit of sparing the families from having to choose. Instead, it gives the
individual autonomy and the family relief.
Page 97 of 174
Con: Alternative sources
Counterplan: Alternative Organ Sources

Counterplan: Use alternative sources of organs TF
With the state of discrepancy between organ donors and people waiting for an organ transplant, researchers and
advocates have begun to consider non-traditional donation. Some potential non-traditional sources of organs
are: 1. ANIMAL ORGANS Animals are a potential source of donated organs. Experiments with baboon
hearts and pig liver transplants have received extensive media attention in the past. One cautionary argument in
opposition to the use of animal organs concerns the possibility of transferring animal bacteria and viruses to
humans. 2. ARTIFICIAL ORGANS Artificial organs are yet another potential option. The ethical issues
involved in artificial organs often revert to questions about the cost and effectiveness of artificial organs. People
who receive artificial organ transplants might require further transplanting if there is a problem with the device.
3. STEM CELLS Stem cells are cells that can specialize into the many different cells found in the human
body. Researchers have great hopes that stem cells can one day be used to grow entire organs, or at least groups
of specialized cells. The ethical objections concerning stem cells have focused primarily on their source. While
stem cells can be found in the adult human body, the seemingly most potent stem cells come from the first few
cells of a human embryo. When the stem cells are removed, the embryo is destroyed. Some people find this
practice morally objectionable and would like to put a stop to research and medical procedures that destroy
human embryos in the process. 4. ABORTED FETUSES Aborted fetuses are a proposed source of organs.
Debates address whether it is morally appropriate to use organs from a fetus aborted late in a pregnancy for
transplantation that could save the life of another infant. Many people believe that this practice would condone
late-term abortions, which some individuals and groups find morally objectionable. Another objection comes
from people who fear that encouraging the use of aborted fetal organs would encourage organ farming, or the
practice of conceiving a child with the intention of aborting it for its organs.
Same as above, needs impact cards, but can be very effective if coupled with other cards.
Page 98 of 174
Con: Financial incentives
Financial Incentives for Deceased

Solvency advocate for giving financial incentives for cadaveric donation. SBH.
P Clark. Financial Incentives For Cadaveric Organ Donation: An Ethical Analysis. The
Internet Journal of Law, Healthcare and Ethics. 2005 Volume 4 Number 1.
Organ donation is a complex and multi-faceted issue that not only impacts on the donor but also on families of
the donor, recipients, and society as a whole. Altruistic organ donation in the United States is premised on the
appeal to give a gift of life by an individual decision-maker. But is relying solely on altruism enough? Our
current organ procurement system is based on financial gain for all concerned (physicians, surgeons,
coordinators, social workers, hospitals, etc.), the altruistic gift' upon which so many recipients depend has been
described as unfair and insensitive to donor families and the source of basic distrust of the system by the public.
It has been argued that the donor and the family are the only participants not directly benefiting from the
process and therefore, some form of compensation is the right thing to do, even if the number of donors and
cadaveric organs does not appreciably increase. 50 In addition, financial incentives have become a part of
medicine (Drs, preferred providers, etc.). . . Under such an evolving system, a single fixed payment incentive
for organ donation could potentially be interpreted as a message to prospective donors and their families that
this process does not involve a unique moral decision, but only what is assumed as a societal obligation and
expected of everyone who participates in the system. 51 The medical, ethical and social justifications for
financial incentives stem from the 5 to 10 year waiting list for organs, the increased number of deaths among
those on the waiting list, and the fact that the projected supply cannot meet the growing demand for organs. For
financial incentives to be effective the following recommendations must be considered:
1) Petition Congress to amend the 1984 National Organ Transplantation Act to allow for financial
incentives for cadaveric organ donation after brain death has been established.
2) Examples of financial incentives would include: $5000 for funeral expenses that would be paid to
the funeral home directly, a $5000 tax credit to the donor's estate, a $5000 payment to the charity
of choice of the donor or the donor's family, etc. These incentives would be under the jurisdiction
of UNOS.
3) Post-mortem donations would be controlled by UNOS who would verify that organs would be
distributed as they are, based on medical need and time on the waiting list. This would insure the
equitable allocation of organs for transplantation and allow for transparency in the process.
4) Pilot programs, that are broad based, should be initiated and expanded to evaluate the potential
effects of financial incentives, in order to assess the balance between harm and good.
Page 99 of 174
Efforts should continue to increase voluntary organ donations as well as increasing the efforts at
disease prevention that would help reduce the need for organs. Financial incentives for cadaveric organs
are controversial but after examining them medically and ethically, there is no reason why such incentives
should not be initiated. Basic economics teaches that incentives matter. The higher the incentives the more
willing will be donors to overcome other costs and disincentives. This is not only good for the donor and his
or her family, but it is also good for the recipients whose lives will be saved and for society as a whole who
will benefit from decreased medical costs. This issue is important for all of us because not only could each
of us become potential donors in the near future, we could also become potential recipients.(pg.1)
This evidence functions as preempts to a few potential arguments against the position, such as people
arguing that it is ethically wrong to sell or buy organs. This works as a solvency advocate for a
counterplan that argues that we ought to give financial incentives to the families of deceased family
members that donate.
Financial incentives increase human dignity. SBH.

Other critics of financial incentives such as Dr. Francis Delmonico a transplant surgeon at Massachusetts
General Hospital argue that, any attempt to assign a monetary value to the human body or its body parts, even
in the hope of increasing organ supply, diminishes human dignity and devalues the very human life we seek to
save. 37 This argument seems illogical. If the best interest of the donor is protected and these incentives save
lives and save medical resources that in the long run will benefit society, then how is the dignity and respect for
human life devalued? By donating one's organs after brain death, the donor is giving to others and society
the gift of saving human life. If we believe as social beings our good, our flourishing, our best interests are
inextricably bound up with the well-being of others, 38 then cadaveric organ donation is also good for the
donor. More than 6,000 patients die each year waiting for organs. Allowing viable organs from post-mortem
donors to be wasted when thousands of lives could be saved seems to diminish human dignity and devalue
human life. Secondly, a 10% to 15% increase in transplants could save the nation millions of dollars in health
care costs. One example of this potential savings would be to increase kidney transplants. Logically, to place
individuals on immunosuppressants and remove them from dialysis machines would seem to be much
more cost effective for society as a whole. One could argue this would increase human dignity by valuing
human life.(pg. 1)
This would answer arguments your opponent would make about how selling organs devalues human life.
It could also be used as a net benefit to a counterplan.
Page 100 of 174
Justice requires incentives because it has the intention to help those in need. SBH.
Justice recognizes that each person must be treated fairly and equitably, and be given his or her due.
Justice also pertains to distributive justice, which concerns the fair and equitable allocation of resources,
benefits and burdens, according to a just standard. As social human beings we ought to want to contribute to
the good of others and society as a whole. Cadaver organ donation is a service to individual recipients
and to society as a whole. Raising awareness about the need for organs encourages donors/families to give the
gift of life to others in need. This gift will not only increase the supply of organs for recipients, but will benefit
society by decreasing medical costs and allowing for a more just allocation of resources. It is estimated that
over 20 years, the expected savings to the health system of getting a kidney versus staying on dialysis are about
$95,000. 47 Critics of financial incentives for cadaveric organ donation claim that this is just the first step on the
slippery slope toward allowing wholesale buying and selling of organs. They argue that with the present
scarcity of organs in the United States and around the world, many fear that people will start advocating for
allowing living donors to sell their organs. One example of this is Pakistan's unregulated and fast growing
kidney transplant trade, where foreigners can buy kidneys from impoverished Pakistanis in contravention to
established medical norms. The marketing of kidneys has become a lucrative business in Pakistan. 48 Ethically,
the very wealthy are the buyers and the poor are the sellers. This unequal distribution of medical resources is
completely unjust. The vulnerable could be coerced into donating their organs out of financial necessity. As
mentioned above, there are also concerns about the recent trend of soliciting organs over the internet.
Bioethicist David Magnus of Stanford University argues that our organ allocation system is imperfect, but
there is a lot of effort and a lot of thought to make it as fair as possible. Once you go down this road and allow
people to jump ahead in the queue through a popularity contest through the Web, you can be assured justice
goes out the window. 49 Both of these trends would be socially disruptive because it is just one more way that
minorities and other vulnerable groups would be exploited for the sake of the wealthy. This would be a blatant
form of injustice. However, cadaveric organ donation does not have to lead to the slippery slope. One way
to eliminate unfairness would be for the government to regulate financial incentives to donors and then to
regulate the distribution of the organs to recipients. With safeguards and government regulations, the
supply of organs may increase enough to eliminate the need for financial incentives for living donors. The
principle of justice claims that all people have the right to be treated fairly and equitably. Promoting
financial incentives for cadaveric organ donation is ethically responsible because the intention is to do
what is good and just for not only the donors but for recipients and society as a whole.(pg. 1)
This evidence argues that it is just to have the intention to do what is good for society by increasing the
amount of donors through incentives. It also answers common responses to the position such as
wholesale buying and selling of organs by saying that we would regulate the system and solve the
problem.
Page 101 of 174
Incentives arent used now because everyone is too focused on keeping organ donation
altruistic. SBH.
Satel, Sally. "Test Incentives for Organ Donations Theres No Reason Not To." The
New York Times. The New York Times, 22 Aug. 2014. Web. 22 Aug. 2014. <
http://www.nytimes.com/roomfordebate/2014/08/21/how-much-for-a-kidney/testincentives-for-organ-donations-theres-no-reason-not-to >.
Why are such trials not being run at this time? Several reasons. The transplant community is too complacent,
too wedded to the notion that only altruism is a legitimate motive for donating an organ. Its a romantic
conceit, but a lethal one too. The gift of life is precious; I received it from a friend in 2006. But altruism, as a
strategy, is simply not producing enough organs. It needs to be supplemented with compensated donation.
To be fair, there is some promising movement afoot as the American Society of Transplant Surgeons and the
American Transplantation Society collaborate on a position paper that has been previewed as favoring pilot
trials of incentives. But we need patients to speak out too.(pg. 1)
This answers the common argument asking why, if incentives are so great, they arent being used now.
There are currently disincentives that discourage people from donating. CFS
Deborah Mitchell. March 22, 2010. Organ Donations Decline as Need Increases
http://www.emaxhealth.com/1275/24/36134/organ-donations-decline-need-
increases.html
Convincing individuals to be an organ donor is a challenge. Although about 90 percent of Americans say they
support organ donation, only 30 percent know the steps that need to be taken to become a donor. Several factors
contribute to the publics lack of awareness of the issue and to organ shortage itself, as the Cedars-Sinai
researchers note. Some of those factors include disincentives for living organ donors (e.g., loss of income while
taking off work, transplant-related medical expenses may not be covered by the recipients insurance), lack of
understanding by the public about organ donation policies, poor training of medical personnel who request
consent for donations, and an inability to accurately evaluate the quality of donated organs based on currently
available procurement testing.
Page 102 of 174
Con: Ethical incentives
Ethical Incentives
Ethical incentives remove autonomy violations. SBH.
DELMONICO et al. ETHICAL INCENTIVES NOT PAYMENT FOR ORGAN
DONATION N Engl J Med, Vol. 346, No. 25 June 20, 2002
Why draw a line between incentives, such as reimbursement for funeral expenses or life and disability
insurance, and actual payments, such as tax credits or even regulated organ sales? We recognize that some
people may view the difference as symbolic, but in our view, the symbolism is very important. Symbols that are
figurative representations of core social values and boundaries are both subtle and complex and do not always
stand up to purely rational analysis. We bring a bottle of wine to the home of a friend who has invited us for
dinner, not a $20 bill. The Red Cross gives T-shirts, food, and drinks to those who donate blood but would not
give their cash equivalent. Despite the increasing encroachment of market forces into medicine, we believe that
the symbol of altruism in organ donation continues to represent powerful notions about the use of human body
parts.
The fundamental truths of our society, of life and liberty, are values that should not have a monetary price.
These values are degraded when a poor person feels compelled to risk death for the sole purpose of obtaining
monetary payment for a body part. Physicians, whose primary responsibility is to provide care, should not
support this practice. Furthermore, our society places limits on individual autonomy when it comes to protection
from harm. We do not endorse as public policy the sale of the human body through prostitution of any sort,
despite the purported benefits of such a sale for both the buyer and the seller.(pg.1)
This could be a net benefit to a counterplan arguing that we should have ethical incentives to cadaveric
organ donations or it could answer the argument that ethical incentives are financial incentives.
Page 103 of 174
Con: Ethical incentives
Examples of ethical incentives that could be given to cadaveric donors. SBH.

The motives of living donors and the motives of families of deceased donors are complex and not necessarily
purely altruistic.29 Families of deceased donors often regard organ donation as a way of giving meaning to the
death or of allowing the person to live on in others.29 Spouses and siblings who act as living donors
experience the personal reward of seeing that the recipients well-being is restored. Because organ donation is
voluntary and valuable, it should be considered a charitable gift. Society could explicitly thank organ donors for
their gift, as is done with other charitable contributions, without jeopardizing its altruistic basis. New federal
legislation should embrace ethically acceptable ways to encourage such charitable donation of organs, some of
which are outlined here.(pg. 1)
The authors give the further examples of a donor medal of honor, reimbursement for funeral expenses,
organ exchanges, medical leave for organ donation, ensuring access to organs for previous donors, donor
insurance.
Page 104 of 174
Con: Israeli system
Israeli System CP
The Israeli system defined. LZ.
Gil Segal [Center for Health Law, Bioethics and Health Policy, Kiryat Ono College,
Kiryat Ono, Israel; Gertner Institute for Epidemiology and Health Policy, Ramat
Gan, Israel; School of Law, University of Virginia, Virginia, USA]. Making the case
for directed organ donation to registered donors in Israel. Israel Journal of Health
Policy Research 2014; 3: 1. Published online Jan 23, 2014. doi: 10.1186/2045-40153-1. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3909280/pdf/2045-4015-3-1.pdf
In 2008, the Israeli parliament (the Knesset) enacted a new Organ Transplantation Law designed to
increase the performances and coordination of transplantation medicine in Israel, and to increase the
availability of organs. Among its provisions was an innovative plan for creating incentives for both live
donation and deceased donation. Under the new law, live donors receive a uniform sum of money as
compensation for the monetary loss reasonably attributable to procedures associated with organ removal and for
the reimbursement of the donors expenses. In addition, donors are exempt from paying the health tax for a
significant period of time and receive a Certificate of Recognition; they are also exempt from entrance charges
to national parks.
As for deceased donors, the focus of this paper, the National Organ Transplantation Center bears their burial
costs. The law also authorizes the Health Ministry to offer a reward to a person, or to his relative (either during
the persons lifetime or after his death) for agreeing to donate the deceased persons organs. So far the Health
Ministry has only authorized reimbursement of memorial expenses.
Importantly, the 2008 law authorizes the Steering Committee of the National Organ Transplantation
Center to give priority to patients on the waiting list who have signed a donor card, should they or a firstdegree relative need a transplant, as part of the effort to encourage the signing of donor cards and
increase organ donations. In other words, for the first time, the allocation criteria incorporate a non-medical
criterion, a step which raises ethical concerns. This policy has been in effect since April 2012, and during
December 2012, a massive multilingual media campaign was launched to inform the public of their
chance to receive preferred status on the waiting list by signing donor cards. The effect of preferred status
on the size of the donors pool remains to be studied, although early indications demonstrate a positive effect.
The important thing to take away from this is that the Israeli system gives preferential treatment to those
who are registered as organ donors.
Page 105 of 174
Con: Israeli system
The Israeli system has empirically been shown to increase donation rates at a statistically
significant level. LZ.
J. Lavee, T. Ashkenazi, A., J. Cohen and R. Beyar. Preliminary Marked Increase in the
National Organ Donation Rate in Israel Following Implementation of a New Organ
Transplantation Law American Journal of Transplantation 2013; 13: 780785
Wiley Periodicals Inc.
https://www.hods.org/pdf/Preliminary%20Marked%20Increase%20in%20the%20
National%20Organ%20Donation%20Rate%20in%20Israel%20Following%20Impl
ementation%20of%20a%20New%20Organ%20Transplantation%20Law%20(AJT
%202013,13,780-5).pdf
The number of deceased organ donors significantly increased in 2011 to 89, compared to 60 in 2010 or to
any of the previous seven years (95% prediction interval 45.580.5, p = 0.01) (Figure 1A). Deceased organ
donation rate per million population significantly increased in 2011 to 11.4 from 7.8 in 2010 (95%
prediction interval 5.610.4, p = 0.01) (Figure 1B). The monthly number of new registered donors has
significantly risen from a mean number of 2889 in the years 19982010 to a monthly mean of 6273 in 2011,
representing an increase in the total number of registered donors from 10% to 12% of the adult population (95%
confidence interval for the difference between the means 11135654, p = 0.007) (Figure 2). The consent rate
for organ donation from deceased donors has risen in 2011 to 54.9% from 49.2% in 2010, however the
increase is not statistically significant (95% prediction interval 38.756.8, p = 0.11) (Figure 2). The number of
kidney transplantations from living donors has significantly risen from 71 in 2010 to 117 in 2011 (95%
prediction interval 42.291.5, p = 0.003) (Figure 3). The annual number of patients who underwent kidney
transplantation abroad has decreased from a peak of 155 in 2006 to an all-time low of 35 in 2011 (95%
confidence interval for the difference between the means 6.6121.6, p = 0.006) (Figure 3B). The total number
of candidates waiting for an organ transplant has decreased for the first time since 2006 from 1117 in
January 2011 to 1041 in January 2012, though this decrease is not statistically significant (95% prediction
interval 974.41282.0, p = 0.21) (Figure 4A). Similarly, the total number of candidates who died while
waiting for transplants has decreased from 124 in 2010 to 105 in 2011 (95% prediction interval 66.8168.8,
p = 0.5) (Figure 4B).
This shows that the Israeli model has produced some great positive results, many of which are measured
to be statistically significant. The keys things to take away are that deceased organ donation rate
increased at a statistically significant level and that the number of those who died waiting for transplants
has also decreased, both of which are huge impacts.
Page 106 of 174
Con: Israeli system
The Israeli system results in a decrease of transplant tourism, increases living kidney
donations, and decreases the number of people who die on waiting lists. LZ.
J. Lavee, T. Ashkenazi, A., J. Cohen and R. Beyar. Preliminary Marked Increase in the
National Organ Donation Rate in Israel Following Implementation of a New Organ
Transplantation Law American Journal of Transplantation 2013; 13: 780785
Wiley Periodicals Inc.
https://www.hods.org/pdf/Preliminary%20Marked%20Increase%20in%20the%20
National%20Organ%20Donation%20Rate%20in%20Israel%20Following%20Impl
ementation%20of%20a%20New%20Organ%20Transplantation%20Law%20(AJT
%202013,13,780-5).pdf
The banning of reimbursement for organ transplantation in countries where the procurement of such organs has
either been performed against local law or where organ trade has been involved has resulted in an abrupt
decrease in the number of patients undergoing kidney transplantation abroad. Most Israeli patients will not seek
transplantation abroad once it is not reimbursed by law. Most of the few kidney transplantations performed
abroad in 2011 were privately funded by the patients. Travel of Israeli candidates for deceased donors
organs, in particular for heart or liver transplantation, to traditional venues such as China has stopped
completely since the new law has taken effect (13).
In parallel to the significant decrease of transplant tourism from Israel, local living kidney donation has
significantly increased. It is hard to ascertain whether this was the result of the dwindling opportunities to
receive a kidney abroad or due to the removal of disincentives for local living donation. Regardless, the end
result was a marked increase in the number of living kidney donations from 71 in 2010 to 117 in 2011. It
should be emphasized that the various reimbursements to authorized living donors provided by the new law do
not constitute any financial incentives for living donation by themselves but merely serve as removing
disincentives to those considering altruistic living donation. In addition, Israels National Health Insurance Law
grants every Israeli citizen the performance of organ transplantation from approved living or deceased donor
free of charge.
Overall, the significant increase in 2011 in organ transplantations, both from deceased and living donors,
has resulted for the first time since 2006 in a preliminary decrease in the number of candidates awaiting
organ transplantation and in the number of potential recipients who died on the waiting list. These were
not yet found to be statistically significant and should be cautiously observed over a longer follow-up period.
Page 107 of 174
Con: Discrimination
Discrimination
Women give more organs and consistently receive fewer. Switching to an opt-out system
would intensify the already existent lack of trust for the system that women and others
have. SBH.
Along with the poor, the queer, the aged, people with disabilities, and people of color however gendered,
womens general experience of health-care institutions in the United States provides them with reason to
believe that their interests are not reliably taken with due seriousness. Further, it would be frankly astounding if
other national health-care systems were altogether free of such distortions. This endemic feature of health-care
systems makes reasonable the worry that efforts to increase organ availability via opting-out protocols could
weaken confidence in the trustworthiness of the system even further.
Nor is the matter simply a question of perception; it is far from inconceivable that some people would actually
be treated worse than others in such a system. In the United States, there is a significant gender disparity in
living renal transplant donation; for example, women provide kidneys at a significantly higher rate than
do their male counterparts (see Zimmerman et al. 2000) and receive them less often (Bloembergen et al.
1996); wives are apparently much more likely to donate to needy husbands than are husbands to wives in
need. Similar statistics appear to hold good for access to kidneys from cadavers (Garg et al. 2000; for
information concerning liver donation, see Axelrod and Pomfret 2008). Unless we come to understand better
what forces drive these tendencies, and how to counter them effectively, theres reason to fear that an opt-out
system could lead to women giving still more organs, with no guarantee that they wont still receive fewer.
Organ procurement conspicuously rests on a reservoir of social trust. Those willing to provide organs need to be
able to rely on strangers to be sure that their own interests will not be compromised in the light of the dire needs
of otherscrucially, that any chance they might have to survive wont be dis- counted on the grounds that their
transplanted organs might yield greater benefits to (several) others. It might be feared that shifting the social
default from a presumption that organs will not be removed to the presumption that they will be, weakens the
grounds for that trust.
There seems very little in the way of solid evidence that organ procurement systems, whether in opt-out or optin countries, have preyed on the vulnerable in this dramatic way. Cadavers are not immune from exploitation
(see Dicken- son 2008), but reliable accounts of people whose deaths were hastened against their will for
reasons of transplantation are almost vanishingly rare. Yet people need as well to be able to trust that
Page 108 of 174
Con: Discrimination
strangers will use the organs that they provide efficiently, skillfully, and in accordance with a conception of
fairness that is, at the least, facially plausible, carefully thought through, open to discussion and ongoing
deliberation, and scrupulously followed out. Whether procurement and allocation systems are trustworthy in
these respects is something that women and people otherwise marginalized have more reason to doubt.(pg. 1)
This would work as a link to a feminism kritik that argued that an opt-out system increases patriarchal
views.
Opt-out systems increases disrespect for women who are living and deceased. SBH.
Discussions of organ transplant ethics would do well to keep squarely in view that organs are part of bodies, and
bodies are gendered. Has this fact implications for opt-out systems? Feminist philosophers and other scholars
have studied ways in which womens experience of their bodies tends to differ systematically from the experience of men (e.g., Young 1990). While there is, no doubt, considerable variation hereidiosyncratic,
cultural, and class-basedit seems responsible to consider whether any gender-related differences in the
experience, understand-ing, and valuing of ones body might make a policy of opt-out donation more
burdensome for (at least many) women than for people who arent women. Heres a way in which this thought
might be developed: paradigm shallow- pond cases involve acts or, possibly, goodspulling kids from ponds,
writing a small check to Oxfam that will save several lives. They do not typically involve still living parts of
what was ones body. A reason why this slide from human acts to human parts might be problematic stems from
the strong tendencies resident in many human cultures to configure womens bodes largely as means to
heterosexual male gratification. As a consequence of these tendencies, the integrity of the physical
boundaries of womens bodies is routinely deemphasized or disregarded. Because opt-out policies
arguably reduce the significance of the bodys boundaries (albeit after death, and for all genders), they
may reinforce existing tendencies to regard those boundaries as less important for the living. As a
(powerful) generalization, it is women who are particularly vulnerable to any further decrement in respect.
Consequently, an opt-out policy might be reasonably seen as offensive to women, quite apart from whatever
causal influence it might or might not have in promoting practices expressing or motivated by sexist
disrespect.(pg. 1)
views.
Page 109 of 174
Con: Discrimination
Women tend to identify with their bodies more than men making organ donation more
intimately violating than simply an easy rescue of giving up organs not needed
postmortem. SBH.
Consider another way of developing the general concern about gendered differences in embodiment. Stipulate
again that womens relationships with their bodiesthat is, their relevant affective, proprioceptive, and
cognitive patterns tend to be different from those characteristic of men. Then cash out the differences:
whereas men tend to think of their bodies instrumentally, as that which expresses ones will, women tend
to identify with their bodiesto understand the living body as self. Moreover, this gender-inflected
experience of embodiment may well extend beyond a womans own body to those about whom she cares
deeply.7Suppose now that an opt-out system is put into place as a result of deliberation in a democratic
state. Some women might then experience the social expectation that ones organs will be available for
others as more burdensome than would (many or most) men: if someone experiences her body as herself,
having her living organs implanted into another person may be more like an act of intimacythe
continued presence of a part of me within anotherthan an easy rescue. If transplantation is so
understood, explicit consent, not an assumption of even a presumptive responsibility, would seem to be the
proper way to govern provision. Further, regarding provision as even a defeasible responsibility reduces the
expressive possibilities involved in explicit consent. These are, if anything, intensified by understanding a
transplantable organ not as something one simply doesnt need anymore, but as a part of oneself, a part that is
alive and active in the world after ones death. Different notions of embodiment may influence both a persons
understanding of her mortality, and of how her intimates make sense of her death.(pg. 1)
views.
Page 110 of 174
Con: Discrimination
Presumed consent discriminates against minorities by placing a burden on them to opt-out

when they dont have the knowledge or access to opt-out. SBH.
Jacob, Marie-Andree, LL.B. Universit6 Laval; LL.M. York University, J.S.D. in progress,
Health Policy Research, On Silencing and Slicing: Presumed Consent to PostMortem Organ Donation in Diversified Societies, 2003.
Under strict presumed consent, a mere right to opt-out does not leave enough room for active and empowered
decisions, as shall be further explored in Part III. Indeed, it encourages silence as the privileged mode of
participation. Informed consent does not. Under the soft version of presumed consent, the authority presumes
consent, and must make a qualified "reasonable effort" to verify its presumption by searching for a dissenting
voice behind the silence. Still, the reasonable efforts to search and get to alternative voices are preceded by a
medical criterion, that is, the priority to preserve the useful life of the organs to be harvested. Moreover, the
substance of the "reasonable efforts" requirement is unclear. Minorities remain disadvantaged in a situation of
reversible presumption: the burden to opt-out is theirs, regardless of the language barriers, misunderstandings
and communication problems they may encounter in health care facilities. In a multicultural society, the
medical community should "view organ donation through a cultural lens, using understanding and sensitivity to
each ethnic group's cultural framework and the way in which it may influence their decision about whether to
donate."99 Requests for organ donation should be made in a manner that respects cultural difference.""(pg. 1)
Page 111 of 174
Con: Discrimination
Minorities dont support presumed consent. CFS

Under this approach, it appears that presumed consent is the better policy. Public opinion surveys consistently
find that a majority of people say they want to have their organs used for transplantation after death. More than
70% of the public states that they are somewhat or very likely to donate, and about 53.2% of people have
documented their willingness to donate. It makes sense to base the laws default rule according to the
majoritys preference. That is, if 70% of people want to donate organs and only 30% do not want to donate, the
law should assume that people want to donate, thereby satisfying 70% rather than 30% of the population.do or
whites. While 60.5% of whites have granted permission for organ donation on their drivers licenses, only
39.3% of Latinos, and 31.2% of blacks have done so. Vulnerable populations are not only less likely to support
organ donation; they also would be less likely to realize that presumed consent statutes exist and that they
would need to lodge their objections to organ donation. Without a reliable method of opting out of presumed
consent, presumed consent could easily operate to the particular disadvantage of vulnerable populations. Indeed,
Marie-Andre Jacob has argued that the possibility of unfairness to vulnerable populations should push us
toward actual consent. Analogizing to contract law, which places on the more powerful party the burden of
contracting out of default rules, she suggests that default rules for posthumous organ donation place the burden
on doctors to overcome the rules. In other words, the burden should remain on physicians to obtain consent to
organ donation rather than placing the burden on individuals to express their objection to donation.
Page 112 of 174
Con: Regulated market
Regulated Market
Regulated organ markets are safer than the current system of living donations. SBH.
Regulated organ markets also may be safer than the current system of living donation. It is true, but trivially so,
that organ donors become, in some sense, a patient. The obligations that physicians have to their patients would
not change because some donors are compensated and others are not. The existing literature on donor outcomes,
however incomplete, nonetheless, supports the premise that donating a kidney is safe for the long term [5]. By
vastly expanding the number of potential living donors, one can cherry-pick to identify people who everyone
agrees would be at the lowest risk for long-term harm from donation. Incentives would also helpfully eliminate
the psychological pressures brought to bear on living donors, borne of their recipients desperate plight. Far
from suppressing altruism, the authentic altruism of those who still choose to donate (uncompensated) would
thereby be clarified and preserved.
In itself, low socioeconomic status is an independent risk factor for the development of kidney disease over
time, a fact which constitutes sufficient reason to exclude the poorest among us from participation in organ
vending (or for that matter, in living organ donation). Exclusion of the very poor is justified not because poor
donors and vendors are somehow incapable of autonomous judgment. For example, the poor should not be
prohibited from voting in elections for political candidates who proffer the coercive offer of improving the
economic lot of the poor. Rather, exclusion is justified because the purpose of a regulated market in organs is to
increase the number of available organs without increasing harm to others. The right to sell does not impose
an obligation to buy, and the interests of all involved entail an exchange that benefits recipients without
harming sellers.(pg. 5)
This evidence also answers arguments about how the poor are excluded.
Page 113 of 174
Its empirically worked in Iran. The US can learn from Iran with their organ market. SBH.
These protections morally distinguish a regulated system of incentives for organ procurement from the
significant harms generated by organ trafficking, and they would provide a useful guide to the construction of
pilot trials for incentives in this country, as well as a means of assessing the conditions in other countries. Along
these lines, the United States has something to learn from Iran, which is the only country in the world with a
legal pseudo-market in organs from living donors, and the 24-year legacy of that institution provides useful
lessons and cautionary tales [7]. No evidence is perfect, but the peer-reviewed evidence we have from several
sources supports the following facts: (1) for the last decade, Iran has not had a waiting list for transplantable
kidneys; (2) the long-term outcomes of recipients of purchased organs is not significantly different from the
outcomes of recipients of donated kidneys (a useful surrogate marker for the health of organ vendors); (3) the
existence of a flourishing market has not resulted in attrition of the number of kidneys donated by biological
relatives; and (4) uncompensated organ donation from the deceased has increased 10-fold since 2000, when
laws recognizing brain-death as death were approved by the Iranian Parliament. On the other hand, the
following is also true: (1) organ vendors are disproportionately impoverished and poorly educated; (2) the data
on long-term outcomes for organ vendors is conflicting and mixed, but at any rate it is substantially incomplete.
It does not follow that a system of incentives inexorably leads to bad outcomes for vendors. What does follow is
that a defensible system of incentives must offer plausible assurances that the long-term consequences for organ
vendors are at least as safe as for organ donors.(pg. 6)
This could work as a modeling argument for a counterplan that says that the US should follow Irans
model of a free market for organ donation. It also provides empirics.
Page 114 of 174
A regulated market protects the vendors and buyers. SBH.

Ignoring the financing, the proponents of an organ market reject a free market (on grounds of its potential to be
exploitative) and focus instead on a regulated market, and then often a regulated market restricted to United
States citizen vendors [23, 4244]. It is not clear if those who promote this believe they are protecting recipients
or vendors. The answer is probably both. They are protecting recipients because of the greater risks of
infectious diseases in potential vendors abroad [45, 46]. They claim to be protecting the vendors because a
market price of $10,000 in the United States would bring hundreds of thousands, if not millions, of individuals
from third-world countries for whom the dollar amount would be undue inducement. If vendors were not
restricted to citizens of the United States, then the market value could fall to less than $1,000 [30]. This may not
be a large enough incentive for Mr Cranfords friends, but $1,000 could go a long way in China and India. In
addition, if this is the only way for the individual to escape poverty, it is not clear how our protection helps
them. The same arguments regarding the opportunity to escape poverty should hold true for citizens in the
United States who are poor and for poor citizens of China and India.(pg. 11)
Page 115 of 174
Con: Futures market
Futures Market
Explanation of a futures market. SBH.
Morelli, Maria N. Organ Trafficking: Legislative Proposals to Protect
Minors. American University Journal of International Law and Policy 10 (1995):
917-54.
A futures market allows people to contract during their lifetime for the post-mortem removal of any or all of
their organs." As compensation for donating organs, a donor may earn cash money," tax deductions,"
preferential access to organs for the donor's family,'67 a discount on health insurance,' or a survivor's
pension/insurance to the donor's family.'69 Although some fear that a potential criminal market may seek to
make a profit by murdering contracted donors,' two discussed precautions should effectively bar this
consequence. First, if the donor elects post-mortem compensation, then the future donor must name a
beneficiary' to ensure that only the designated beneficiary will receive compensation from the fulfilled
contract." Second, to execute the contract, the donor must die in a hospital where organ harvesting can take
place." To pacify fears of economic exploitation of the poor, individuals may opt out of the contract and forego
future compensation.(pg. 1)
This can function as evidence to read in the NR if the 1AR seriously questions the validity of a futures
market. It also functions as an answer to an argument that says that a criminal market would cause
murders of donor contractors.
A futures market does not allow the rich to exploit the poor. SBH.
Lloyd R. Cohen. Increasing the Supply of Transplant Organs: The Virtues of a Futures
Market November 1989. The George Washington Law Review. Vol 58. No. 1
The answer to the first wealth-based objection is that by only harvesting organs from the dead exploitation of
the poor is precluded.'" For in the cadaver market the vendors are neither rich nor poor merely dead. No one
will be forced by the desperation of poverty t o sacrifice their dignity or health, or undergo great suffering. At
present organ donors are more likely to be rich, white, and well-educated."' If donation of one's organs is not
now considered an indignity when undertaken by the rich, why would it become so for the poor merely because
they receive payment for the organs?(pg. 1)
This functions as an answer to the argument that a futures market would prioritize the rich and exploit
the poor.
Page 116 of 174
Con: Futures market
There arent organ allocation issues because organs go to the buyer not the most in need.
SBH.
The answer to the second objection is that the proposal speaks only to the question of organ acquisition, not
organ allocation. The organs can be acquired by a government agency or licensee and then allocated according
to any conceivable criteria. Though there will be an efficiency loss in not using a market to allocate the organs,
it should be considerably less for organs than for other goods and services. The demand for transplant organs is
highly inelastic at low prices. While 10% erring the price of edible chicken livers to zero will induce many
people who d o not really care for liver to acquire and consume more, lowering the price of human livers for
transplantation to zero will not induce a healthy person to replace his liver or acquire an additional one for good
measure. Another important function of a cash market for a heterogeneous good, like human livers, is to enable
a sorting out based on the particular characteristics of each liver and each recipient (tissue matching). When the
market for other heterogeneous goods is not permitted to operate freely, such as the housing market under rent
control, efficient sorting and matching often does not take place. The man in Brooklvn who would prefer to
move to Manhattan, and the woman in Manhattan who would prefer to move to Brooklyn retain apartments that
do not serve their needs very well because there is no mechanism by which they can exchange them for others.
While it is conceivable that the failure to use price to allocate transplant organs could generate a similar
problem, there is no evidence of a severe misallocation problem under the current regime. Indeed rather than
too little weight being given to matching organs with potential recipients and all organs being allocated
regardless of whether or not there is a good match, some critics claim that there is a severe was rage of organs
because of The inability to find a suitable match for the decedent's organs when such matches are available."
This may be the result of the market only being driven at one end. Only those who seek organs have an
incentive to search those who have custody of cadavers do not. I am optimistic that in conjunction with a futures
market for acquiring organs, something like the current method of allocation would still do a reasonable, albeit
imperfect job of assigning organs to highly compatible recipients.(pg. 1)
This answers arguments about allocation issues.
Page 117 of 174
Con: Futures market
There is no issue with selling what is not yours because you signed a contract to sell your
organs in the future. SBH.
The third moral objection, sale of what is not yours to sell, is more serious because it is more deeply and
universally held than base concerns about wealth distribution. As the ancient Greeks so eloquently said the
human body is the temple of the soul. When the soul departs religious fealty reflecting a symbolic awareness of
the significance of the event requires that those with custody of the body dispose of it with all the dignity
consistent with its former exalted role.'' Thev can donate the organs. but because they have custody and not title
they ma\-not sell it.'"' Some might suggests a solution to the organ shortage reforming the law to permit the
heirs of the decedent to sell his organs on the open market.!'; Such a solution is unsatisfactory not merely
because it would face enormous difficulty in gaining legislative approval, but more importantly because it is
highly unlikely to result in a substantial increase in the quantity of organs supplied.
The motivation for the legal prohibition is a widely felt religious and ethical repugnance at the thought of
mothers treating their sons' livers as a commodity!' Mothers of young men killed in motorcycle accidents are
likely to share in this ethical proscription at least as strong&-as the rest of society. Regardless of what property
rights in cadavers the law purportedly granted to the next of kin, few mothers will sell their sons- livers.
The solution to the problem of finding a morally acceptable means of substantially increasing the number of
organs supplied for transplantation is the creation of a futures market in which individuals sell their own organs
for deliver at death. There is a long history of the legal and widespread sale by people of their blood, semen,
hair, and saliva. Unlike our mother, you do have a moral claim to a property right in your body and therefore
may sell parts of it. (pg. 1)
This answer the moral objection of the sale of what is not yours which is an issue with multiple other
counterplans with incentives.
Page 118 of 174
Con: Futures market
How a futures market works. SBH.

Although it-is possible to conceive of the occasional severely injured person moments before his death
prospectively and intentionally selling his liver, kidneys, etc., this is hardly a satisfactory solution in the general
case. Given the emotional and physical agony of the vendor discussing such matters would be unseemly and in
most cases the soon to be deceased will be incapable of expressing his desire. The major organs of those who
die of disease are usually unsuitable for transplantation. T h e best organs corn, from victims of traumatic head
injuries and cerebral hemorrhage.?' By the time these people arrive at the hospital they are usually in state of
permanent unconsciousness. The futures market therefore requires that the decedent make a prospective
contingent sale of his own organs at a time when he is in good health.
In its appearance. the proposed market would be but a slight variation on the current system of contingent organ
donation. People could be offered the opportunity to sign organ sales contracts when they receive their driver's
licenses, buy insurance, stand on street corners, or are solicited through the mail. The only substantial difference
from the current system is that the vendor will be promised, remuneration in return. Pertinent information, such
as name, Sex, date of birth, social security number, beneficiary, and limitations on which organs may be
harvested, would be placed in a computer file that could be accessed by telephone. In that respect it would
function much like the National Organ Procurement and Transplantation Network.'(pg. 1)
A futures market proves the best, robust solution to the organ shortage problem. SBH.
-A futures market is a robust solution to the organ shortage problem. So not only does it directly attack the
problem of insufficient incentives for people to donate and for their nest of kin to acquiesce, it also indirectly
and powerfully attacks the more pressing problem of providing incentives for hospitals and medical
professionals to facilitate the process. It is like clearing a clogged pipe with a constant high pressure blast of
water rather than replacing the suspected clogged section. Wherever the blockage, now or in the future, the
financial incentive will flush it out. Whether the problem is people's reluctance to confront their own mortality,
relatives' reluctance to authorize the dismemberment of their loved ones, donators' reluctance to harvest organs
without the approval of relatives, or hospitals' reluctance to establish appropriate procedures the creation and
legal enforcement of property rights in the decedent's body will bring all the incentives into line. (pg. 1)
Page 119 of 174
Con: Futures market
Example of how much money would be given for an organ. SBH.

HOW large a fee will be paid to the decedent's estate for the harvested organs? This could either be left to the
market or imposed legislatively. If the former, price will .be determined at the point where the supply and
demand curves cross. If the latter, it must be a politically acceptable price. in the sense that it is generous
enough to bring to the market those who are in the relatively price elastic portion of the supply curve, and yet
not so generous as to seriously increase the cost of organ transplantation. I doubt that there would be much
difference between the outcomes of the market and a reasonable political process. What might that outcome be?
Acknowledging that we are reasoning in the dark and this is but the bare outline of a proposal, I will offer some
ballpark estimates: $5000 for each major organ such as the liver, kidney, or heart, and substantially lesser
amounts for other tissue such as blood, pituitary glands, skin, bone marrow, and corneas.(pg. 1)
There would not be a significant increase in cost of organ donation and transplants to the
buyer or seller. SBH.
While $5000 per organ may seem like a small fortune to many potential donors. it would be only a trivial
addition to the costs of transplant. The one-year cost for a liver transplant is $230,000 to $340,000 and for a
heart transplant is $170,000 to $200,000. Five thousand dollars plus additional administrative costs of perhaps
$1000 for each heart would represent a small fraction of the total 'cost of the transplant operation and further
treatment expenses.(pg. 1)
This answers the argument that a futures market will increase the cost of transplants drastically.
Page 120 of 174
Con: Futures market
A futures market is cheaper than the alternatives. SBH.

In addition to being effective, robust, and morally acceptable such an organ market would be efficient: that is, it
would both generate more organs and cost less than the alternatives. What would it cost? While it could be
naive and erroneous, particularly in this case, to treat cost as synonymous with budgetary expenditures, let us
begin there. If as many as 20,000 cadavers are harvested each year at an average payment to the estate of
$15,000 plus another $2000 for administrative costs unique to a futures market, the entire expenditure will be
$340,000,000 per year. That figure, however, greatly overstates the social costs. If the same amount of money
were spent each year in some alternative attempt to increase organ donation, such as by educating and
informing the public and the medical profession, it would entail the consumption of real resources equal to the
entire expenditure, and thus represent a true social cost. When it is paid to the estate of the decedent, in contrast
only the marginal person will have exhausted totally his expected payment as a compensation for enduring the
psychological pain of thinking about and acknowledging his mortality. The total of these psychological costs for
all those switching on to the plan will depend on the elasticity of the supply curve of cadaver sales and is likely
to be considerably less than the S300.000,000 portion of the expenditure that goes to the decedents' estates. This
of course assumes that the psychological cost of confronting one's own mortality should be treated as a social
cost.'" If not, then arguably the entire $300.000.000 paid to the decedents' estates is a mere transfer payment
rather than a social cost. Even if some portion of the $13,000 payment to the estate is properly treated as an
opportunity cost, in that it compensates the decedent for acknowledging his own mortality in this particularly
vexing fashion, all payments above the opportunity costs are a mere transfer payment or producer's surplus.
Thus the remuneration could be increased tenfold to $50,000 per major organ or more without increasing the
social cost.(pg. 1)
This could function as either an answer to the argument that its expensive or function as a net benefit to
a counterplan saying that its more efficient and saves the government money.
Page 121 of 174
Con: Public support
Public Support
In some countries presumed consent has been a disaster and strongly publically opposed.
CFS
2000 Article 4.
Other countries have not had similar success with their presumed consent laws. For instance, the Brazilian
government implemented a presumed consent system in February 1997, only to abolish it one year later, citing
widespread public fear and criticism. In the United Kingdom, heated public debate followed the British Medical
Association's ("BMA") 1999 resolution to change its longstanding policy of rejecting presumed consent. Critics
labeled the BMA's proposed opt-out system "body snatching" and warned that it would violate human rights
standards and demean people's dignity. Because of the lack of public support, the government eventually
rejected the proposal.
Page 122 of 174
Con: Autonomy
Autonomy
Peoples bodies are used as a means to anothers ends violation their autonomy. SBH.
Veatch, Robert M. (Professor of Medical Ethics at the Kennedy Institute of Ethics) and
Pitt, Jonathan B. (Adjunct Professor of Law, Georgetown Law School) The Myth
of Presumed Consent: Ethical Problems in New Organ Procurement Strategies.
Transplantation Ethics. Georgetown University Press, 2000. Print.
To presume consent is to make an empirical claim. It is to claim that people would consent if asked, or, perhaps
more precisely, that they would consent to a policy of taking organs without explicit permission. The reasoning
behind true presumed consent laws is that it is legitimate to take organs without explicit consent because those
from whom the organs are taken would have agreed had they been asked when they were competent to respond.
That, however, is a claim that, if it is to be made with authority, must be corroborated with empirical evidence.
Social survey evidence makes clear that if we assume people would agree to having their organs procured if
they were asked, we would be wrong something like 30-50 percent of the time. A 1993 Gallup poll shows that
only 37 percent of Americans are very likely to want their organs transplanted after their death, and only 32
percent are somewhat likely. Furthermore, only 55 percent are willing to grant formal permission for organ
removal. It should also be noted that although 55 percent are willing to grant permission, only 28 percent have
actually done so. In other words, only about half of the Americans who are willing to grant permission have
taken the proactive steps necessary to do so, creating a large number of false negatives. We might expect that if
the United Statess were an opting-out system, we might also see a large number of false-positives. Based even
on the larger figure of 69 percent who would either be very likely or somewhat likely to want their organs
to be transplanted, it is clear that there can be no basis for presuming consent. Claiming such a presumption is
an ill-informed notion at best; it is an outright deception at worst.(pg. 1)
Page 123 of 174
Con: Autonomy
Presumed consent leads to a loss of autonomy and mistrust in health care systems globally.
SBH.
Veronica English and Linda Wright Presumed Consent the Answer to Organ
Shortages? May 26, 2007, British Medical Journal, August 15, 2014
Presumed consent refers to laws that permit the procurement of organs without explicit permission. The term is
used widely in discussion of systems of opting in or opting out of organ donation. The US Institute of
Medicine is concerned that the introduction of presumed consent without the appropriate public support
could reduce donation rates in countries where autonomy is highly prized, such as North America.4 People
may be more likely to donate when they feel they retain control of that decision rather than the law
dictating that donation should take place. Brazil had to withdraw its system of presumed consent because
it aggravated mistrust in the health care system.4(pg. 1)
This argument could be an argument that has a good impact to an NC that says that opt-out systems
violate autonomy. It also can turn back the common affirmative utilitarian arguments by proving that a
lack of autonomy increases resentment for the government and a decrease of respect for the government.
Page 124 of 174
Pro Counters
Page 125 of 174
Pro Counters: Autonomy violations
AT - Autonomy Violations
Presumed consent and express consent both make assumptions about the choice of the
deceased. The only difference is an operational one. But, since the majority of
populations say they would want to give up their organs, presumed consent is the better
of the two options. SBH.
Cohen, Carl. "The Case for Presumed Consent to Transplant Human Organs After
Death." Transplantation Proceedings 24.5 (1992): 2168-172. Http://carl-cohen.org.
1992. Web. 17 Aug. 2014. <http://carl-cohen.org/docs/The Case for Presumed
Consent.pdf>.
A second moral objection rests upon what is claimed to be a critical difference between consenting and not
objecting. If we rely upon express consent we realize autonomy (this critic holds), but if we rely only upon the
absence of objection we may fail to do so. Hence a procurement system built upon express consent is always
morally sound even if clumsy, while one built upon the presumption of consent could not be reliably sound
even if it were expeditious.
Wrong. There is a difference between express consent and not objecting, but that difference cannot guide
us in a moral choice between the one presumption and the other. If persons do in reality object to the use
of their organs (but never register that objection) a system that requires express consent will protect his
autonomy more surely than the revised system here defended. But with the presumption reversed. the
very same point can be made in reverse: if one does in reality consent to the use of ones organs (as most
of us do, although never registering that consent) a system that presumes consent will protect his
autonomy more surely than the present system can.
The difference in focus here is that between positive acts (expressly consenting or expressly refusing
consent) and negative acts (refraining from refusing or refraining from consenting). This is an operational
difference, not a moral one. It can have moral consequences, but the merit of proceeding in the one way or the
other depends largely upon what we believe to be the general inclination of those about whom one of those
presumptions must be made. If we knew that only I or 2 persons in 10 would autonomously donate their organs,
a system that presumed consent, protecting 10% automatically but obliging the other 90% to register their
objections to make their will effective, would be unfair. But if we have good reasons to believe that 7 or 8 of 10
or even 6 of 10, would in fact choose to donate their own organs for lifesaving uses after death. a system that
presumes the absence of consent (what we have now) similarly protects a minority and obliges the majority to
register their views expressly, and it is then unfair.
Page 126 of 174
Whether we require consent to be expressed or require refusal to be expressed should depend upon what we
believe the majority would have done in fact. if all had registered their views. We may presume one way. Or
presume the other but presume we must. Either way we place a heavier load upon those for whom the
presumption made is incorrect. Moral principles by themselves give no indication which presumption is the
fairer. Acting justly requires respect for the autonomous judgments people would actually have made, or (if we
are unsure of that) what we may most reasonably suppose they would have made. That reasonable supposition
we can reliably make. Therefore presuming that consent would have been given is in fact fairer. more protective
and more likely to realize autonomy than presuming (as we do now) that it would not have been given.(pg.
2172)
This argument functions as a non-unique to negative positions that argue that opt-in systems violate
autonomy because each system has a choice. The only real difference is operational, not moral.
Presumed consent is the better system to ensure autonomy is protected. It presumes consent,
something that a rational person would chose and what the majority of society agree
with. SBH.
Cohen, Carl. "The Case for Presumed Consent to Transplant Human Organs After
Death." Transplantation Proceedings 24.5 (1992): 2168-172. Http://carl-cohen.org.
1992. Web. 17 Aug. 2014. <http://carl-cohen.org/docs/The Case for Presumed
Consent.pdf>.
That is the form of what we do now, but the present substance is problematic. We presume now for all persons
that there was a will not to donate: then under some circumstances we seek express consent to do what we had
presumed would not have been wanted. That express consent we most often seek from the family of the
decedent, there being no other resource.
The consequences of presuming in this pattern are often gravely unfortunate: familial distress is commonly
caused by the mere request for consent, and the refusal of it often results in the loss of human lives that might
otherwise have been saved. But in addition to its unfortunate results, the present system is wrong, wrong
because it undermines in practice the very principle upon which it was supposed to have been built. As it must,
it incorporates into law and practice a presumption about what people generally want to happen to the organs of
their bodies after death, but the presumption thus incorporated is one now known to be inconsistent with the
actual wishes of most persons. At least, of most persons in these times in the United States. We honestly aim to
protect autonomy, but by our current practice we commonly vitiate it.
The majority of people now heartily support the concept of organ donation. Most persons, when asked,
express without qualification their willingness to donate their own organs after death. As early as I968,
support in the United States for organ transplantation from cadavers was shown to be strong and widespread.
Page 127 of 174
By I975, still an early date from the perspective of organ transplantation, a majority of those even in rural and
relatively unsophisticated areas expressed positive support for organ transplantation. In regions more
sophisticated. in Los Angeles County. for example. and in Houston." those supporting organ donation (even
back in I975) were more than three fourths of the whole. In Liverpool in I979 that figure was 93%."
Some who support transplantation are nevertheless un-easy with the vision of the donation of their own organs.
Every person conscious of his own will has some difficulty in picturing his own death. But what most
Americans would say in their most rational moments, and (if they were in a position to be asked) would
most likely say about the lifesaving uses of their own bodily remains, is clear: Yes, our organs may be
used by others, if this will save lives, the present system. Depending entirely upon the express consent of the
decedents family after death. Thus errs in its empirical underpinning, and by that error promotes a great moral
mistake.
All too frequently the spouses and children of dying patients respond negatively to the request for donation. But
families are thus being obliged to answer a question terrible, at the moment it is being asked, for the very reason
it must then be asked. And they are being asked at that moment to override what is widely presumed. Under
such circumstances the responses of families often do not reliably reflect the autonomous wishes of decedents.
We ask the wrong persons, at the worst possible times. What they should never have been asked at all.
As a matter of morality, our weightiest obligation here is to decedents, about whose wishes we (usually) must
make some presumption. To best realize their autonomy we should presume what we have strong empirical
reason to believe was in fact their wish, that if their organs might be used to save another life, they ought to be
so used.
Presuming general consent to organ donation is therefore the right thing to do: that is the chief reason.
and a very powerful reason. to turn the present system right side up. At the moral core of this matter lies
autonomy. Of which consent in the disposition of one's body is one manifestation: presuming consent for
beneficent transplantation of organs is the best, imperfect but still the best, realization of autonomy in
any population like ours that strongly favors the donation of cadaveric organs.(pg. 2169)
In either an opt-in or an opt-out system, autonomy is violated. The best system that minimizes those
violations is an opt-out system because its more probably in line with a rational persons decisions. This
can function either as offense under an affirmative position that argues that we ought to protect
autonomy or a turn to a negative position that argues that opt-out systems violate autonomy.
Page 128 of 174
Presumed consent may better educate the patient. LZ.

Presumed consent may increase the likelihood that decisions about donation are voluntary and informed. Since
the decision to object to donation would be made voluntarily by the patient or the family (depending on how the
presumed consent system were designed), the decision could be made at a time when the decisionmakers were
not confronting their own or their loved one's death. It therefore might be more deliberative and dispassionate
than a decision under required request.
If the decision is made in an emotional time, then the decision is unlikely to rational and autonomous. A
system of presumed consent would not fall prey to that problem.
A system of presumed consent prevents the family from overriding the autonomous choices of
the individual. LZ.
Presumed consent also may enhance patient autonomy. Under required request, the ultimate decision to donate
typically is made by the patient's family, rather than by the patient. Even in the infrequent case in which the
patient had signed a donor card or otherwise expressed a desire to donate, surgeons are unlikely to remove
organs unless the family has given permission. When the family disagrees with the patient's disposition,
required request therefore may frustrate the patient's actual wishes.
Depending on how it was implemented, presumed consent might reduce the ability of the family to override the
decedent. The family might be given no right to object when the patient, assuming he or she was competent, had
not refused donation. More likely, the role of the family might be limited, at least nominally, to expressing what
they believed to be the patient's desires rather than their own.
Since another type of system allows the family to intervene, it overrides the autonomous choices of the
patient. Using presumed consent ensures that the patient gets to decide what happens to his or her body.
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Presumed consent helps overcome psychological barriers when choosing. LZ.

Although it is commonly believed that the public is opposed to presumed consent, some commentators argue
that most people in fact are favorable or indifferent and simply cannot admit it or act upon it. In support, these
commentators cite the fact that far more people state that they are willing to donate their organs than fill out
donor cards. This suggests that people are in favor of donation in the abstract, but that psychological factors
involved in contemplating their own deaths, or those of their loved ones, make them unable to articulate their
true wishes. By eliminating the need to confront donation actively in order to donate, presumed consent might
overcome these psychological impediments and allow individuals to give effect to their true beliefs.
Before leaving the subject of why presumed consent might be beneficial, it is worth pointing out that, while it is
important to attempt to create a donation system that is more humane, in which decision-making is more
autonomous and informed, and that is more consistent with underlying personal beliefs, the chief purpose of
presumed consent is to increase the supply of donor organs. Therefore, even if presumed consent did not
provide any of these secondary benefits, it still might be preferred to existing approaches so long as it yielded a
significantly greater number of transplant organs.
If psychological barriers hinder people from making educated choices, then people arent actually
exercising their autonomy. A system of presumed consent would help people make the choices they
actually want to make.
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As long as a system of education existed, it would be consistent with individual autonomy.

LZ.
A better approach would be to educate patients and their families about how presumed consent worked and to
construct an effective opting-out method by which they can express their objections to donation. In this way, a
presumed consent system can be consistent with the ethical objectives of achieving individual autonomy and
respecting the decedent and the wishes of the family, at the same time that it increased the supply of transplant
organs by avoiding the need for express consent.
If people are informed about this system and have ample ability to opt-out, then it doesnt violate
individual autonomy.
Bodily autonomy is violated in both an opt-in and an opt-out system making the violations
non-unique. SBH.
Marie-Andree Jacob On Silencing and Slicing: Presumed Consent to Post-Mortem
Organ Donation in Diversified Societies 9-1-2003 Tulsa Journal of Comparative
and International Law Vo 11 Is. 1 Art. 7
The presumed consent scheme has different results for each. In the first case, A cherishes the idea of donating
her organs. When she dies, the presumed consent mechanism operates, and her wishes are technically fulfilled.
B, on her part, does not want to be a post-mortem organ donor. Because of presumed consent, and the
impossibility for her to opt-out, her body will be salvaged after her death. From the perspective of bodily
integrity, her situation can be alarming. For example, imagine that B was a homeless person. Her body was not
given much attention and care (that is, no meeting of minimal needs with respect to food, warm clothing and
adequate housing) by the State while it was functioning and alive. In other words, her bodily integrity, while she
was alive, was repeatedly violated. The irony would be that the State, as soon as death occurs, would suddenly
have not only the interest but also the presumed authority to pay close attention to Bs body (e.g. the State will
perform sophisticated procedures on her body: first, to insert a catheter through her skin, to flush her abdominal
cavity with preservation fluid and keep her organs chilled and viable for transplants; then to slice her body and
extract the wanted organs).
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Supposing an informed consent scheme (or presumed refusal) as the default rule, another two scenarios could
play out. The case of B demonstrates someone who does not want to donate, could not express it anywhere, and
will, technically, have her wishes respected. As mentioned, B was voiceless during her lifetime in the State, but
at least, due to the default rule, her desires are not being frustrated at the end of her life her corporeality,
arguably her last and ultimate site of control, is lefi: intact.
Now look back at A, who wanted to donate her organs. Since she could not register as an organ donor, the
default rule of informed consent has unhappy consequences for her. One could argue that, at least, her dead
body was respected and left intact, and that the State did not dare salvage her body in the interest of others
without knowing her desires. However, this argument would bring little relief to A (or to As decedents), and
does not genuinely recognize her perspective. A profoundly wanted to give her organs. The value of
preservation of bodily integrity, while broadly shared in society, is not part of A's particular vision of the good
as much as the importance of giving her organs after death is.
The above shows how awkward and arduous, or even impossible, it is to determine a hierarchy of the
suffering that will be caused by creating a default rule of organ procurement. It shows how impossible is
the search for a lesser violation here. The argument that informed consent preserves bodily integrity
most adequately is not convincing. It is true that informed consent has been, and will remain, a safeguard
against most medical abuses on the body. However, a default rule of consent to organ procurement is as
imposing and exclusionary as presumed consent. One choice for all is maladjusted in an area where
individual empowerment is basic.
Organ procurement is a delicate area. To say the least, organ procurement default rules, as they are structured
and implemented today, are problematic. Query what can be done to make default rules less harmful, or
which default rule has simpler and easier opt-out arrangements.(pg. 274)
This answers negative positions that say an opt-out system violates bodily autonomy by proving that
bodily autonomy is violated equally in both an opt-out and opt-in system.
Page 132 of 174
Pro Counters: Control of body
AT Lose Control of Body

People shouldnt be afraid of losing control of their body because safeguards exist to protect
against that. LZ.
Danielle Hamm [ethics adviser, British Medical Association], Juliet Tizzard [deputy head
of ethics British Medical Association]. Presumed consent for organ donation. BMJ
2008; 336 doi: http://dx.doi.org/10.1136/bmj.39475.498090.80 (Published 31 January
2008)
One of the major concerns people have with a presumed consent system is that individuals will lose control over
what will happen to their body after death, and the state will take over. This is not the case. Like the current
system, under presumed consent people would retain the choice over whether or not to donate after death.
Imperative to any change in legislation would be a widespread public information campaign, which would
target sections of society that are hard to reach. Mechanisms must be in place to ensure all members of the
public are informed of their choices and can register an objection quickly and easilyfor example, through
their general practitioner, post office, or electoral registration forms. As an added safeguard, the system would
retain a role for relatives. After death, relatives would be informed that the deceased person had not opted out of
donation and, unless they objecteither because they know of an unregistered objection by the person or
because it would cause major distress to the close relativesthe donation would proceed.
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Pro Counters: Religious objections
AT Religious Objections
Most religions encourage organ donation and exceptions can be granted on religious
grounds. LZ.
Andrew D Lawson [Consultant in Pain Medicine & Anaesthesia & Medical Ethicist, Royal
Berkshire Hospital; Honorary Senior Lecturer, Medical Ethics, Imperial College,
London]. Presumed consent for organ donation in the United Kingdom. Journal of
the Intensive Care Society. Volume 9, Number 2, July 2008.
In Judaism, donating organs is an obligatory moral duty, a mitzvah chiyuvit. In Jewish Law, the position is quite
similar to the concept of presumed consent in that in the absence of any explicit direction given by the deceased,
the organs should be removed. In Israel, the objection of the family has no validity, unlike most other countries.
The position of the Roman Catholic Church is that organ donation is an act of charity and that one way of
nurturing a genuine culture of life is the donation of organs, performed in an ethically acceptable manner.
While not explicitly advocating presumed consent, Catholicism is associated with countries having presumed
consent policies. The prevailing, but not uniform, trend in Islamic writing favours organ donation. Many
Muslim scholars, drawing from the Quran (And whoever saves a life it would be, As if he had saved the life of
all the people. Quran, 5: 32) have declared that organ donation is an act of merit and in certain circumstances
can be an obligation. Such views have been supported by the Sarah Academy of the Organisation of Islamic
Conference (representing all Muslim countries) and the Grand Ulema Council of Saudi Arabia amongst others.
It is not clear whether moving to presumed consent will be acceptable. In Singapore, Muslims have been
granted exception to presumed consent on religious grounds.
As long as the opt-out system is responsive to religious objections, it is not an issue for
presumed consent. LZ.
In summary, although the extent of religious opposition may be uncertain, and although some religious groups
may be moving toward a more favorable attitude toward donation and transplantation generally, religious
concerns cannot be ignored in designing a presumed consent program. For one thing, both the orthodox Jewish
Page 134 of 174
and Japanese Shinto religions seem to be dead set against any approach that would deny the family the right to
object to donation. Educational efforts that accompanied the adoption of presumed consent therefore would
have to pay particular attention to religious groups with known objections, and the methods for opting- out
would have to be highly effective and "user-friendly." It might even be necessary for the opting-out system to
include special mechanisms for ensuring that religious objections were identified and respected. Given an
adequate opting-out system, however, religious concerns need not preclude the adoption of presumed consent.
Even if religions are dead set against any sort of organ donation, an opt out system can take into account
their objections.
Islam in the majority of cases has supported organ donation. SBH.

Oliver, Michael, Alexander Woywood, Aimun Ahmed, and Imram Saif."Organ Donation,
Transplantation and Religion." Nephrology Dialysis Transplantation. N.p., 10 Oct.
2010. Web. 21 Aug. 2014.
<http%3A%2F%2Fndt.oxfordjournals.org%2Fcontent%2Fearly%2F2010%2F10
%2F20%2Fndt.gfq628.full%23aff-1>.
Violating the human body, whether living or dead, is forbidden in Islam. However, altruism is also an
important principle of Islam, and saving a life is placed very highly in the QuranWhosoever saves the
life of one person it would be as if he saved the life of all mankind (chapter 5:32). In this dilemma, the
principle that reconciles the two is necessity overrides prohibition (al-darurat tubih al-mahzurat). This
principle has been used previously to approve the use of pork insulin and porcine bone grafts [6]. In a
formal decision in 1996, the UK Muslim Law Council issued an Ijtihad (religious ruling) that organ
transplantation is entirely in keeping with Islam [7]. Accordingly, Muslims in the UK may carry donor
cards, and live donation is seen as an act of merit. Previously, the Islamic Jurisprudence Assembly Council in
Saudi Arabia approved deceased and live donation in a landmark decision in 1988 [7]. Similar formal rulings
are in place in, among others, Egypt, Iran [8] and Pakistan.
However, although internationally most Islamic scholars endorse organ donation, many individuals within the
faith are still reluctant, particularly regarding deceased donation. Thus, most transplants in many predominantly
Muslim countries are still live donations. In Iran, deceased donation amounted to only just 13% of renal
transplants performed in 2006 [8]. In Turkey, Saudi Arabia and Kuwait, the numbers are ~ 25% [8]. It is,
however, premature to conclude that all of the differences in deceased and live donation activities are
necessarily due to religious factors alone, as logistical problems may play a major role as well.
One explanation for these observations is the fact that Islam, as all religions, is not monolithic. Of note, there
appears to be some discrepancy between Indo-Asian and Arab Muslim scholars in that the former are often less
approving of organ donation [9]. Singapore may serve as an extreme example in that a countrywide presumed
Page 135 of 174
consent system is in operation, but Muslims are automatically exempt [10]. Various reasons are given for the
ongoing scepticism, including the thought that the human body is entrusted to man and not for man to interfere
with at leisure. The concept and definition of brain stem death are also controversial as described elsewhere
[11]. Muslim burial customs deserve consideration as well: it is traditional for Muslims to be buried within 24 h,
and a lengthy organ retrieval procedure may raise concerns [12]. It is also noteworthy that religious concerns
play a role even among Muslim physicians. A survey in 2005 in Turkey showed that as many as 21% of doctors
cited religious concerns as a reason not to be more proactive about organ donation [13]. Efforts to promote
organ donation may therefore have to include Muslim physicians as well.
Due to these ongoing uncertainties, Muslims may seek the advice of their local imam, and ultimately, the
decision/advice of this scholar is respected. A recent review of 70 contemporary fatwas confirmed some degree
of heterogeneity, although all supported transplantation [14]. It is therefore vital that education in organ
donation be targeted at those individuals who are most influential within a community. A recent study from Iran
suggested that Ramadan with its emphasis on altruism may be a good opportunity to foster organ donation
among Muslims and described an increase of organ donation cards in that period [15].(pg. 1)
This evidence gives preempts to many answers including arguments about how many Muslims look to the
advice of their local imam for guidance on the question of whether to get an organ donation.
The majority of Christians endorse organ transplantation. SBH.

Oliver, Michael, Alexander Woywood, Aimun Ahmed, and Imram Saif. "Organ
Donation, Transplantation and Religion." Nephrology Dialysis Transplantation.
N.p., 10 Oct. 2010. Web. 21 Aug. 2014.
<http://ndt.oxfordjournals.org/content/early/2010/10/20/ndt.gfq628.full/aff-1>.
The Christian faith appears to generally endorse transplantation, although there are clearly different
nuances in opinion. Most Anglican, Catholic and Protestant scholars seem to agree that organ donation is
an act of selflessness and endorse transplantation. One act of support has gained particular publicity, namely
the fact that the current pope Benedict XVI has publicly announced that he carries a donor card at all
times [16]. The previous pope, John Paul II, also publicly supported organ donation, not least in the
encyclical letter Evangelium Vitae, in which he praised organ donation as a praiseworthy example of
Christian love [17]. The Church of England takes its support for organ donation even further and declared
organ donation a Christian duty in 2007 [18]. However, the church also emphasized that there were different
views as to whether an opt-in or opt-out system of consent was appropriate [18]. Another example of the
positive views of organ donation by Christianity is the 1990 joint declaration of the Catholic and Protestant
Church in Germany, which also encouraged organ donation [19]. As far as we are aware, all major protestant
denominations support organ donation or do not object, including the Pentecostal Church and Presbyterians.
The same seems to apply to the Eastern Christianity. In 2005, the head of the Greek Orthodox Church,
Page 136 of 174
Archbishop of Athens and All Greece Christodoulos announced that he and the members of the Holy Synod had
all signed organ donor forms [20]. Neither the Anabaptists, such as the Amish, nor the Brethren and Mennonite
Churches seem to have any particular views on this issue, nor any specific objections.(pg. 1)
This gives multiple historical examples of when those of the Christian faith favored organ donation and
helping others.
Jehovahs Witnesses are allowed to have organ donation so long as there is no blood
transfusion. SBH.
N.p., 10 Oct. 2010. Web. 21 Aug. 2014.
Jehovahs Witnesses are a non-Trinitarian Christian denomination, distinct from mainstream Christianity, and
deserve special consideration. The issue of transplantation in Jehovahs Witnesses is not straightforward and
compounded by the refusal of blood transfusion. This affects transfusion of full blood, platelets and plasma
[28]. Dialysis, plasma exchange, substitution of clotting factors or albumin, and erythropoetin treatment are all
allowed [28]. Some have argued that consent to rescue transfusion should be a prerequisite for transplant listing
[29]. Transplantation itself was not allowed for Jehovahs Witnesses until very recently. In fact, religious
guidance from the 1960s stated
When men of science conclude that this normal process will no longer work and they suggest removing the
organ and replacing it directly with an organ from another human, this is simply a shortcut. Those who submit
to such operations are thus living off the flesh of another human. That is cannibalistic. However, in allowing
man to eat animal flesh Jehovah God did not grant permission for humans to try to perpetuate their lives by
cannibalistically taking into their bodies human flesh, whether chewed or in the form of whole organs or body
parts taken from others. [30]
This view of transplantation was only revised in the 1980s, and contemporary guidance views the decision
for or against transplantation as an individual choice [31], under the assumption that no blood is
transplanted. Since then, small case series of kidney and kidneypancreas transplantation in Jehovahs
Witnesses have been reported [32]. Early post-operative deaths in anaemic patients, however, have been
described as well [33].(pg. 1)
Page 137 of 174
Remember, this is going to be countered by arguments about how Jehovah's Witnesses still cannot get
blood transfusions. This evidence takes that argument into account in saying that it is possible and organ
transplants have happened in the past to Jehovah's Witnesses.
Organ donations is deeply rooted in the history of Hindus. SBH.

N.p., 10 Oct. 2010. Web. 21 Aug. 2014.
Hinduism is the predominant religion in South Asia with ~ 1 billion followers. It has no founder and no
universal authority. Hindus believe in transmigration of the soul and reincarnation, whereby the deeds of an
individual in this life will eventually determine its fate in the next. Another important tenet of Hinduism is to
help those who are suffering, and Daan, or selfless giving, ranks third among its Niyamas (virtuous acts)
[36,37]. However, the physical integrity of the dead body is not seen as crucial to reincarnation of the soul:
As a person puts on new garments, giving up the old ones. The soul similarly accepts new material bodies
giving up the old and useless ones [38].
Interestingly, reports about the use of body parts to benefit others are also deeply embedded in Hindi
mythology. In fact, the earliest depiction of xenotransplantation is the case of Ganesha, one of the best known
and most widely worshipped deities in the Hindu pantheon, who is pictured with an elephant head. Various
Hindu scholars have endorsed organ donation publicly. Hasmukh Velji Shah of the World Council of Hindus
stated that
The important issue for a Hindu is that which sustains life should be accepted and promoted as Dharma
(righteous living). Organ donation is an integral part of our living. [37](pg. 1)
Page 138 of 174
Sikhism as a religion and Sikhs have a positive attitude towards organ donation. SBH.
Oliver, Michael, Alexander Woywood, Aimun Ahmed, and Imram Saif."Organ
N.p., 10 Oct. 2010. Web. 21 Aug. 2014.
Sikhism is a monotheistic religion founded in 15th Century India by Guru Nanak Dev Ji (14691538) [39]. The
word Sikh means learner, and there are no ordained priests in Sikhism; the Sikh temple (gurdwara) is in the
care of a reader (granthi), who is appointed by the community. Sikhs think religion should be practised by living
in the world and coping with lifes everyday problems. Sikhism also stresses the importance of doing good
actions [39]. Sikhs believe in life after death, and a continuous cycle of rebirth. All Sikhs, apart from stillborn
babies and infants dying within a few days of birth, are cremated [40]. In Sikhism, the physical body is not
crucial to the cycle of rebirth, as the soul of a person is eternal while the body is simply flesh. Accordingly, a
survey within a Sikh community in the UK demonstrated a generally positive attitude towards organ donation
[41].(pg.1)
The Jewish faith has multiple prohibitions against organ donation. SBH.
N.p., 10 Oct. 2010. Web. 21 Aug. 2014.
However, many Jewish scholars feel that these concerns are overridden by the urge to save lives (pikuach
nefesh). Saving a life is a fundamental value in Judaism. In fact, Jewish law demands that one should violate
almost all other commandments to save a life (except for the prohibitions of murder, idolatry and illicit sexual
relations). This guidance has been used to solicit live donation, but some have also used it in the context of
deceased donation, arguing that pikuach nefesh overrides the three prohibitions mentioned above [34]. Of
course, it is conceivable that somebody could question as to whether a kidney transplant is truly life-saving,
given that survival on dialysis is a viable alternative. Jewish scholars have already discussed a similar issue,
corneal transplantation. Although not strictly life-saving, it was felt that blindness was similar to death, and
corneal transplantation was Halachicly acceptable [34].(pg. 1)
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Pro Counters: Free market
AT Free Market
Moving to a market system exploits the poor. SBH
Smith, Jennifer M. Kidney Transplantation: Only for the Well-to-Do? Campbell Law
Review 31 (2009): 333-59.
Transplant professionals are aggressively debating overturning the ban of the sale of human organs in the
United States, which would presumably result in the rich legally purchasing organs from the poor.201 But this
would be absolute irony: If the United States over- turns the ban on the purchase and sale of human organs, as
many transplant professionals are proposing, then the group of persons who would be likely targets for selling
their organs poor people would be most likely not to financially qualify to be a kidney recipient in the
event they needed a kidney. There are a limited number of kidneys and they are being doled out to those who
can afford to maintain the life of the kidney. Health care in America must be more accessible to more people.
And as one senator in favor of passage of one of the earlier ESRD bills asked: How do we explain that the
difference between life and death is a matter of dollars?202(pg. 359)
This answers a negative position that says that we ought to allow for the sale of organs in a free market
system by proving a negative effect in that it exploits the poor since the poor sell their organs but can
never receive them due to expensive post-operation care and the price of organs.
Page 140 of 174
Pro Counters: Rights of dead
AT - Rights of the dead

Legal rights of the dead. TF
Presumed consent statutes should be considered merely social legislation for purposes of evaluating their impact
on liberty interests, and if so characterized, should meet constitutional requirements. As noted in Federal
Communications Commission v. Beach Communications, Inc., where a contested statute is, in its nature, social
or economic legislation, the means of the statute need only be rationally related to intended ends. Importantly,
the courts are not bound by the articulated reasons of the challenged statute or the reasons articulated in
legislative history. The courts will uphold a challenged statute if there is "any reasonably conceivable state of
facts that could provide a rational basis for the classification" of the statute. Statutes presuming consent to organ
donation do have a rational basis. The supply of donated organs in the United States falls far short of the
demand." Thousands of people die every year waiting for organs to be donated."' In response to the demand for
donated organs and the costs to individuals and society at large, a legislature may decide that presumed consent
is the best means to increase the organ supply. It matters not that there may be different and less invasive means
to achieve the end under a rational basis analysis, only that the means to the end are rationally related.
Argument in response to constitutional/legal rights of the deceased.
Constitutional rights end once the citizen dies. CFS

2000 Article 4.
The seminal case discussing non-property claims following presumed consent organ harvesting is State v.
Powell.'5' In each of the individual cases consolidated in Powell, a medical examiner, acting under Florida's
limited coroner release statute, removed the corneal tissue from decedents without first providing notice to or
obtaining consent from family members. In ruling on the constitutionality of the coroner release statute, the
court "beg[an] with the premise that a person's constitutional rights terminate at death."' Accordingly, the court
only addressed constitutional rights held by the decedent's next of kin.'
Page 141 of 174
Pro Counters: Preferred status
AT Preferred Status for Organ Donors CP

This is the same as paying for organs. LZ.
f
Unfortunately, this proposal has serious flaws. First, it is objectionable from an ethical perspective because it
amounts to a de facto institutionalization of payment for organs. That is to say, payment for something can
occur in various ways. Typically, in the contemporary and industrialized setting, it involves the transfer of
moneys. However, as is clear from the rulings and guidelines of taxation departments in most countries, it may
also consist in the exchange of something for a valuable consideration. Transplantation is a valuable
consideration by any persons standards. Consequently the proposal amounts to the suggestion that organs be
considered items for sale. As will become clear for the subsequent discussion, that concept is ethically
abhorrent.
Preferred status is basically the same as paying for organs and other sections in the brief demonstrate
why paying for organs is a morally abhorrent idea.
The assumption behind this claim is that people are only self-interested, but countries like
Canada disprove this. LZ.
f
Second, the proposal locates the reason for the low number of donations in the factually mistaken and morally
repugnant assumption that most Canadians are motivated by considerations of self-interest. That assumption is
demonstrably mistaken. The example of blood donation illustrates this only too well. Canada, with its
Page 142 of 174
essentially voluntary system of blood donation, does very well in comparison to countries who depend on
payment to ensure an adequate blood supply. Therefore the spirit of altruism is alive and well in Canada.
Adoption of this quid-pro-quo proposal would tend to weaken this altruistic perspective, which has been part of
the Canadian tradition for years. However, even in countries that have a sizable proportion of paid blood
donations, the vast majority of blood comes from volunteer donors who donate simply because they wish to
save a life. Ethically, a community whose actions are motivated by considerations of altruism is to be
preferred to a community whose actions are centrally based on self-interest (Titmuss, 1970).
Since countries like Canada and others have volunteer systems of blood donation that work because
people want to donate blood, it shows that people arent entirely motivated by self-interest and disproves
the assumption behind the counterplan.
This program has a high likelihood of decreasing organ availability and doesnt solve the
real problem. LZ.
f
Third, it is unclear that this proposal would be acceptable in purely practical terms. If the egoistic assumption of
the proposal were to be accepted as valid then, arguably, it would be mainly those persons who had reason to
believe that they might be in need of transplantation in the future who would donate organs in the expectation
that they would then have a preferred chance of access. In other words, instead of increasing the organ supply, it
would at best amount to a temporally dislocated re-distribution. With this, the proposal would run the very real
risk of actually resulting in a decrease in overall organ availability.
Since only people that needed organ donations would then donate, it doesnt solve anything because those
would be the same people that then receive organs. It would be nothing more than redistributing organs
to the same people.
Page 143 of 174
There is a chance that such a program will encourage unhealthy behaviors. LZ.
f
Finally, proceeding further on the egoistic hypothesis, instituting such an approach might well have a negative
effect on social attitudes towards reasonable and prudent health habits: If people are genuinely egoistically
inclined, then they could easily come to ignore warnings about the effects of smoking, drinking, sedentary or
dangerous life-styles, etc. All they would have to do is donate their organs, and they could continue their
unhealthy habits secure in the expectation that they would have priority when they needed an organ
replacement.
If the assumption behind this system is true, then people would have no incentive to remain healthy
because they could just receive organs when necessary.
This system doesnt necessarily result in any extra organs for transplantation. LZ.
Quigley, Muireann [Centre for Social Ethics and Policy/Institute for Science, Ethics, and
Innovation, School of Law, University of Manchester, Manchester, United
Kingdom]; Wright, Linda [Department of Surgery and Joint Centre for Bioethics,
University of Toronto, Toronto, Ontario, Canada]; Ravitsky, Vardit [Bioethics
Programs, Department of Social and Preventive Medicine, School of Public Health,
University of Montreal, Montreal, Quebec, Canada]. Organ Donation and Priority
Points in Israel: An Ethical Analysis. Transplantation Journal. Issue: Volume
93(10), 27 May 2012, p 970973. Copyright: 2012 Lippincott Williams & Wilkins,
Inc.
Similar concerns may be raised regarding people in certain potentially adverse health states. A person with
chronic hepatitis C, knowing that they are at increased risk of liver failure, could join the organ donor register to
secure a higher place on the waiting list should the need arise. Although it is possible that their other organs
could be transplanted after death to another person with hepatitis C (of the same viral genotype), due to the
much reduced pool of possible recipients, it is an unlikely scenario. Thus, this would not result necessarily in
any extra organs for transplantation. This seems to disadvantage others with similar medical needs, who had not
taken strategic advantage of the system.
Page 144 of 174
It may be argued that the way around this problem is to exclude those groups who are unlikely to ever
contribute to the organ pool through a system of medical testing and certification of good health. However, such
an approach presents pragmatic and ethical difficulties. First, besides the cost of testing and certification, it
might further deter people from joining the register due to the time and effort involved. Second, such a
suggestion seems to present its own problem: people most likely to need a transplant due to a foreseeable health
state would be the ones systematically disadvantaged because they would not have access to waiting list
prioritization enjoyed by those who are in good health. Thus, whether those individuals in adverse health states
were permitted to participate in the system or not, there would seem to be ethical issues that need to be
addressed.
This means that even if this system does increase the number of organ donors, it doesnt necessarily mean
more usable organs or that it helps those with real medical needs.
Page 145 of 174
Pro Counters: Removal of altruism
AT Removal of Altruism
Presumed consent facilitates rather than reduces altruistic behavior. LZ.
Ethical objections to presumed consent therefore must be based on its inability to meet one or more of the other
four objectives. The second objective is a restatement of Ramsey's defense of voluntary behavior, which was
mentioned earlier: the more the state takes away the opportunity to act voluntarily, the less of an opportunity
individuals have to be altruistic, and therefore the less virtuous our community will be. Since presumed consent
laws eliminate the need to express our willingness to donate organs, they arguably reduce our ability to act
generously.
One response to this objection is that presumed consent laws facilitate rather than reduce altruistic behavior.
This follows from the argument, described earlier, that people really want to donate their organs, or those of
their loved ones, but for psychological reasons cannot bring themselves to do so. According to this argument,
presumed consent allows people to fulfill their altruistic impulses by refraining from objecting, which is
psychologically easier for them than having to give their express consent. While altruistic action ideally might
be preferred to altruistic inaction, altruistic behavior, even of an inactive sort, is better than nonaltruistic
behavior.
This argument is absurd. People shouldnt die because of a lack of altruism. LZ.
In addition, Ramsey's position seems to lead to an absurd result. Imagine telling a patient waiting for a lifesaving transplant that he will be allowed to die just in case someone decides at the last minute to be benevolent
and to donate the needed organ. Given the fact that people have not been willing to donate enough organs under
encouraged voluntarism and required request, it is hard to accept the idea that we should avoid saving lives and
improving quality of life on the off-chance that people's behavior suddenly will change.
Page 146 of 174
Pro Counters: Removal of altruism
By helping individuals overcome psychological barriers, presumed consent can help

individuals express their actual desires. LZ.
On the other hand, presumed consent could alter the very meaning of the act of donating organs. What
used to be an altruistic act could become routine. Another label for presumed consent is, in fact, "routine
salvaging." Organ procurement could lose its solidarity component, since it would have no "donation" ethos.
Since presumed consent bets on passivity, it may be unlikely to actually encourage active altruism. Some would
say this is better than nothing, and that minor increases of altruism on the passive level helps people to help
others, which is good. Yet there is a philosophical breakdown in the theory. One of presumed consent's
underlying rationales is that it is easier to have people do nothing, rather than have them take any positive step
to reverse the presumption by registering a refusal to donate. Yet betting on passivity is qualitatively different
from presuming consent.16 The ease of smoothly targeting inactive or uninformed citizens as potential donors
has disturbing qualities: "[i]f one allows the existence of situations which easily generate donors, an illegitimate
aspect of organ removal by presumed consent arises."" The inherent desire to do things rapidly and efficiently,
and the possible manipulation of donors, is ethically troublesome, as elaborated below.
However, Maxwell Mehlman writes that presumed consent arguably "allows people to fulfill their altruistic
will by refraining from objecting, which is psychologically easier for them than having to give their
express consent."' He bases this conclusion on the fact that people "really want to donate their organs, or those
of their loved ones, but for psychological reasons cannot bring themselves to do so."' Presumed consent, "[by
eliminating the need to confront donation actively in order to donate," would help solve this uneasy and
unfortunate situation, and would finally "allow individuals to give effect to their true beliefs." The routine
arrangement of presumed consent is considered useful in light of the argument that "there is a repulsive feeling
about donating one's organs. People might find it difficult to agree to donate their organs for a number of
reasons, including the "unimaginable condition of death" and the metaphysical "conviction of our immortality.
The argument is that because fear, taboo, and superstition surround death and bodily alteration of
cadavers, we should avoid asking the disconcerting question of donation. Organ retrieval could then
occur in a more efficacious way, without confronting the psychological blocks of individuals. It is also
argued that a policy of presumed consent would erode this particular social taboo.
Since psychological barriers impede choices, a system of presumed consent that overcomes psychological
barriers actually helps people give according how they would feel otherwise. Basically, people want to be
altruistic, but they cant be because of these psychological barriers so presumed consent helps people be
altruistic.
Page 147 of 174
Pro Counters: Constitutionality
AT Constitutionality
The Fifth Amendment doesnt negate because courts dont recognize organs as property. LZ.
It is extremely unlikely that a court would declare a presumed consent law with an effective opting-out system
unconstitutional on the basis that it deprived persons of substantive property rights in violation of the fifth
amendment. Most courts have not regarded donor organs as property within the terms of the amendment.
Historically, English law conferred jurisdiction over the disposition of corpses on ecclesiastical courts rather
than on the secular authorities and their common law courts. As a consequence, English common law, which
was the source of the legal principles governing property rights in the United States, never included dead bodies
or their constituent parts within its rules. American courts followed suit, holding that neither the decedent nor
the next of kin have a property right in the body in the usual sense. Instead, family members at most have a right
to dispose of the deceased's remains, consistent with laws and government regulations on the subject. While this
right is often referred to as a "quasi-property" right, most courts have held that it does not confer upon the
family the type of property rights that are protected by fifth amendment. However, the Court of Appeals for the
Sixth Circuit recently held that families had a "substantial interest in the dead body" that was protected by due
process.
Page 148 of 174
Pro Counters: Constitutionality
Even if organs were property, a presumed consent system does not constitute taking. LZ.
Even if organs were accorded the status of constitutionally protected property, a presumed consent system
would not necessarily constitute a "taking" under the due process clause of the fifth amendment. Assuming that
the body were returned to the family in a condition suitable for burial following removal of organs for
transplantation, the family would not be deprived of its right to dispose of the body or of any of its value.
Furthermore, the opting-out system would allow the family to prevent removal of organs (assuming no contrary
indication by the decedent), so that the family's failure to exercise its opting-out rights could be deemed to be
acquiescence, rather than a taking without permission. In any event, in view of the legal prohibition against the
sale of organs, it is hard to imagine how donors or their families could receive "just compensation" under the
takings clause of the fifth amendment.
Page 149 of 174
Pro Counters: Market regulation
AT Market Regulation
Market regulation wont work just as it hasnt worked in any attempts in the status quo.
People will always search for a cheaper price. SBH.
Since the current system of altruistic organ donation has not met the demand for organs, some critics suggest
that the way to resolve this problem is to turn to a market approach that would permit the sale of human
organs.41-44 However, the ethical principle that one should not sell ones body applies whether the market is
regulated or left to the vicissitudes of capitalism.45 A system regulated by a government agency (e.g., the
Department of Health and Human Services) would probably not be the only source of organs for sale. In fact,
the futility of trying to regulate payments to donors is suggested by worldwide experience. In the current global
market, prices vary depending on the region and the social status and sex of the donor. For example, in
Bombay, India, the current price for a womans kidney is said to be $1,000; in Manila, the Philippines, the price
for a mans kidney may be closer to $2,000; and in urban Latin America, a kidney can be sold for more than
$10,000. Such are the payments allegedly made to the vendor; payments to the broker are an additional expense
that can drive the cost of the organ even higher. Payments have allegedly exceeded $200,000 for arrangements
in which the financial transaction occurred in another country and the transplantation was performed in the
United States.18
Brokering in the United States according to market criteria of donor suitability would probably be no different.
If the current prohibition against the sale of organs were rescinded, there would be little legal or ethical
justification for preventing persons from bypassing the regulated system and using other means to obtain a
better price for an organ from a more medically suitable donor. The Internet can be used to secure the best price
for any commodity. A federally regulated system would have to outlaw Internet bidding and set a controlled
price for certain types of donors or continuously modify the price.(pg. 1)
Page 150 of 174
Pro Counters: Organ matching
AT Internet Organ Matching

Its unregulated, which leads to a host of problems. SBH.
The demand for organs is causing some of the more than 98,000 citizens on the official waiting lists to seek
other means to save their lives. One such means is Internet Organ Matching. Supporters of this recent initiative
believe that it can dramatically improve the odds of finding a donor and that learning about the recipient can
motivate more people to become donors. 40 Various organizations such as LinksForLifeCampaign.com and
MatchingDonors.com have been successful in finding appropriate organ matches and saving lives.
MatchingDonor.com has caused some controversy because it charges a fee of $595 for unlimited access or
$295 per month. The founders of this website claim that the fees go toward running the Website and that if there
are special circumstances the fee can be waived. The site has over 2,000 potential donors and over 100 possible
recipients. 41 The major problem with internet organ matching is that it is totally unregulated. Donors might not
be telling the truth about their health, there could be future extortion from recipients and there is no screening
going on of their psychiatric and psychological stability to name just a few concerns. Many may be altruistic
people but there are others who may be depressed, who have a low self-esteem and who may suffer from mental
illness. 42 Other skeptics argue that it could also promote racial and religious discrimination and facilitate illegal
trafficking in organs. 43 In order to protect both donors and recipients there must be a more viable option to
increasing the supply of organs to meet the ever increasing demand. The issue set before us is whether financial
incentives for cadaveric donation are ethical. This author will argue that under respect for persons, beneficence,
nonmaleficence and justice the appropriate use of financial incentives for cadaveric organ donation is not only
ethical but medically and socially responsible.(pg. 1)
Page 151 of 174
Con Counters
Page 152 of 174
Con Counters: Donation rates
AT - Opt-Out Systems Increase Donation Rates

The difference between an opt-in and opt-out system is marginal. The real differences come
from things like differing mortality rates. SBH
Coppen, Remco, Roland D. Friele, Richard L. Marquet, and Sjef KM Gevers. "Opting-out
Systems: No Guarantee for Higher Donation Rates." Transplant International
(2005): 1275-279. Http://onlinelibrary.wiley.com. 2005. Web. 19 Aug. 2014.
http://onlinelibrary.wiley.com/store/10.1111/j.1432-2277.2005.00202.x/asset/j.14322277.2005.00202.x.pdf?v=1&t=hz33p69t&s=5f7ef39ccdfa8d12b258b361d662445491
3405f1.
Results
The relationship between the average donation rate and the relevant mortality for organ donation is shown in
Fig. 1.
There is a strong correlation between the donation rates and the mortality rates which are relevant for organ
donation [Spearmans q 14 0.81 (P < 0.01)]. Countries with low donation rates usually have low mortality rates
relevant for organ donation, while countries with high donation rates have high relevant mortality rates.
To determine the influence of other factors on the difference in the donation rates, these rates should be
corrected for the differences in mortality rates. Only after this correction is it possible to ascertain any influence
of factors other than mortality. The donor efficiency rate reflects the number of organ donors as a percentage of
the mortality for organ donation. Figure 2 shows that countries with an opting-in system vary in their donor
efficiency rate. This variability is also found in the countries with an opting-out system, which indicates that
there is no correlation between consent systems and organ donation rates. This finding is confirmed by the ttest. According to the results of this test, there is no relation between the different systems and the efficiency
rates. In other words, when donation rates are controlled for differences in relevant mortality there is no
significant influence of the systems on these rates.
Discussion
Our analysis indicates that the apparent relationship between consent systems and organ donation rates
disappears after controlling for difference in relevant mortality.
Gevers et al. have shown that countries may differ in their laws concerning consent systems, but in
practice differences turn out to be much smaller. In their analysis of the national transplantation laws,
and interviews with several contacts in these countries, they have shown that relatives always seem to
Page 153 of 174
Con Counters: Donation rates
play a certain role in the opting-out systems and that in practice these systems do not always work strictly
as such.(pg. 1277)
This answers arguments about how the opt-out system increases organ donation. This could be coupled
with a counterplan to show that real results in organ donation numbers come from the policies enacted,
not the systems.
Presumed consent does not increase donation rates. CFS

Johns Hopkins Medicine "Presumed Consent Not Answer to Solving Organ Shortage in U.S.,
Researchers Say" November 29, 2011.
http://www.hopkinsmedicine.org/news/media/releases/presumed_consent_not_ans
wer_to_solving_organ_shortage_in_us_researchers_say
Segev and his team conducted in-depth interviews with transplant experts in 13 European nations with
presumed consent legislation. They found that, despite the laws, the process of organ donation in those
countries does not differ dramatically from the process in countries, such as the United States, that require
explicit consent. They also found that the United States ranked third among the nations surveyed in rates of
organ donation from the deceased, with 26.3 deceased donors per million population. Only Spain (34.1) and
Portugal (26.7) did better. It does not appear that by simply having presumed consent legislation on the books
that donation rates will rise, says Brian J. Boyarsky, the Hopkins researcher who conducted the interviews.

It would be a poor use of the United States resources to implement presumed consent. CFS
Johns Hopkins Medicine "Presumed Consent Not Answer to Solving Organ Shortage in U.S.,
Researchers Say" November 29, 2011.
http://www.hopkinsmedicine.org/news/media/releases/presumed_consent_not_ans
wer_to_solving_organ_shortage_in_us_researchers_say
Implementing presumed consent legislation, Segev argues, would take a huge amount of time and energy with
minimal payoff. Many countries with presumed consent have much lower rates of organ donation than the
United States, he notes. Segev says there are still lessons to learn from countries like Spain, whose donation rate
far surpasses the United States. In Spain, there are dedicated physicians at every hospital who are
knowledgeable about transplant issues and who screen for potential donors, manage their care and approach
families. He believes these dedicated physicians are a key reason why Spain has a higher rate of donation, not
the mere existence of presumed consent. We need to foster more awareness of transplantation and transplant
issues to procure more organs for lifesaving transplants rather than force people to donate their relatives organs
if they fail to opt-out before death, he says.
Page 154 of 174
Con Counters: Selling immoral
AT - Selling body parts immoral

Selling body parts has historical and empirical roots TF
Donations
Proposals to pay for organs, even from cadavers, have been sharply criticized on several grounds. One of the
most common is that payment is immoral because it involves the commodification of body parts.
Individuals who make this argument deny that people have the right to control the use of their bodies. If women
can get paid to host the eggs of other women and bear their children- as they can in the United States -why
cannot men and women get paid for selling their organs to save the lives of others? Surely, the moral
considerations involved in allowing pay for organs that save lives are no weaker, and for many persons would
be stronger, than those involved in allowing pay for the use of wombs to create lives. Table 5 considers the most
important arguments that have been advanced against payment for organs by comparing that system with issues
raised by a voluntary army. The first row and first column discuss the claim that monetary payments for organs
is undesirable because that involves commodification of body parts. But the voluntary army used by the United
States and many other nations allows the commodification of the whole body since volunteers expose
themselves to injury and death if they are sent into conflict. Not only has the voluntary army been considered a
success in the United States, but several European nations- such as France- that originally favored the draft have
been shifting to a voluntary army.
Uses historical logic to justify why incentivizing selling is not immoral.
Page 155 of 174
Con Counters: Target poor
AT - Organ market would target the poor as donors

Turn, organ markets would actually target those in middle to upper class TF
Donations
This argument was also made against the voluntary army, that it would become an army of the poor. However,
it did not quite work out that way. The very poorest often cannot qualify for the armed forces because they have
insufficient education, low test scores, may use drugs, and so forth. Similarly, the organs of poor individuals
who use drugs, or have aids, hepatitis, or other serious illnesses would be rejected as posing too large a risk to
recipients. So probably the healthy poor and middle classes would actually provide most of the organs for live
transplants under a market incentive system. Of course, a quota could be placed on the number of organs from
poor individuals, but is that desirable? It is also claimed that payment for organ donations from living
individuals would encourage impulsive and reckless provision of organs, partly because donors would not be
able to sufficiently calculate the risks involved. If impulsive donations were a problem, a few weeks cooling off
period could be required to give donors sufficient time to change their minds.
Preempts AFF argument that legal market would target poor.
Page 156 of 174
Con Counters: Utilitarianism
AT - Utilitarianism justifies mandatory organ

procurement
Utilitarianism works for the con respect for autonomy considered TF
Doctrine
The problem, of course, is that utilitarianism conflicts with the strictest respect for persons. Utilitarian principles
may justify intrusions into persons entailing pain, harm, or suffering-or, simply, their use as a means to others'
utility, thus prima facie violating their character as autonomous, dignified beings. Accepting a utilitarian
standard to justify intrusions directed against incompetents will facilitate extending a balancing approach to
marginally compelling situations, perhaps even where the person subject to the intrusion is capable of
withholding consent. Given, however, that enormous benefits may flow from such nonconsensual intrusions,
one may argue that maintaining respect for persons is an exercise in moral form over moral substance. Direct
and tangible suffering, even death, may result from strict refusal to allow intrusions which will not benefit the
incompetent. Moreover, the costs to the incompetent will often appear slight, insubstantial, or merely statistical,
and considerably less than the benefits realized by the beneficiaries of departures from the rule of respect.
Perhaps abstract moral principles should jealously be guarded. But the price of maintaining respect in many
situations, measured by the suffering not alleviated, will often seem exorbitant.
Use this card with other consequentialist labeled cards in the NEG brief.
Page 157 of 174
Con Counters: Public opinion
AT - Public Opinion
Public support should not be a deciding factor in organ procurement policy. CFS
2000 Article 4.
It is also important to remember that the United States currently employs an opt-in organ procurement system,
under which people generally record, or otherwise make known, their decision to donate organs. Thus, unlike
the European presumed consent or optout systems, a person is under no obligation to register an organ donation
objection. Moreover, the European models show that true opt-out systems require widespread public education
and motivation to ensure a general understanding of the consequences of inaction; no such protections are in
place in the United States. Finally, the fact that most Americans claim to support organ donation is irrelevant
when analyzing presumed consent, for, as John Stuart Mill notes, laws based on public opinion are quite likely
to be wrong when applied to the individual. Therefore, there is not necessarily a correlation between strong
public support and personal choice
Page 158 of 174
Cases
Page 159 of 174
Aff Case
Affirmative Case
Introduction:
Every day, 18 people die waiting for an organ transplant. That number represents moms, dads, children, loved
ones.
Because of the preventable lives lost, I affirm: Resolved: A just society ought to presume consent for organ
procurement from the deceased.
Observation 1. The resolution uses the phrase just society, but a truly just society cannot and does not exist.
While some might argue the US is just, the US still engages in actions that others deem unjust. Rather debate
about how a just society exists, we ought to debate with the assumption that if a just society existed, it would
presume consent for organ procurement from the deceased or not.
I offer the following definitions for a fair debate:
James Prottas4 explains what the presumed consent approach is in terms of organ procurement from the
deceased.
[In
a] presumed-consent approach. In a nation where such a law exists, in France, for example, a physician may remove an organ from
a cadaver if the deceased has not previously left instructions forbidding organ donation. The wishes of the
decedent's family have no legal force (Farfor 1977).
There are two archetypal approaches to defining, in law, the rights of the deceased and his family with regard to organ procurement. At one extreme is the "pure"
Because the resolution asks what a just society ought to do, I value justice defined as giving each their due. The
actor of a just society is the government because a governmental actor is the one that can enact policy changes
such as switching to a presumed consent system. A governmental actors primary obligation is to protect
citizens since they are a third party actor and must weigh costs and benefits between different policies. Cass
Sunstein5 writes,
Jeffrey M. Prottas [Health Policy Center, Brandeis University]. Organ Procurement in Europe and the United States The Milbank Memorial Fund Quarterly. Health
and Society, Vol. 63, No. 1. Winter, 1985.
5
Cass Sunstein and Adrian Vermuele, Is Capital Punishment Morally Required? The Relevance of Life-Life Tradeoffs, Chicago Public Law & Legal Theory
Working Paper No. 85 (March 2005), p. 17. University of Chicago Law Professor explains,
Page 160 of 174
Aff Case
In our view, both the argument from causation and the argument from intention go wrong by overlooking the distinctive features of government as a moral agent. Whatever the general status of the act-omission distinction as a matter of moral philosophy, the distinction
[U]nlike individuals, governments always and necessarily face a choice

between or among possible policies for regulating third parties.
[A g]overnment is in the business of creating permissions and prohibitions. When it
explicitly or implicitly authorizes private action, it is not omitting to do anything or refusing to act. Moreover,
the distinction between authorized and unauthorized private action
becomes obscure when
government formally forbids private action but chooses a set of policy instruments that do not adequately or
fully discourage it.
is least impressive when applied to government poi. The most fundamental point is that
The distinction between acts and omissions may not be intelligible in this context, and even if it is, the distinction
does not make a morally relevant difference. Most generally,
for example, private killing
Thus, the criterion to uphold the value is reduction of suffering. The reduction of suffering means to take any
action that attempts to remove the pain and suffering of many so long as it does not cause more pain and
suffering. Prefer this criterion for one additional reason.
The moral equality of persons demands a utilitarian approach to actions. Rakowski6 argues,
individuals' status as moral equals requires that the number of people
kept alive be maximized. Only in this way, the thought runs, can we give due weight to the fundamental equality of
persons; to allow more deaths when we can ensure fewer is to treat some people as less valuable than others.
On one side, it presses toward the consequentialist view that
Further, killing some to save others, or letting some die for that purpose, does not entail that those who are killed or left to their fate are being used merely as means to
the well-being of others, as would be true if they were slain or left to drown merely to please people who would live anyway. They do, of course, in some cases serve as
means. But they do not act merely as means. Those who die are no less ends than those who live.
It is because they are also no more ends than

others whose lives are in the balance that an impartial decision-maker must choose to save the more numerous group, even
if she must kill to do so.
Thus, the reduction of suffering is necessary and sufficient for achieving the value of justice.
The thesis of the affirmative case is that presumed consent of organ donation from the deceased reduces
suffering by saving lives through providing organs, alleviating the need for illegal sale of organs, and protecting
autonomy.
Taking and Saving Lives Columbia Law Review, Vol. 93, No. 5, (Jun., 1993), pp. 1063-1156 Published by: Columbia Law Review Association, Inc. Stable URL:
http://www.jstor.org/stable/1122960
Page 161 of 174
Aff Case
Contention One:
My first contention argues that organ procurement from the deceased saves lives.
Sub point A is the uniqueness. The demand for organs is high while the supply is low leading to large waiting
lists whose numbers increase on a yearly basis. Kenneth Gundle7 explains,
Every day in the United States, 17 people die waiting for an organ transplant. The number of people on the
waiting list for an organ has more than tripled over the last ten years and now exceeds 82,000 individuals; at the
same time, the number of donors has remained relatively stagnant (OPTN, 2004). In 2001, 6,439 people died while waiting for a transplant,
nearly double the 3,916 candidates who died while waiting just five years earlier in 1996 (OPTN, 2004; The Lewin Group,
2000; Wright, 1998). Neither the waiting list nor the number of patients who are dying each year is showing any sign
of decrease instead, there is only an increasing organ shortage crisis in the United States.
The implication is that the waiting list and number of people dying waiting for an organ every year is
increasing, making it imperative that we change the system now.
Subpoint B is the link. Presumed consent increases organ donation. Countries with presumed consent have, on
average, 25-30% higher cadaveric donation rates. Empirics prove. Alberto Abadie and Sebastien Gay8 explain,
On the whole, our empirical results suggest that presumed consent laws may greatly increase the supply of
cadaveric organs for transplantation. However, it would be erroneous to interpret our results as evidence that presumed consent is the sometimesportrayed silver-bullet for organ shortage. First, it is unlikely that a 25% to 30% increase in cadaveric donation would eliminate completely the organ shortage problem
Kenneth Gundle [Kenneth Gundle is a junior majoring in Human Biology with an Area of Concentration in "Biological and Social Issues in Organ Transplantation."
He first became interested in organ donation policy during a class entitled "The Nations Health." The research presented here was supported by a Chappell-Lougee
Scholarship and a Haas Summer Fellowship..]Presumed Consent for Organ Donation Perspectives of Health Policy Specialists2004. Medical Anthropology. SURJ.
Abadie, Alberto, and Sebastien Gay. 2006. The impact of presumed consent legislation on cadaveric organ donation: A cross-country study. Journal of Health
Economics 29.4: 599620.
Page 162 of 174
Aff Case
in some countries, like the U.S., although it would help considerably to alleviate [the organ shortage problem.] it. To see this assume that percentage increases in
cadaveric donations translate roughly to percentage increases in cadaveric transplantation. Table IV in column (1) shows the range for the number of additional
transplantations that a 25% to 30% increase in cadaveric transplantations would have represented in the U.S. for the period of 1995-2002. For the same period, columns
(2) and (3) show the yearly change in the number of patients on waiting lists and the yearly number of deaths on the waiting list, respectively. Columns (4) to (6) show
the same variables for the U.K. and the period 1994-2001. The figures in Table IV suggest that a 25% to 30% increase in cadaveric transplantation could potentially
close the gap between the demand and the supply of organs in the U.K., but not in the U.S. Moreover, it seems likely that an increase in the supply of cadaveric organs
would be followed by a reduction in the supply of organs from living donors. Substitution of organs from living donors would attenuate the effect of an increase in
cadaveric organs on the size of the waiting lists.29 Finally, many questions remain unanswered about how to implement a legislative change of this type. Although
recent studies have reported successful transitions to a presumed consent default (see, for example, Michielsen, 1996), it seems likely that in some countries the
imposition of a presumed consent law, without building first sufficient social support, could generate an adverse response towards organ procurement efforts. V.
Conclusions Previous studies have pointed out that, on average, presumed consent countries do not produce significantly higher organ donation rates. Moreover, several
authors have hypothesized that this lack of correlation is produced by the fact that presumed consent laws are rarely enforced and that, in practice, family consent is
always required before organs are extracted. In this article, we argue that legislative defaults on organ donation may affect the consent decisions of the families, even if
they are not enforced. First, we use a simple model to illustrate how presumed consent laws may affect organ donation rates. In addition, u[U]sing
a panel of
countries, we show that, once other determinants of organ donation are accounted for, cadaveric donation rates
are 25% to 30% higher in presumed consent countries. The magnitude of this estimate does not vary much across the different specifications
of our empirical model. Furthermore, using the panel structure of our data we are able to reject the presence of additive fixed effects. Health professionals and organ
donation activists in the U.S., Great Britain, and several other countries have proposed changing legislative defaults on organ donation to presumed consent. The results
of this article suggest that presumed consent laws may alleviate organ shortages. Further research is needed, however, to understand better how societies perceive and
respond to legislative changes of this nature.(pg. 17)
Prefer my study for the (_) reasons.

1) It shows that when other determinants of cadaveric donation rates are accounted for, the coefficient on
the presumed consent variable is still large and significant even if Spain is excluded from the sample. (They
take out Spain from their analysis because Spain's system has had an outlier effect on other studies.)
2) There are multi-variables that measure potentially relevant country characteristics, for example, religious
beliefs, whether the country has a common law or a civil law system, and the number of deaths caused by
motor vehicle accidents and cerebrovascular diseases.
3) The study was conducted over a 10 year period which is good to ensure there are no year by year
fluctuations.
4) The study had a sample size of 22 countries which accounts for country by country variation.
5) Its statistically significant, which means it checks for random fluctuations.
The implication is that deceased donation saves more lives. 1 deceased donor saves 8 lives since every organ
can be donated. So a 25%-30% increase in organ donation from the deceased saves thousands of lives.
Page 163 of 174
Aff Case
Subpoint C. are the impacts. An increased donation rate saves lives and money. Its been empirically proven in
Spain. Kenneth Gundle9 2 furthers,
Higher rates of organ donation not only result in saved lives, but frequently in saved financial resources. Spain
estimates that its 10,000 renal transplants save approximately $207 million every year (Lpez-Navidad et al.,
2002). Compared to dialysis, transplanting a kidney is beneficial both in quality of life for the patient and in
money spent. In the United States, there are currently over 50,000 people on the waiting list for kidney
transplants, which potentially represents a large savings in healthcare expenditures.
Prefer my impacts for (_) reasons:
1) Timeframe: My arguments outweigh on timeframe because the first piece of Kenneth Gundel evidence
explains how the waitlist and waitlist deaths are skyrocketing every year making is an imperative now to
take actions to change that.
2) Probability: There is a very clear link from step to step about how there is a shortage of organs now and
how empirically in the past opt-out systems have increased organ donation and saved countries lives and
money.
3) Qualitatively: the quality of life goes up when someone can get a transplant quicker due to a shorter
waiting list because they can sooner get off of medical procedures such as dialysis with kidney
transplants.
This links back to my criterion of reduction of suffering because it prevents thousands of deaths, saves people
and the government money, and increases the quality of life.
Contention Two:
My second contention argues that increasing donations alleviates the need for the black market.
Kenneth Gundle [Kenneth Gundle is a junior majoring in Human Biology with an Area of Concentration in "Biological and Social Issues in Organ Transplantation."
He first became interested in organ donation policy during a class entitled "The Nations Health." The research presented here was supported by a Chappell-Lougee
Scholarship and a Haas Summer Fellowship..]Presumed Consent for Organ Donation Perspectives of Health Policy Specialists2004. Medical Anthropology. SURJ.
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Subpoint A. The black market exists now because organs are high demand and low supply forcing many to go
towards illegal purchase of organs. This is the mentality that allows the black market to flourish. Roger
Mendoza10 explains,
An underground economy refers to profitable exchanges and transactions involving illegal commodities.
Studies show that a combination of high
levels of demand for these commodities and stiff government restrictions on their provision (legality, financing and pricing) and/or production
(service delivery, operations and management) encourages the growth of underground economies or black markets.9 Broad consensus
on the part of the government and the people, as to which commodities should be traded legally and how, as well as an overall change in public responsiveness, is
critical since underground economies cannot be eradicated by government action alone.10 The current academic and policy debate centers on the legitimacy (or at least
Black market kidney (or organ) trading is illegal because

governments consider it to be repugnant.11,12 It also leads to negative/harmful behavior among individuals,13
such as cash-strapped hospitals and facilities selling operations that they are ill-equipped to perform.14 As several
permissible extent) of the profit-motive behind kidney transplantation.
studies show, these behavioral and ethical implications (policy costs) outweigh from the standpoint of most governments the benefits to be derived from a legally
constituted, compensation-basedalbeit regulatedkidney market.1517 Other studies further stress the indirect or spillover effects of legalizing compensated kidney
donations (e.g. health inequities and unfair access to required medical care).14,18,19(pg. 1)
The implication is that the black market exists now because organs are high in demand and low in supply.
Reversing those current trends would logically remove the profit from the system and make the need for a black
market system diminish since it is based on profit.
Subpoint B. Presumed consent diminishes the need for the black market through decreasing the demand and
increasing the supply of organs. Sheri Glaser11 explains,
Presumed consent, when the state strictly follows it, is the best-practice method of legally obtaining organs. In countries with
presumed consent laws, there is a higher procurement rate for organs than in countries without these laws. Many argue that if the demand for
organs were met legally, then people would have less incentive to illegally obtain organs and the black market
would eventually diminish. On a more basic level, if there were more organs available for transplant, then more peoples lives would be saved. In
addition, presumed consent leads to improvements in tissue matching between donor organs and recipients, and it allows surgeons to be more particular about which
organs are selected. Furthermore, these laws allow for more careful application of brain-death criteria because t[T]he
increased supply of donor
organs diminishes incentive to obtain organs through inappropriate means. For example, there have been cases in Russia and
Argentina where organs were removed from comatose patients who were pre- maturely declared brain-dead. Presumed consent also ensures that organs are fresher
because it eliminates the doctors need to contact the deceaseds next of kin, thus shortening the time between death and determination of consent. Lastly, the decision
as to whether or not to donate organs is not made during the grieving period immediately following someones death.
10
Mendoza, Roger L. "Price deflation and the underground organ economy in the Philippines." Journal of Public Health 33.1 (2011): 101-07. Price Deflation and the
Underground Organ Economy in the Philippines. 22 Mar. 2010. Web. 20 Aug. 2014. <http://jpubhealth.oxfordjournals.org/content/33/1/101.full>.
11
Glaser, Sheri R. "Formula to Stop the Illegal Organ Trade: Presumed Consent Laws and Mandatory Reporting Requirements for Doctors."
Http://www.wcl.american.edu. N.p., Winter 2005. Web. 17 Aug. 2014. <http://www.wcl.american.edu/hrbrief/12/2glaser.pdf>.
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This argument is bolstered by the Alberto Abadie and Sebastien Gay empirics proving that organ donation is
increased by 25%-30% largely diminishing the need for the black market.
Subpoint C are the impacts. The black market is deceptive and ditry, leading to rights violations on a global
scale. Organs are stolen, children are kidnapped and their organs harvested, and people are cheated out of the
sale of their organs. This happens on a daily basis. Ajit Vadakayil12 explains,
The illicit kidney trade makes up 78 percent of the black-market organ trade. This figure will increase with increase of diseases of affluence such as diabetes, high
blood pressure and heart problems. The people who gain are the rich transplant patients who can afford to buy a kidney, the doctors and hospital administrators, and the
middlemen, the traffickers. Its morally wrong. Everybody has 2 kidneys that filter the toxins out of the bloodstream. If a patient with failure in both kidneys will die
quickly unless he is treated with a dialysis machine or get a transplant. The transplants prolongs the lives of the patients but patients who receive organs from living
donors have better survival rates rather than those receiving from deceased donors. This
globally black market is deceptive and dirty. The

traffickers use deception, violence and coercion to buy and sell organs from desperate people and sell them for
much higher price to more developed countries. These middlemen form partnership with soul less doctors in different hospitals who perform
these transplants for an arranged fee and no questions. Many of the black marketed kidneys harvested by the rootless gangs are
destined to patients in Israel. In India Russian Jews are involved in body organ trade , along with some foreign funded Christian missionary NGOs. It is necessary for
the Indian Govt to keep vigil, when large scale disasters take place like earth quakes and bomb explosions. Every dead body cadaver must be examined by trained
people to check out of any kidney or body part has been harvested, then dressed up in proper bloodless clothes and kept in the morgue. Approximately,
90,000 kidney transplants, 30,000 liver transplants and 8000 heart transplants are performed on this planet
today, a major portion of which is illegal and done by the body part harvesting mafia with parts sourced from India. The mafia surgeons removes
kidneys, lungs, pieces of liver, even corneas, bones, tendons, heart valves, skin and other sellable human bits. The organs are kept in cold storage and air lifted to illegal
distribution centers in Israel, United States, Germany, Scandinavia, UK, South Africa, and other rich, industrialized locales. This barbaric business makes more money
than human trafficking and drug trafficking. Jews are obligated under Jewish law to bury a person whole with all their body parts. If organ transplantation was legally
allowed to be performed, all organs and tissue not transplanted from the donor must remain with the cadaver for appropriate and prompt burial. It is not illegal in Israel
to buy and sell organs . All this makes organ transplants for Jews lucrative business for hospitals, doctors, and insurance companies. With a population of less than 7.5
million and a very modern medical system, Israel has an alarming shortage of donors because of their religious belief. Israel has admitted that it harvested organs from
the dead bodies of Palestinians in the 1990s, without permission from their families. The admission follows the release of an interview with Jehuda Hiss, the former
head of Israel's forensic institute, in which he said that workers at the institute had harvested skin, corneas, heart valves and bones from Palestinians and foreign
workers. Harvested organs were alleged to have been used by the military and in public hospitals. The hospitals claimed Israeli law permits organs to be removed
without the familys consent. In November 2008, when a Turkish man by the name of Yilmaz Altun, fainted at Pristina airport while waiting to board
a flight back home to Turkey. He was revived and when questioned by the police, he said he had donated his kidney to an Israeli recipient. Kosovo law forbids the
removal and transplant of organs. He said the [a]
ring had "thrown him out to the street" after they took his kidney, and did
not provide any medical aftercare as promised . In July 2009 the FBI conducted raids involving money laundering and bribery arresting fortyfour persons including five rabbis. The human organ trafficking ring was uncovered in part of the investigation. One of the rabbis arrested said he had been in the
human organ business for ten years. "His business was to entice vulnerable people to give up a kidney for $10,000 which he would turn around and sell for $160,000."
Thanks to the Zionist Jewish monopoly over the world TV and media, any further news of this disgusting practice was soon either suppressed, or totally covered up. A
New Jersey corruption probe in 2009 found that Levy Izhak Rosenbaum of Brooklyn "brokered the sale of black-market kidneys, harvesting organs from Palestinians
Many street children in Indian cities

have disappeared or met violent deaths at the hands of criminal body parts dealers scavenging for organs and
body parts. In 2008 a black market organ transplant ring was busted . The gang had been harvesting kidneys from poor Indian laborers, sometimes against their
and selling them to desperate patients in the U.S. for as much as $160,000," the Associated Press reported.
12
Capt. Ajit Vadakayil [been in command of chemical tankers (mainly) for more than 6640 days -- spread over 30 years ( a world record!]KIDNEY SALE
TOURISM AND BODY ORGAN HARVESTING IN INDIA - CAPT AJIT VADAKAYIL October 29, 2012.
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wishes, and using them in foreigners desperate for transplants. Police who busted the ring said that surgeons paid as little as $ 900
for the kidneys and then sold them for as much as $50,000. The racket, based in Gurgaon, New Delhi, drew victims from as many as
eight Indian states and lasted for almost a decade. The Indian police declared a suppressed figure of more than 500 illegal kidney transplants--the actual is much more
. The ring, was run by two Indian brothers , neither of whom had any medical training but who oversaw the surgery, and most of this was done for the Israeli Jews and
Some
unwilling illiterate migrant labourer donors, were held at gunpoint before their organs were harvested. While the low
the West . One of the brothers is Amit Kumar arrested in Nepal hiding in a Jungle resort at Chitwan, with $230,000 in cash and a check for $24,000 on him.
cost of medical care in India has made it an increasingly popular destination for foreigners in need of everything from tummy tucks to heart surgery, the Gurgaon
kidney transplant racket shocked the country, sparking debates about medical ethics and organ transplant laws. Indian
police declared that the ring

had links to several private hospitals, 10 pathology laboratories , several dozen nurses, and 40 dialysis centers ,
and a coach outfitted as a laboratory in New Delhi. Subsequent raids uncovered a kidney transplant waiting list with 48 names.
Laborers who were kidnapped, blood-typed, then held under guard for days or weeks until they were wheeled,
terrified, into an operating room. On release, they were warned they would be killed if they informed. The Toronto
Star newspaper reported that Kumar's family lives in the Toronto-area suburb of Brampton, where he and his wife bought a house for $610,000, moving in shortly
afterward. In December 2009, Israel admitted that, in the 1980s and 1990s, there had been organ harvesting of skin, corneas, heart valves and bones from dead bodies
Facebook is being
used to lure young girls for prostitution and for body harvesting in desperately poor countries. The plastic surgery industry
survives on human tissue--dont be under illusion that real plastic is going in. Poor patients without too many inquisitive relatives are
offered FREE surgery as a humanitarian scheme in rich private hospitals. When the patient dies ( !!??) body parts
are harvested , and the body draped up nicely, to be incinerated. In March 2003, police in Latvia investigated whether Tutogen's local
supplier had removed tissue from about 400 bodies at a state forensic medical institute without proper consent. Wood and fabrics, replacing muscle
and bone, were put into the deceased to make it look like they were untouched before burial, local media reported. Some
of Israeli soldiers, citizens, Palestinians and foreign workers at the Abu Kabir Forensic Institute without the permission from relatives.
of the tissue fragments found on the bus came from 35-year-old Oleksandr Frolov, who had died from an epileptic seizure. On the way to the cemetery, when we were
in the hearse, one of his feet we noticed that one of the shoes slipped off his foot, which seemed to be hanging loose, his mother, Lubov Frolova, told ICIJ. When
my daughter-in-law touched it, she said that his foot was empty.Later, the police showed her a list of what had been taken from her son's body. Two ribs, two
Achilles heels, two elbows, two eardrums, two teeth, and so on. I couldn't read it till the end, as I felt sick. I couldn't read it, she said. I heard that [the tissues] were
shipped to Germany to be used for the plastic surgeries and also for donation. I have nothing against donation, but it should be done according to the law. In downtown
Seoul, the country's capital, ( Gangnam style area ) Plastic Surgery agencies proudly claim that human tissue products are FDA-approved and are therefore
safe. Some medical centres advertise FDA-approved AlloDerm a skin graft made from donated American cadavers for nose enhancement. Officials in charge
of human tissue for the South Korean FDA, said the country imports 95 per cent of its human-tissue needs. Raw tissue is shipped in from the US and Germany. This
tissue, once processed, is often re-exported to Mexico as manufactured goods. Ninety five per cent of the company's implants are made from human tissue, while 5 per
cent come from cows and pigs tissues . There are new chemical drugs like Ciclosporin which slows down the reactions of rejection. Viaspan, discovered by two
American researchers and manufactured by DuPont, extends the transportation and conservation times of the organs (32 hours for a liver instead of 8; 12 hours for a
heart instead of 4). Thanks to the progress of science, the human body has become a valuable source of raw materials. Blood, organs, tissue, bone, sperm, ova, corneas,
skin, embryos and placenta all now have commercial value. And traffic of all kinds in these materials is multiplying. 10,000 African Albinos hide when they see white
In 2000, pathologist Dick Van Velzen at the Alder

Hey Children's Hospital in Liverpool confessed to removing thousands of organs from children's bodies and
storing them in hospitals all over the country. In addition to over 2,000 hearts, there were a large number of
brain parts, eyes taken from over 15,000 stillborn foetuses and perhaps most disturbingly of all, a number of
children's heads and bodies. Al Jazeera Magazine referred to an international Israeli conspiracy to kidnap
children and harvest their organs and repeats a Pravda story that Israel has brought some 25,000 Ukrainian
children into the occupied entity over the past two years in order to harvest their organs. Several Russian and Ukrainian
men ,as someone spread the rumor that the body parts of the Albinos have magic powers.
officers who sailed with me have lost attractive young girls from their own circle of friends and acquaintances. One of them was the wife of my own third Russian mate
.
This links back to the criterion of reduction of suffering because it reduces the suffering that people go through
when their organs are stolen or bought. It reduces the amount of diseased organs that enter the system, theft and
illegal purchase of organs, and the dehumanization that occurs because poorer people from Eastern countries
sell their organs to rich Westerners.
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Contention Three:
My third contention is the protection of autonomy.
Subpoint A is that autonomy is not violated in an opt-out system. Presumed consent and express consent both
make assumptions about the choice of the deceased. The only difference is an operational one that makes no
moral difference. Carl Cohen13 1 explains,
A second moral objection rests upon what is claimed to be a critical difference between consenting and not objecting. If we rely upon express consent we realize
autonomy (this critic holds), but if we rely only upon the absence of objection we may fail to do so. Hence a procurement system built upon express consent is always
There is a
difference between express consent and not objecting, but that difference cannot guide us in a moral choice
between the one presumption and the other. If persons do in reality object to the use of their organs (but never
register that objection) a system that requires express consent will protect his autonomy more surely than the
revised system here defended. But with the presumption reversed. the very same point can be made in reverse:
if one does in reality consent to the use of ones organs (as most of us do, although never registering that
consent) a system that presumes consent will protect his autonomy more surely than the present system can. The
difference in focus here is that between positive acts (expressly consenting or expressly refusing consent) and negative acts
(refraining from refusing or refraining from consenting). This is an operational difference, not a moral one. It can have moral consequences,
morally sound even if clumsy, while one built upon the presumption of consent could not be reliably sound even if it were expeditious. Wrong.
but the merit of proceeding in the one way or the other depends largely upon what we believe to be the general inclination of those about whom one of those
presumptions must be made. If we knew that only I or 2 persons in 10 would autonomously donate their organs, a system that presumed consent, protecting 10%
automatically but obliging the other 90% to register their objections to make their will effective, would be unfair. But if we have good reasons to believe that 7 or 8 of
10 or even 6 of 10, would in fact choose to donate their own organs for lifesaving uses after death. a system that presumes the absence of consent (what we have now)
similarly protects a minority and obliges the majority to register their views expressly, and it is then unfair.
Subpoint B is that autonomy is better protected in a presumed-consent society. The way we chose which way
we presume ought to be based upon the decisions people would have actually made. Carl Cohen14 2 furthers,
13
Cohen, Carl. "The Case for Presumed Consent to Transplant Human Organs After Death." Transplantation Proceedings 24.5 (1992): 2168-172. Http://carl-cohen.org.
1992. Web. 17 Aug. 2014. <http://carl-cohen.org/docs/The Case for Presumed Consent.pdf>.
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Whether we require consent to be expressed or require refusal to be expressed should depend upon what we
believe the majority would have done in fact. if all had registered their views. We may presume one way. Or presume the other
but presume we must. Either way we place a heavier load upon those for whom the presumption made is incorrect. Moral principles by themselves give no indication
which presumption is the fairer.
Acting justly requires respect for the autonomous judgments people would actually have
made, or (if we are unsure of that) what we may most reasonably suppose they would have made. That reasonable supposition we
can reliably make. Therefore presuming that consent would have been given is in fact fairer, more protective and more
likely to realize autonomy than presuming (as we do now) that it would not have been given.(pg. 2172)
The majority of society would give up their organs meaning that we ought to presume consent in order to
protect the most amount of autonomy. Its the better of the two options. Carl Cohen 315 concludes,
That is the form of what we do now, but the present substance is problematic.
We presume now for all persons that there was a will not to
donate: then under some circumstances we seek express consent to do what we had presumed would not have been wanted. That express consent we most often
seek from the family of the decedent, there being no other resource. The consequences of presuming in this pattern are often gravely
unfortunate: familial distress is commonly caused by the mere request for consent, and the refusal of it often
results in the loss of human lives that might otherwise have been saved. But in addition to its unfortunate results, the present
system is wrong, wrong because it undermines in practice the very principle upon which it was supposed to have
been built. As it must, it incorporates into law and practice a presumption about what people generally want to happen to the organs of their bodies after death, but
the presumption thus incorporated is one now known to be inconsistent with the actual wishes of most persons. At least, of most persons in these times in the United
The majority of people now heartily support

the concept of organ donation. Most persons, when asked, express without qualification their willingness to
donate their own organs after death. As early as I968, support in the United States for organ transplantation from cadavers was shown to be strong and
States. We honestly aim to protect autonomy, but by our current practice we commonly vitiate it.
widespread. By I975, still an early date from the perspective of organ transplantation, a majority of those even in rural and relatively unsophisticated areas expressed
positive support for organ transplantation. In regions more sophisticated. in Los Angeles County. for example. and in Houston." those supporting organ donation
(even back in I975) were more than three fourths of the whole. In Liverpool in I979 that figure was 93%." Some who support transplantation are nevertheless un-easy
with the vision of the donation of their own organs. Every person conscious of his own will has some difficulty in picturing his own death.
But what most

Americans would say in their most rational moments, and (if they were in a position to be asked) would most
likely say about the lifesaving uses of their own bodily remains, is clear: Yes, our organs may be used by others,
14
Cohen, Carl. "The Case for Presumed Consent to Transplant Human Organs After Death." Transplantation Proceedings 24.5 (1992): 2168-172. Http://carl-
cohen.org. 1992. Web. 17 Aug. 2014. <http://carl-cohen.org/docs/The Case for Presumed Consent.pdf>.
15
Cohen, Carl. "The Case for Presumed Consent to Transplant Human Organs After Death." Transplantation Proceedings 24.5 (1992): 2168-172. Http://carl-cohen.org.
1992. Web. 17 Aug. 2014. <http://carl-cohen.org/docs/The Case for Presumed Consent.pdf>.

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if this will save lives, the present system. Depending entirely upon the express consent of the decedents family after death. Thus errs in its
empirical underpinning, and by that error promotes a great moral mistake. All too frequently the spouses and children of dying patients respond negatively to the
request for donation. But families are thus being obliged to answer a question terrible, at the moment it is being asked, for the very reason it must then be asked. And
they are being asked at that moment to override what is widely presumed. Under such circumstances the responses of families often do not reliably reflect the
autonomous wishes of decedents. We ask the wrong persons, at the worst possible times. What they should never have been asked at all. As a matter of morality, our
weightiest obligation here is to decedents, about whose wishes we (usually) must make some presumption.
To best realize their autonomy we

should presume what we have strong empirical reason to believe was in fact their wish, that if their organs
might be used to save another life, they ought to be so used. Presuming general consent to organ donation is
therefore the right thing to do: that is the chief reason. and a very powerful reason. to turn the present system
right side up. At the moral core of this matter lies autonomy. Of which consent in the disposition of one's body
is one manifestation: presuming consent for beneficent transplantation of organs is the best, imperfect but still
the best, realization of autonomy in any population like ours that strongly favors the donation of cadaveric
organs.(pg. 2169)
This links back to the criterion by reducing the suffering of the person who is giving up their organs and their
families. (It also functions as a turn to an autonomy NC.)
Thus, I affirm.
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Negative Case
Introduction:
Because a system of presumed consent logically does not respect the autonomy of individuals, I negate the
resolution, Resolved: A just society ought to presume consent for organ procurement from the deceased.
Because of the term ought in the resolution, I value morality. Within the context of medical decisions,
autonomy is an important part of morality. Dr. Paula Boddington writes:
Dr Paula Boddington [Stipendiary Lecturer in Philosophy at Hertford College of Oxford.] (1998), Organ Donation After Death Should I Decide, or Should My Family?. Journal of Applied
Philosophy, 15: 6981. doi: 10.1111/1468-5930.00074
Ensuring
that important decisions are based upon free and informed consent is one major way of ensuring
autonomy and in turn, respect for persons. In particular, autonomy in medical decision making is vital because
medical decisions are decisions important to the health and lifestyle of the individual. They may even be decisions
of life or death. Additionally, the ability to make autonomous decisions over ones own person, that is, to
maintain bodily integrity, is also considered of crucial significance and so lends particular
important to medical decisions.
The second main justifying ground for informed consent in medicine is based upon the notion of respect for persons and the accompanying notion of autonomy.
Although questions of benefit and harm are of

course relevant considerations in organ donation, a key issue again and again in debate on organ donation
is how respect for persons respect for the dead organ donor is maintained. Utilitarianism, in itself, has little
of great interest to say on the matter of persons, and indeed one of its major, justified, criticisms, is that it fails to give any
adequate account of how and why individual persons should be respected. The question of who should make the
It is this second justification, of respect for persons and for autonomy, that is focused on here.
decision is, of course, essentially a question of autonomy, and cashing autonomy simply in utilitarian terms will omit much necessary richness. Utilitarianism may be called upon
to help with a practical solution where an examination of autonomy and respect for persons fails to show us a clear way; but it is inadequate as a full analysis of the issue. I
therefore leave aside utilitarian considerations to focus on respect for persons, via examining further the notion of autonomy.
Thus, the criterion is respecting individual autonomy. Boddington 2 clarifies what autonomy means and
gives two additional warrants for the criterion:
An autonomous person is one who can make rational decisions, based
on his or her own values, which are truly his or her own. An autonomous person is thus truly to this extent in
charge of his or her own life. To respect a persons autonomous decisions then, it is necessary to allow, or more
strongly to enable, that person to reach such decisions in the best possible way. That is, adequate relevant information must be given to
arrive at a rational decision; and elements of coercion or deception must be absent.
Individual autonomy and the important of its protection.
Individuals live with and interact with each other; some things that are part of my life are part of your life and there will be disputes at the borders. These borders may be very
wide, and constructed in different ways. A major question of this paper is how to draw these borders to resolve disputes between individual and family. One way of addressing the
question of the proper extent of autonomy is to say that an individual should be allowed autonomous control over those aspects of his or her life which are most closely connected
with her or her person. Its another question how close is close enough; and, indeed, exactly how the person is conceptualized. One thing which is closely connected with the
person of course, is his or her body; hence the explicit call for control over bodily integrity. So, another major question of this paper asks how closely connected to the person is his
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or her dead body, and how strong are any claims for autonomous control over that dead body. It is necessary to consider exactly why autonomy is considered to be an
important value [for]. Two main reasons can be sketched. Firstly, respect for individual autonomy [is] can
be seen to be a device of political liberalism used to protect individual liberty, [and] prevent cultural imperialism and the
tyranny or the majority. Hence respect for autonomy can protect difference cultural, religious and moral values; it may sometimes be presented as a sort of
neutral arbitrator between these values. Its importance is highlighted in a multicultural situation. One of the earliest and most influential expressions of this is contained in John
Stuart Mills famous harm principle whereby it is claimed that the only justification for interfering in anothers liberty is to prevent harm to others.
Secondly, respect for individual autonomy can also be seen, not just as a device for respecting different value systems, but as the expression of a
particular value system (or set of value systems) which values the individual, and individual choices, beliefs, and actions,
very highly. Such value systems, broadly common in much of the Western world, typically give priority, or at least high value, to the individual as opposed to the
community. For instance, such value systems would tend to wish to protect the individual from what are viewed as excessive demands on him or her from the community. In
addressing the question at hand, both of these aspects of autonomy must be considered. In the ethical literature, most attention has been given to autonomy as a value attaching to
individuals. I shall discuss the idea that we need also to consider that the notion of autonomy may also apply to groups of people in this case, to families. We also need to
consider the question of how, if at all, notions of autonomy and of respect for persons could be translated to the case of the deceased potential organ donor. I turn to these last
questions first.
Additionally, a just society must recognize the rights of the individual. Professor of Political Science Mark
Warren explains:
Warren, Mark E., [Harold and Dorrie Merilees Chair for the Study of Democracy in the Department of Political Science, University of British Columbia]. "DEMOCRACY AND THE
STATE." The Oxford Handbook of Political Theory. Oxford: Oxford UP, 2006.
society consists of the individuals who compose it, together with the relations
among them. Thus, if a society is good, this means that it is good for the individuals in society and the
The first set involves the ontological proposition that a
relationships they maintain. Public goods, collective goods, community, and culture are relational, and irreducible to individual goods. But these greater goods are judged as good
From this follows the norm of moral equality in collective rule: because each
individual life is an end in itself, collective decisions ought to recognize, respect, and benefit individuals
owing to their consequences for individuals.
interests and values equally, insofar as possible. This moral intuition is central to democracy, and makes the concept morally compelling, apart from any institutional embodiments.
Moreover, because this intuition is shared by many moral theories in one form or another, democracy benefits from and expresses this moral purpose without requiring a single
moral theory for its morally compelling qualities.
My thesis is that a system of presumed consent does not respect individual autonomy.
Contention One:
Contention I: presumed consent undermines the concept of inviolability. Professor of Philosophy Eike-Henner
Kluge writes:
EIKE-HENNER W. KLUGE [Professor and Chair, Department of Philosophy, University of Victoria, Canada]. Improving Organ Retrieval Rates: Various Proposals and Their Ethical
Validity. Health Care Analysis 8: 279295, 2000. 2000 Kluwer Academic Publishers. Printed in the Netherlands.
http://download.springer.com/static/pdf/195/art%253A10.1023%252FA%253A1009496002775.pdf?auth66=1409091433_76769d54f2d220d20b496c3e766cb2bd&ext=.pdf
The
presumed consent approach would go contrary to this social recognition of the right of informed consent. It may well
be asked, whether matters that touches ones personal identity as an embodied being deserve less careful treatment and consideration than matters of merely commercial concern.
Prima facie, at least, it would seem that the ethical scruples that validate the objection to the above-mentioned marketing practices should apply with full force to the case of organ
donation.
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Neg case
Moreover, the presumed consent approach commits a basic logical error: It confounds the failure
to exercise ones autonomy in a positive fashion i.e., failing to exercise the right to say No!
with having given permission.
presumed concept is fundamentally misguided: It undermines the principle that unless we
have given explicit consent to interference with our person, our body remains inviolate. This is what
underlies the right to freedom from non-consensual interference with ones person. Therefore if the logic of the presumed consent option
were to be applied consistently, it would mean that someone who did not want to be interfered
with physically, whether that be sexually or in any other fashion, would have to inform potential
trespassers to the individuals person of that fact. That would reverse the polarity of the right to inviolability. The
individuals body would become public property unless a right of dominion was claimed by the
individual person. It would thus destroy the very notion of a person as an embodied entity.
Furthermore, the very concept of
Logically, a system of presumed consent does not hold. It undermines the very notion of inviolability and make
autonomy a meaningless concept. Autonomy is about positive consent, not the absence of rejection. This means
a system a system of presumed consent disrespects individual autonomy because it is logically incoherent.
Contention Two:
Contention II: the principle of non-malfeasance means that we should minimize false positives and reject a
presumed consent approach. Kluge 2:
One of the foreseeable
consequences of a presumed consent approach would be that there would be false positives
i.e., situations where the individual did not know about the option and therefore had not refused,
situations where the individual in fact had objected but for some practical reason the refusal was never processed, the refusal was not available at the time of death, etc. The
Principle of Non- Malfeasance is a fundamental ethical principle of most modern societies. It entails that foreseeable harms
should be minimized. False positives are a foreseeable and avoidable harm. Consequently
presumed consent is not an ethical option.
As well, if the right to self-determination is accepted as a central social value, then every effort should be made to safeguard it.
Since people might not have consented to donate their organs so we should err on the side of caution and
respect individual autonomy by rejecting a system of presumed consent. A system of presumed consent will
inevitably disrespect individual autonomy and take some organs without the actual consent of the donor.
Contention Three:
Contention III: organ donation is one of the last acts of a person. Thus, we should use a system of informed
consent. Boddington 3 writes:
Page 173 of 174
Neg case
Consider, however, that it has been shown above that the significance of free and informed consent in the medical case [means] derives
from two main sources. Firstly, that medical decisions are lifestyle decisions. At first sight, organ donation is obviously not a medical procedure in precisely this sense. But there is
organ donation,
can be seen as one of the last acts of the person, and so in a way, to choose to donate or not to
donate can be expression of how that person wanted to live his or her life, and how he or she
wished his or her death to be handled, and so in this sense, a lifestyle decision. Philosophically, the moment of
an important proviso here, that an answer to this question hangs on how the person is conceptualized. On one way of looking at persons and at
donation
physical demise is not always taken to be the last moment of personhood or the last chance for any assessment of that persons life, although it may be. There is a range of views
here.
Therefore, informed consent better respects autonomy because it allows people to choose. Only a system of
informed consent takes into account that the fact that organ donation is the result of an autonomous choice to
give. Presuming consent doesnt allow for individuals to actually choose whether or not they want to donate
since it is no longer a choice to give, thus denying individuals their ability to express how they wanted to live
their life.
Thus, because a system of presumed consent violates individual autonomy, I negate.
Page 174 of 174

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Foundation Briefs

Advanced Level September/October Brief

Resolved: A just society ought to presume consent

Defend Your Source

Defend Your Source

Amber Rithalia, Catriona McDaid, Sara Suekarran, Lindsey Myers,

Defend Your Source

Capt. Ajit Vadakayil

Francis L. Delmonico, Robert Arnold, Nancy Scheper-Hughes, Jeffrey

Defend Your Source

James Lindemann Nelson

Defend Your Source

Michael Oliver, Alexander Woywood, Aimun Ahmed, and Imram Saif

Defend Your Source

Remco Coppen, Roland D. Friele, Richard L. Marquet, and Sjef KM

T. Millar, R Walker, JW Ironside, C Smith, JE Bell, JC Arango, DJ

Defend Your Source

Nicanor Pier Giorgio Austriaco

Defend Your Source

J. Lavee, T. Ashkenazi, A. Stoler, J. Cohen, and R. Beyar

Muireann Quiqley, Linda Wright, and Vardit Ravitsky

Robert M. Veatch and Jonathan B. Pitt

Defend Your Source

Defend Your Source

Veronica English and Linda Wright

Defend Your Source

UW Organ and Tissue Donation.

Definition of Presumed Consent TF

Definition of presumed consent. CFS

Topic Analysis One

Topic Analysis One

Breakdown of the resolution.

Stock aff positions

Social contract affs

Other aff arguments.

Stock neg positions

Other neg arguments

Topic Analysis One

Topic Analysis Two

Topic Analysis Two

Topic Analysis Two

Affirmative and Negative Burdens

Topic Analysis Two

Pro: Higher donation rates

Opt-Out Systems have Higher Donation Rates

Its statistically significant, which means it checks for random fluctuations.

Pro: Higher donation rates

A comparison of 5 studies show an increase in organ donation from country to country.

Pro: Higher donation rates

Pro: Higher donation rates

When the default assumption is donation, donations rates increase at a statistically

Pro: Higher donation rates

Pro: Higher donation rates

Pro: Higher donation rates

Increasing organ donation also has massive financial benefits. CFS

Pro: Higher donation rates

A meta-study found presumed consent to increase organ donation rates. CFS

Pro: Higher donation rates

Pro: Black Market

Pro: Black Market

Pro: Black Market

Pro: Black Market

Legal organ market would fight the black market TF