An organ donation begins with the person's death certificate. When rescued from, say, a scene of an accident, a person is admitted to the hospital where they will receive the full breadth of the nation's emergency medicine apparatus where possible. At this point, nobody is looking or even thinking about the person's organ donor status. In many countries, doctors work to save patients until brain death, as brain death is entirely irreversible and the gold standard in modern medicine. Clinical death involves the stopping of both lung and heart activity, but using resuscitation it is possible to restart either in the right conditions. Clinical death, if prolonged and if the person is not supported by a heart-lung machine ('life support'), leads to brain death.

This is a whole philosophical field about death and how to define it, but for medical purposes it is good enough to know that we think because of neurons and brain cells. When these die, the foundation of what enables us to feel, think and experience things, is destroyed²⁾. If this state is reached, doctors will cease life-saving efforts. This happens thousands of times a day and is entirely normal. If in the future brain death somehow became reversible, a new line will be determined by when doctors will stop trying.

The point is, once a person is brain dead, they will not be helped anymore. Nothing in our current medicine will bring them back, noone ever has come back from brain death³⁾, this is the point by which nobody, including any doctor on Planet Earth, will help them anymore. They're dead. Now, a death certificate is issued and only now will the person be checked for donation status. If they consented to donation, they will be brought to a different team that handles the harvesting. The doctors who originally tried to save you are never aware of your donation status and wouldn't care either way, as they have no incentive for you to die. These doctors in the emergency department have long, illustruous careers in medicine, having went through the entire medical system and whose career depends on them having a good safety record.

One of the longest lasting discussions in our society since the enlightenment and our medical advances is how to handle organ donations. Fundamentally, a person's body is generally considered to be under the authority of that person, and that continues even if the consciousness inhabiting that body 16 out of 24 hours a day has ceased to be. Funerals are done at the behest of the dead person, using their will as stated during lifetime to put their body to rest. In cases where such a will does not exist, they are presumed to have wanted to be buried anyway. Under this, a person has to explicitly state that they want their body to be used for charitable means instead, and this basis is how we have come to the system we have today: Boringly called “opt-in”, opt-in means that the government is providing a service (organ donation) that you pro-actively have to sign up for to become part of it. You have to explicitly state in writing that this is what you want in the case that you happen to die.

Organ donations are a good thing. People who need an organ can be given many more years of qualitative life when receiving an organ, but in all cases they have to wait long times to get one, if they ever get one at all. Waiting times of 9 years are the norm. The arguments against organ donations on the other hand are pretty weak. In most cases, individuals are either largely unaware of how badly organs are needed, how much more organs would improve the people's lives and as a result aren't particularly motivated to opt in. Opting in would involve not just getting a donor card or signing up online, but for most it would also involve confronting some doubts that they still have about organ donation. For example, the idea of being harvested from before being properly dead, or the idea that doctors put in less effort when trying to save a donor are doubts that can be easily overcome, but doing so would involve confronting fear and some education.

Specifically for these people, the idea is to reverse the system and make it so that everyone would be harvested by default, unless the person has stated in writing during their life that they do not want this. Some countries have already implemented this, and, as a strong advocate for organ donation, I am personally enthusiastic about this because this is a way to make a major impact, and it is politically realistic. I know that most things I advocate for are unlikely to actually get passed by lawmakers, but a proposition to switch to opt-out has genuine odds of making it through, which would cut waiting times for donations substantially and give millions of people more healthy lifetime at no cost whatsoever. Dead people are dead, the only one you're hurting by harvesting organs are people's sensibilities, but they are nothing in comparison to the joy donation recipients will feel by getting to spend another 6 years with your loved ones.

And of course, those who really don't want to still have the option to opt out. If one, for any reason, decides that they don't like the idea of things being done with their body after death (besides getting liquified into ashes, I guess that's A-OK) they may opt out at any time for no cost either.

Most arguments I see against organ donation typically revolves around some kind of fear of death, and the refusal to accept that one's life will at some point end. Most people I've talked with want to believe that, at any point in this, they either will or at least might be harvested when alive. Doctors might put in less effort, they might not be properly dead, maybe they'll just wake up randomly, why should brain death be irreversible… these kinds of things. They seem to think that as long as “they” exist in some meaningful form, even if just as skin and flesh, they're still them in some way and get very squeamish if someone proposes doing something with their body, even if they're so dead that the last thing that would be done with them is being burned to ashes in an oven; which they would do even if somehow their body got up from the stretcher and started walking around. They like seeing themselves alive, and just the thought of being dead is scary.

The other reservation to organ donation I've seen is religiously motivated. Something about the human body is sacrosanct, and even though harvesting organs here to put them into another body there violates the sacredness of the human body. This is entirely feels-based and has no grounding in either reality OR the bible, neither of which would tell you that making the life of a living person better at the cost of a dead person's organs is in any way bad or an affront to god or his perfect creation. His creation obviously is not perfect, and god knows as much.

One of the things that made me unsure for a long time was whether I even have anything healthy in me that could be useful. Well, it turns out that it is possible to transplant body tissue that you'd never even think of. Even if your heart sucks, and your lung sucks, and your liver and your kidneys suck, they can still use your retina. Many tissues can be transplanted in general and, even if an organ itself sucks, it is at least functional which is better than what the people on the organ donation waiting list have.

Becoming an Organ Donor is the easiest, fastest and cheapest way to make a life-changing impact on another person, available to anyone! In Germany, government buildings sometimes prepare flyers with a donor card, and these days citizens can sign up in the digital organ donation register via the internet. The best way is probably to just google and see the results. I already googled it for you, just click the link: Google Search: Organ Donation.