[PASSED] Repeal "Organ and Blood Donations Act"

[Unibot II]

WORRIES that while Clause 1 legalizes donation, transplantation, and transfusion, no exception is made for individuals and/or nations who may have an objection to such a process on religious grounds.

WISHES that this resolution had distinguished between blood, organ, and tissue donations when stipulating conditions for donation as Clause 2 reads: Prohibits the removal of organs, tissues, blood, and components thereof from live patients without informed consent unless otherwise dictated in another one of this Assembly's resolutions.

Medicial scientists have been known to categorize blood as an "organ" when necessary, in fact, organ transplantation and blood transplantation are referred to as being the same process by many. ^[1]

I don't think it is a stretch for a member-nation with a religious community that is sensitive to blood transfusions etc. it could specify blood as an organ and thus have an opt-out system under this resolution. Personally, I'd let that religious community deal with it.

ACCEPTS that individuals who are medically categorized as "brain dead" are unable to provide informed consent, which delays organ and tissue harvesting until after "brain dead" individuals have medically died.

Bull.

The resolution does not specifies a time-scale from when the informed consent needs to be specified -- it could be specified months ago in an opt-out licencing system or an opt-in system; whatever floats a nation's boat.

Nor does the resolution actually specify who needs to provide the consent -- I expect national laws to define the rules of consent succession; leaving that to nations seems to be a good idea.

I reject the notion however that the Patient's Rights Act is relevant to defining consent succession -- it only is applicable in life-saving treatments, not organ harvesting.

NOTES that Clause 5 requires compatibility testing be done for all blood transfusions, even when blood from a universal blood donor may be available should there not be time to allow for such compatibility testing.

But does not define the extent of compatibility testing and furthermore, modern medicine recognizes that compatibility testing is necessary for universal blood donations since rare adverse reactions do occur.

These arguments all seem like your stretching it.. a lot. Personally I don't care if you think all of the people's responses in this thread are "loopholely", there still true -- the law says what the law says, but more importantly for this resolution: the law doesn't say what the law doesn't say, for which, you and any other nation can fill in the law where necessary.

I'm not particularly interested in a crusade to repeal stuff so you can put another notch on your belt. Especially when this repeal is insane (doing the same thing and expecting a different result) and insulting to the intelligence of voters -- who are currently voting down this repeal, seemingly in the face of virtually the same arguments.

Opposed.

[Mousebumples]

I'm not particularly interested in a crusade to repeal stuff so you can put another notch on your belt. Especially when this repeal is insane (doing the same thing and expecting a different result) and insulting to the intelligence of voters -- who are currently voting down this repeal, seemingly in the face of virtually the same arguments.

Opposed.

I don't know if you failed to notice the potential new repeal text with largely different arguments. I kept the arguments regarding the compatibility testing, but there's a whole new argument to start things up. Given the way that the current repeal attempt is going, I thought a wholesale revision of the arguments was in order. (I also have this rebuttal of CD's arguments against the updated draft.)

If you have thoughts on the updated repeal arguments, I'd be interested in hearing them.

Further, you should know me well enough to know that this isn't just "another notch on my belt." Given my own (IRL/OOC) medical background, I am honestly surprised that I haven't written more health care proposals in the past. I feel that both this resolution - and the stem cell resolution - have shortcomings that should be rectified. And you know as well as I do that I can't "fix" those resolutions without first repealing them.

[Discoveria]

"Some thoughts from the Discoverian WA office."

Potential alternate draft *snip*
UNDERSTANDS the meritorious intent of Clause 7, which states: Forbids transplantation or transfusion of infected and/or diseased blood, organs, tissues, or components thereof from one person (a donor) to another person (a recipient);

DOCUMENTS that as the resolution in question fails to differentiate between life-threatening infections and diseases, as there are some infections and diseases that will not put recipients at risk. However, due to the poor wording of this resolution, individuals with high cholesterol, cytomegalovirus, and/or hyperthyroidism would be prohibited from donating as signs of their condition(s) may be detected in blood, organs, tissues, and/or components.

"This appears to be the only argument for a repeal that we find convincing, so far. Perhaps Christian Democrats was unaware of the possibility of transplanting an organ infected with CMV when drafting their resolution; describing this as "poor wording" might be a little unfair.

The wording could do with some proofreading. Further, I don't think individuals with high cholesterol or hyperthyroidism would be prohibited from donating; these examples should be removed.

• I would dispute the view of 'high cholesterol' as a disease. Has the World Health Authority defined the term 'disease'? Hypercholesterolaemia by itself is asymptomatic. While it contributes to atherosclerosis, which is a disease process, it seems foolish to use a national definition of 'disease' so rigid that it excludes anyone with minor medical conditions. Mousebumples' list of related conditions to hypercholesterolaemia does constitute a list of diseases, but they are not diseases because of the elevated cholesterol, but because of their individual aetiology, pathogenesis and impact on the patient.
• In hyperthyroidism, there is no reason (of which I am aware) to be wary of transplanting tissues other than the diseased thyroid tissue. For example, why should anyone object to a corneal transplant from a hyperthyroid patient? I don't think the original resolution forbids this.
• (OOC: Amended.) The original resolution forbids transplantation of diseased organs/tissues/blood. It does not prohibit donations from individuals because the individual has a disease or infection - it prohibits transplanting those diseased or infected tissues only. The wording in the current draft does not reflect this at all - it sounds more like a misunderstanding of the original resolution.
• The wording about 'one might detect signs of disease' is irrelevant as the original resolution does not address this issue at all." Matthew later added, "To clarify, Clause 7 prevents transplantation when the tissue is diseased or infected, not when 'signs of disease' are detected. This could be amended slightly."

WISHES that such individuals were permitted to donate blood, organs, tissues, and/or components due to the scarcity of such resources within the span of our multi-verse.

"As applied to individuals with CMV infections, and similar conditions, I find this clause appropriate. (Our physicists are slightly concerned at the use of 'multi-verse', though.)"

BELIEVES, additionally, that individuals in WA member nations should not need to suffer such discrimination that prevents their ability to donate when they don't have any condition that would impact the health of the patients who would benefit from their donations.

"Slight ambiguity in whom the final "their donations" refers to."

NOTES that Clause 5 reads as follows: Orders that compatibility testing be done regarding all blood donations and transfusions in order to prevent negative transfusion reactions resulting from incompatible blood types;

REALIZES that this clause requires that compatibility testing be done prior to all blood transfusions, as that is the only way to truly act to protect negative transfusion reactions.

REGRETS the wording of such a clause as it would prevent the transfusion of blood from a universal blood donor in the event of an urgent trauma situation where the required delay for compatibility testing could mean the difference between life and death.

"While this argument does have technical merit, I doubt that in practice any lives would be lost as a result of this clause. In an urgent trauma situation, the patient will need a rapid assessment as well as medical stabilisation. To give blood, the patient would require a cannula or alternative form of venous access. The delay in assessment and then in siting a cannula would then coincide with the small delay required for basic compatibility testing. In any case we accept that such testing could occur concurrently with the giving of O-negative blood, on the basis that the transfusion would be stopped if any complications arose. The original resolution allows for this. Further, medical professionals have other options for stabilising a patient's circulation, such as sterile saline, and would not necessarily resort to blood transfusion as a first response."

WORRIES that while Clause 1 of this resolution legalizes donation, transplantation, and transfusion, no exception is made for individuals and/or nations who may have an objection to such a process on religious grounds.

"This objection seems unfair. Provision for religious objections to transfusion and transplantation is well within the capacity of national governments and the original resolution does not restrict this in any way."

"In conclusion, then, we recognise only one substantial argument for a repeal - in order to legalise the transplantation of tissue infected with CMV or similar infections where the benefits outweigh the risks. We would consider voting for such a repeal depending on the proposed replacements and the likely outcome of a successful repeal."

[Mousebumples]

"This appears to be the only argument for a repeal that we find convincing, so far. Perhaps Christian Democrats was unaware of the possibility of transplanting an organ infected with CMV when drafting their resolution; describing this as "poor wording" might be a little unfair.

Fair enough. Would "unfortunate wording" be a more amenable option?

The wording could do with some proofreading. Further, I don't think individuals with high cholesterol or hyperthyroidism would be prohibited from donating; these examples should be removed.

1. I would dispute the view of 'high cholesterol' as a disease. Has the World Health Authority defined the term 'disease'? Hypercholesterolaemia by itself is asymptomatic. While it contributes to atherosclerosis, which is a disease process, it seems foolish to use a national definition of 'disease' so rigid that it excludes anyone with minor medical conditions. Mousebumples' list of related conditions to hypercholesterolaemia does constitute a list of diseases, but they are not diseases because of the elevated cholesterol, but because of their individual aetiology, pathogenesis and impact on the patient.

I don't believe the WHA has defined disease. Further, it has been ruled previously that definitions from one resolution do not carry over to another. The resolution in question failed to define disease (not that I think it needs to be defined, to be honest), and, in the absence of such a definition, I'll offer a few different definitions for your consideration:

• a disordered or incorrectly functioning organ, part, structure, or system of the body resulting from the effect of genetic or developmental errors, infection, poisons, nutritional deficiency or imbalance, toxicity, or unfavorable environmental factors; illness; sickness; ailment. (Dictionary.com)
• any deviation from or interruption of the normal structure or function of any body part, organ, or system that is manifested by a characteristic set of symptoms and signs and whose etiology, pathology, and prognosis may be known or unknown. (Medical Dictionary) [There is a list of diseases on this particular page, following the definition, and I'm happy to limit my "list" of diseases in the repeal text to those listed here. CMV is listed, for one, and various thyroid conditions are also listed. For clarity, I expect that I will leave hyperthyroidism as I don't expect non-medical WA ambassadors to be familiar with Graves' Disease, for example, unless they have a personal connection to such a disease. Various cholesterol diseases are listed, and I could easily find another one or two examples to use in place of high cholesterol.)
• an impairment of the normal state of the living animal or plant body or one of its parts that interrupts or modifies the performance of the vital functions, is typically manifested by distinguishing signs and symptoms, and is a response to environmental factors (as malnutrition, industrial hazards, or climate), to specific infective agents (as worms, bacteria, or viruses), to inherent defects of the organism (as genetic anomalies), or to combinations of these factors (M-W.com)

The reason why individuals with the disease I listed would be prohibited from donating is the exact wording of the clause: Forbids transplantation or transfusion of infected and/or diseased blood, organs, tissues, or components thereof from one person (a donor) to another person (a recipient);

The clause makes no reference to "in order to prevent transmission of infection or disease" (which is, of course, implied but not explicitly said, so such a judgment call should not be used to determine whether some infections and/or diseases are "okay" or not). Further, in the event of an individual with, say, Hepatitis B, a pancreas transplant with Hepatitis B may be appropriate. (They can't get the disease again if they already have it, right?) However, even with the scarcity of organs, that's not allowed.

I totally understand what you're saying, but what you're saying isn't borne out in the resolution's text. This, honestly, isn't even loopholeable, unless you're taking the (I think) questionable approach of redefining "disease" and condition" outside of what common definitions are.

And now I'm realizing that I should have been defining "diseased" above - not "disease." From the same resources:

• having or affected with disease. (Dictionary.com
• Affected with disease. (Medical Dictionary)
• M-D.com just references back to disease, which I've already listed above

If the blood, organs, tissues, or components thereof are "affected with disease" (which, I suppose I could look up "affected" next, but I think we can both - hopefully - agree that affected is a synonym of "impacted by" or "containing signs of" or ... something along those lines?

I'll concede that hyperthyroidism may not prevent organ donations (depending on the organ in question and the severity of the disease, of course), but high cholesterol affects the atherosclerosis (or buildup of lipids on the walls of blood vessels) throughout the individual's body. Blood vessels tend to be present in pretty much every organ in the body, so it is present (and arguably affecting) every organ that could potentially be transplanted.

2. In hyperthyroidism, there is no reason (of which I am aware) to be wary of transplanting tissues other than the diseased thyroid tissue. For example, why should anyone object to a corneal transplant from a hyperthyroid patient? I don't think the original resolution forbids this.

The question isn't whether or not anyone OBJECTS. It's whether or not the cornea is affected by hyperthyroidism. That's what the resolution says, so that's what the resolution means. I honestly wish the clause was worded in such a way as to allow for patients (and their doctors) to decide "this disease or infection doesn't matter - we'll take the blood, organ, etc., anyhow."

And, funny you should mention a corneal transplant. I can't say whether or not a cornea, specifically, would be affected by hyperthyroidism, but the eyes definitely can be affected in general. (Graves' Disease Ophthalmopathy) Graves' Disease is the most common form of hyperthyroidism, and may be characterized by (per Wiki) "upper eyelid retraction, swelling (edema), redness (erythema), conjunctivitis, and bulging eyes (proptosis)." However, I'd argue that the cornea would likely at least be affected by the disease in question, even if it may not impact the health of the cornea overall.

3. (OOC: Amended.) The original resolution forbids transplantation of diseased organs/tissues/blood. It does not prohibit donations from individuals because the individual has a disease or infection - it prohibits transplanting those diseased or infected tissues only. The wording in the current draft does not reflect this at all - it sounds more like a misunderstanding of the original resolution.

I apologize if I'm misunderstanding your meaning here, but many diseases (notably the 3 that I listed in the repeal text), all affect the entire body to a point. We're not dealing with Pink Eye here; we're not dealing with Celiac disease. All 3 of the diseases in question are testable via the blood, and blood goes everywhere.

If there is too much thyroid hormone, every function of the body tends to speed up. Therefore, some of the symptoms of hyperthyroidism may be nervousness, irritability, increased perspiration, heart racing, hand tremors, anxiety, difficulty sleeping, thinning of the skin, fine brittle hair, and muscular weakness—especially in the upper arms and thighs. More frequent bowel movements may occur, but diarrhea is uncommon. Weight loss, sometimes significant, may occur despite a good appetite, vomiting may occur, and, for women, menstrual flow may lighten and menstrual periods may occur less often. source[/quote]

Although hypercholesterolemia itself is asymptomatic, longstanding elevation of serum cholesterol can lead to atherosclerosis.[7] Over a period of decades, chronically elevated serum cholesterol contributes to formation of atheromatous plaques in the arteries. This can lead to progressive stenosis (narrowing) or even complete occlusion (blockage) of the involved arteries. Alternatively smaller plaques may rupture and cause a clot to form and obstruct blood flow.[8] A sudden occlusion of a coronary artery results in a myocardial infarction or heart attack. An occlusion of an artery supplying the brain can cause a stroke. If the development of the stenosis or occlusion is gradual blood supply to the tissues and organs slowly diminishes until organ function becomes impaired. Source

My commentary: While advanced high cholesterol should be preclude individuals from donating organs, early and/or asymptomatic high cholesterol may not be dangerous, even if the high cholesterol and atherosclerosis can be detected in the organs in question.

Does that clarify things a bit? And/or does that not match what I think I've written in the repeal text? I can certainly expand things out to be clearer, if that would help ...

4. The wording about 'one might detect signs of disease' is irrelevant as the original resolution does not address this issue at all." Matthew later added, "To clarify, Clause 7 prevents transplantation when the tissue is diseased or infected, not when 'signs of disease' are detected. This could be amended slightly."

What does "diseased" mean to you? Does that not mean "affected by disease" (or, perhaps, showing signs of disease) ? I'm not sure where the miscommunication is happening here ...

"As applied to individuals with CMV infections, and similar conditions, I find this clause appropriate. (Our physicists are slightly concerned at the use of 'multi-verse', though.)"

Eh, I can fix that to be, more generally, "on an international level" or something.

BELIEVES, additionally, that individuals in WA member nations should not need to suffer such discrimination that prevents their ability to donate when they don't have any condition that would impact the health of the patients who would benefit from their donations.

"Slight ambiguity in whom the final "their donations" refers to."

Hrm, I'll see what I can play with here ..

"While this argument does have technical merit, I doubt that in practice any lives would be lost as a result of this clause. In an urgent trauma situation, the patient will need a rapid assessment as well as medical stabilisation. To give blood, the patient would require a cannula or alternative form of venous access. The delay in assessment and then in siting a cannula would then coincide with the small delay required for basic compatibility testing. In any case we accept that such testing could occur concurrently with the giving of O-negative blood, on the basis that the transfusion would be stopped if any complications arose. The original resolution allows for this. Further, medical professionals have other options for stabilising a patient's circulation, such as sterile saline, and would not necessarily resort to blood transfusion as a first response."

Main example that I've given before - imagine that we're dealing with a plane crash in the wilderness. There's no hospital nearby, no lab nearby. You'd have to transport the patient's blood (and/or the patient) in order to complete a compatibility test. Yes, these circumstances are (hopefully?) rare, but they still exist. Survivors of a plane crash may not have time to be transported to a hospital for a blood test if they have an emergent need for a blood transfusion because they're bleeding out.

"This objection seems unfair. Provision for religious objections to transfusion and transplantation is well within the capacity of national governments and the original resolution does not restrict this in any way."

Eh, I could remove this one. I don't love the argument, but I know it's not present in the repeal that's currently At Vote, so that's why I left it in the initial redraft.

"In conclusion, then, we recognise only one substantial argument for a repeal - in order to legalise the transplantation of tissue infected with CMV or similar infections where the benefits outweigh the risks. We would consider voting for such a repeal depending on the proposed replacements and the likely outcome of a successful repeal."

Thank you for your support. As you may have realized, I have 3 concurrent replacements in the drafting stage. (Yes, I'm planning to submit all 3, if my repeals are successful.) If you have any thoughts or feedback on any of those, I'd welcome them.

Yours in gratitude,
Nikolas Eberhart
Ambassador from the Doctoral Monkey Feet of Mousebumples
WA Delegate for Monkey Island

[Christian Democrats]

Organ X is infected with cholesterol? Cholesterol is neither an infection nor a disease. It is a steroid that must be present in the body for proper functioning.

Saying that a donated organ is infected with cholesterol is like saying donated blood is infected with hypertension.

The organ, blood, or tissue itself must be infected. If it has been slightly affected by disease but is not infected itself, then there is no prohibition on giving it to another person.

I admit that I lack some knowledge; but, as I stated, it would not be a good idea to give someone an organ infected with cytomegalovirus. According to Wikipedia (not the best source, I know):

HCMV infection is typically unnoticed in healthy people, but can be life-threatening for the immunocompromised, such as HIV-infected persons, organ transplant recipients, or newborn infants.

[Mousebumples]

HCMV infection is typically unnoticed in healthy people, but can be life-threatening for the immunocompromised, such as HIV-infected persons, organ transplant recipients, or newborn infants.

Yes. However, given the prevalence of CMV (or HCMV, fine) within the RL, excluding organs that have been exposed to CMV is not feasible. Hell, most recipients have been exposed to CMV, as I detailed above.

There are treatments available (that go along with the usual immunosupressive therapies) that are regularly used in organ recipient patients. (OOC: I have a patient in my own pharmacy who is on Valcyte [valgancyclovir] for this very reason.)

Your resolution DECIMATES the amount of organs that can be transplanted if CMV-exposed people cannot donate organs.

[Christian Democrats]

HCMV infection is typically unnoticed in healthy people, but can be life-threatening for the immunocompromised, such as HIV-infected persons, organ transplant recipients, or newborn infants.

Yes. However, given the prevalence of CMV (or HCMV, fine) within the RL, excluding organs that have been exposed to CMV is not feasible. Hell, most recipients have been exposed to CMV, as I detailed above.

There are treatments available (that go along with the usual immunosupressive therapies) that are regularly used in organ recipient patients. (OOC: I have a patient in my own pharmacy who is on Valcyte [valgancyclovir] for this very reason.)

Your resolution DECIMATES the amount of organs that can be transplanted if CMV-exposed people cannot donate organs.

Terms are being conflated. There is a difference between CMV-exposed and CMV-infected.

Many people have antibodies to CMV because of past exposure, but what percentage are actually infected with CMV at any given time?

At some point, about 40 percent of people worldwide will be infected with CMV. This does not mean, however, that 40 percent of people are infected at a given time. I cannot find any reliable statistics, but it seems that the percentage of people actually infected with CMV at a given time would be around 10 percent (maybe).

According to the New York Department of Health, "CMV is a common virus that infects 50 to 80 percent of people at some time during their lives" (emphasis added). This does not mean that half of people have CMV at any given time. Only a small percentage of people have CMV at any given time.

Furthermore, it is standard practice in the real world to screen blood for CMV. Infected organs, as I have pointed out, can threaten the lives of recipients.

[The Palentine]

Should this make it to queue, then you can coulnt on my support, old bean.
Excelsior,
Sen. Horatio Sulla

[Linux and the X]

According to [snip]

According to an actual doctor, you're wrong.

[Christian Democrats]

According to [snip]

According to an actual doctor, you're wrong.

Appeal to authority?

Maybe a doctor of pharmacy . . . not a doctor of medicine (or so it seems).

I have a patient in my own pharmacy

I want to know how many people have CMV at any given time. Forty percent will have it during their lifetimes, but many fewer will have it at any given time.

To provide an analogous example, 100 percent of people eat. At any given time, maybe only 10 percent of people are eating (just a guess).

Forty percent of people worldwide get CMV. At any given time, only a small portion of the population actually has the virus.

Almost all people still would be allowed to donate organs, tissues, and blood (even if they had CMV in the past).

[Discoveria]

(OOC)

I don't want to venture too far into technical realms. The idea of a World Assembly where each proposal requires specialist knowledge to evaluate doesn't sound like much fun (even if it is realistic).

Nevertheless, to respond to your post in full...

Fair enough. Would "unfortunate wording" be a more amenable option?

That's fine.

I don't believe the WHA has defined disease. Further, it has been ruled previously that definitions from one resolution do not carry over to another. The resolution in question failed to define disease (not that I think it needs to be defined, to be honest), and, in the absence of such a definition, I'll offer a few different definitions for your consideration:

• a disordered or incorrectly functioning organ, part, structure, or system of the body resulting from the effect of genetic or developmental errors, infection, poisons, nutritional deficiency or imbalance, toxicity, or unfavorable environmental factors; illness; sickness; ailment. (Dictionary.com)
• any deviation from or interruption of the normal structure or function of any body part, organ, or system that is manifested by a characteristic set of symptoms and signs and whose etiology, pathology, and prognosis may be known or unknown. (Medical Dictionary) [There is a list of diseases on this particular page, following the definition, and I'm happy to limit my "list" of diseases in the repeal text to those listed here. CMV is listed, for one, and various thyroid conditions are also listed. For clarity, I expect that I will leave hyperthyroidism as I don't expect non-medical WA ambassadors to be familiar with Graves' Disease, for example, unless they have a personal connection to such a disease. Various cholesterol diseases are listed, and I could easily find another one or two examples to use in place of high cholesterol.)
• an impairment of the normal state of the living animal or plant body or one of its parts that interrupts or modifies the performance of the vital functions, is typically manifested by distinguishing signs and symptoms, and is a response to environmental factors (as malnutrition, industrial hazards, or climate), to specific infective agents (as worms, bacteria, or viruses), to inherent defects of the organism (as genetic anomalies), or to combinations of these factors (M-W.com)

I agree you don't have to define 'disease'. That can be left to nations.

The definition from Merriam-Webster seems to fit best with my understanding of disease. I would say that the distinguishing characteristics of a disease are (1) impairment of bodily or mental function, (2) a specific cause or set of causes, such as an infection, (3) excluding accidents, trauma.

NB in real life, the WHO has its "International Statistical Classification of Diseases and Related Health Problems", or ICD-10, which constitutes a list of all 'diseases'. You could then define disease as 'any of the conditions listed in the ICD-10'.

The reason why individuals with the disease I listed would be prohibited from donating is the exact wording of the clause: Forbids transplantation or transfusion of infected and/or diseased blood, organs, tissues, or components thereof from one person (a donor) to another person (a recipient);

The clause makes no reference to "in order to prevent transmission of infection or disease" (which is, of course, implied but not explicitly said, so such a judgment call should not be used to determine whether some infections and/or diseases are "okay" or not). Further, in the event of an individual with, say, Hepatitis B, a pancreas transplant with Hepatitis B may be appropriate. (They can't get the disease again if they already have it, right?) However, even with the scarcity of organs, that's not allowed.

I totally understand what you're saying, but what you're saying isn't borne out in the resolution's text. This, honestly, isn't even loopholeable, unless you're taking the (I think) questionable approach of redefining "disease" and condition" outside of what common definitions are.

I think the resolution's text does bear out what I've said, without using dodgy definitions. If the tissue/organ/blood is diseased or infected, it can't be transplanted. If the person's disease is strictly limited to one part of their body, as for example in the case of a cataract, the rest of their body is fair game for transplantation (to put it crudely).

Yes, the resolution does forbid your hepatitis B transplant. This is the same sort of argument as for allowing CMV-infected transplants, and I've agreed that this argument is fair.

I note that Christian Democrats is beginning to mount a defence along the lines of 'CMV isn't that bad'. I will have to take this development into account.

Yes, a better wording of that clause would have said something like 'in order to prevent infection or a serious threat to life or health', or 'where the benefits outweigh the risks'.

And now I'm realizing that I should have been defining "diseased" above - not "disease." From the same resources:

• having or affected with disease. (Dictionary.com
• Affected with disease. (Medical Dictionary)
• M-D.com just references back to disease, which I've already listed above

If the blood, organs, tissues, or components thereof are "affected with disease" (which, I suppose I could look up "affected" next, but I think we can both - hopefully - agree that affected is a synonym of "impacted by" or "containing signs of" or ... something along those lines?

'Diseased = affected by disease' seems okay in general, but not perfect. To clarify, I do not consider the whole person to be diseased unless their condition actually does result in that scenario. Someone with asthma has a lung disease. Someone with hyperthyroidism has an endocrine disease; their thyroid gland is diseased, but I would not consider the rest of their body to be diseased even though hyperthyroidism affects the rest of the body. I think that there is some room for interpretation here.

I'll concede that hyperthyroidism may not prevent organ donations (depending on the organ in question and the severity of the disease, of course), but high cholesterol affects the atherosclerosis (or buildup of lipids on the walls of blood vessels) throughout the individual's body. Blood vessels tend to be present in pretty much every organ in the body, so it is present (and arguably affecting) every organ that could potentially be transplanted.

Then it comes down to a question of degree. A replacement proposal could take that into account. However, I don't think nations would interpret the original resolution as making the tiniest bit of atherosclerosis a barrier to transplantation. They won't be using such a rigid definition of disease, so I think your objection is academic.

The question isn't whether or not anyone OBJECTS. It's whether or not the cornea is affected by hyperthyroidism. That's what the resolution says, so that's what the resolution means. I honestly wish the clause was worded in such a way as to allow for patients (and their doctors) to decide "this disease or infection doesn't matter - we'll take the blood, organ, etc., anyhow."

And, funny you should mention a corneal transplant. I can't say whether or not a cornea, specifically, would be affected by hyperthyroidism, but the eyes definitely can be affected in general. (Graves' Disease Ophthalmopathy) Graves' Disease is the most common form of hyperthyroidism, and may be characterized by (per Wiki) "upper eyelid retraction, swelling (edema), redness (erythema), conjunctivitis, and bulging eyes (proptosis)." However, I'd argue that the cornea would likely at least be affected by the disease in question, even if it may not impact the health of the cornea overall.

The question is whether or not the cornea is diseased... doctors in different nations might legitimately come to different conclusions based on their understanding of disease, right? What I said above applies here. I would say that although the cornea is affected by hyperthyroidism, it is not diseased in the same sense that the thyroid gland is diseased.

3. (OOC: Amended.) The original resolution forbids transplantation of diseased organs/tissues/blood. It does not prohibit donations from individuals because the individual has a disease or infection - it prohibits transplanting those diseased or infected tissues only. The wording in the current draft does not reflect this at all - it sounds more like a misunderstanding of the original resolution.

I apologize if I'm misunderstanding your meaning here, but many diseases (notably the 3 that I listed in the repeal text), all affect the entire body to a point. We're not dealing with Pink Eye here; we're not dealing with Celiac disease. All 3 of the diseases in question are testable via the blood, and blood goes everywhere.

If there is too much thyroid hormone, every function of the body tends to speed up. Therefore, some of the symptoms of hyperthyroidism may be nervousness, irritability, increased perspiration, heart racing, hand tremors, anxiety, difficulty sleeping, thinning of the skin, fine brittle hair, and muscular weakness—especially in the upper arms and thighs. More frequent bowel movements may occur, but diarrhea is uncommon. Weight loss, sometimes significant, may occur despite a good appetite, vomiting may occur, and, for women, menstrual flow may lighten and menstrual periods may occur less often. source

Although hypercholesterolemia itself is asymptomatic, longstanding elevation of serum cholesterol can lead to atherosclerosis.[7] Over a period of decades, chronically elevated serum cholesterol contributes to formation of atheromatous plaques in the arteries. This can lead to progressive stenosis (narrowing) or even complete occlusion (blockage) of the involved arteries. Alternatively smaller plaques may rupture and cause a clot to form and obstruct blood flow.[8] A sudden occlusion of a coronary artery results in a myocardial infarction or heart attack. An occlusion of an artery supplying the brain can cause a stroke. If the development of the stenosis or occlusion is gradual blood supply to the tissues and organs slowly diminishes until organ function becomes impaired. Source

My commentary: While advanced high cholesterol should be preclude individuals from donating organs, early and/or asymptomatic high cholesterol may not be dangerous, even if the high cholesterol and atherosclerosis can be detected in the organs in question.

Does that clarify things a bit? And/or does that not match what I think I've written in the repeal text? I can certainly expand things out to be clearer, if that would help ...

As above, I think this comes down to whether the transplant doctors in your nation consider the tissues to be diseased or not. I don't think the resolution removes this 'judgement call' from your transplant doctors.

In case you're wondering why I accepted the infected tissue argument but not the diseased tissue argument, it's because infection is much more clear-cut than disease.

4. The wording about 'one might detect signs of disease' is irrelevant as the original resolution does not address this issue at all." Matthew later added, "To clarify, Clause 7 prevents transplantation when the tissue is diseased or infected, not when 'signs of disease' are detected. This could be amended slightly."

What does "diseased" mean to you? Does that not mean "affected by disease" (or, perhaps, showing signs of disease) ? I'm not sure where the miscommunication is happening here ...

It does mean that, in general. In specific cases, the definition of 'diseased' as "affected by disease" is too rigid. It's really hard for me to describe the exact sense of what I'm thinking about with the term 'diseased'. One way to understand it might be as different levels of being affected. With hyperthyroidism, the primary problem is with the thyroid gland; it is diseased. The rest of the body is secondarily affected as a result of the problem in the thyroid gland; it is affected, but not diseased in the same sense, because the problem does not lie with the rest of the body, it lies with the thyroid. The removal of the diseased thyroid gland (plus further medical treatment) would correct the problems in the rest of the body, which was never 'intrinsically' diseased in the first place. I really think the resolution allows for doctors to think like this and decide when a tissue is diseased and when it isn't. For atherosclerosis, I would have to invoke a judgement call based on how affected a tissue is.

Main example that I've given before - imagine that we're dealing with a plane crash in the wilderness. There's no hospital nearby, no lab nearby. You'd have to transport the patient's blood (and/or the patient) in order to complete a compatibility test. Yes, these circumstances are (hopefully?) rare, but they still exist. Survivors of a plane crash may not have time to be transported to a hospital for a blood test if they have an emergent need for a blood transfusion because they're bleeding out.

This is a hypothetical situation, and I don't think the resolution should be repealed solely on the basis that it creates a problem like this. (There's no hospital or lab nearby, but you have plenty of fresh blood to pump into the victims? The only thing stopping you is a bit of international law?) Realistically, the first responders would arrive at the scene, triage, and have basic resources (saline, sterile water for infusion, bandages) to help the victims. Maybe the ambulance carries some blood, I'm not sure if they routinely do. I would expect that the patients could be stabilised and transported to hospital with the response team's existing resources, and then blood could be tested and transfused. It's not perfect, but I am not expecting the WA to create perfect legislation. (Imperfect legislation is hard enough. )

If the repeal does pass, then yes, you could improve on the existing wording. I don't think the wording is so bad that it justifies repeal.

I've peeked at your replacements. I may make suggestions in due course.

[Mousebumples]

According to the New York Department of Health, "CMV is a common virus that infects 50 to 80 percent of people at some time during their lives" (emphasis added). This does not mean that half of people have CMV at any given time. Only a small percentage of people have CMV at any given time.

Furthermore, it is standard practice in the real world to screen blood for CMV. Infected organs, as I have pointed out, can threaten the lives of recipients.

Yes and no. You're oversimplifying things - a lot.

CMV generally does not affect/infect/impact healthy, immuno-competent individuals. If they are asymptomatic (as they aren't "infected"), how would you expect a medical professional or a lab test to tell if they are contagious, if they are an uninfected carrier of the disease, etc.

From Wikipedia:

Most infections with CMV are not diagnosed because the virus usually produces few, if any, symptoms and tends to reactivate intermittently without symptoms. However, persons who have been infected with CMV develop antibodies to the virus, and these antibodies persist in the body for the lifetime of that individual.

The presence of antibodies within an individual's bloodstream indicates that they had been infected with CMV in the past and that they may currently have an active, subclinical infection. It's difficult to tell if someone is presently infected as active culturing of the virus is generally only successful if they are symptomatic. (Which, again, most of these patients are not.)

The presence of antibodies in a given individual is age-dependent: 58.9% of individuals aged 6 and older have been infected with CMV while 90.8% of individuals aged 80 and older have been infected with CMV. A study in Portugal found that 77% of a 2100 person adult sample had been infected with CMV. However, there's no solid data that I've been able to find with regards to how many people are ACTIVELY infected at any point.

However, given the ability of CMV to "reactivate" (similar to the Herpes Simplex, which causes cold sores and, also, herpes) at any time, the relevance of such tests in an otherwise asymptomatic individual seems to be completely worthless. So you find out that Donor A has CMV antibodies but is presently "not infected." By the time you get the results back, the disease could have reactivated, so your results may be wholly irrelevant.

So far as it being "standard practice to screen for CMV" - you're (again) omitting important facts in the interest of presenting your case.

Blood donations are commonly screened for CMV. However, donations that contain CMV are still used. It's just that those that are CMV-free are used for babies.

Why is CMV Negative Blood Preferred for Pediatric Transfusions?
CMV can persist in infected donor white cells and is often transmitted by a blood transfusion, but rarely causes disease. However, in the case of low birth weight infants the consequences of such infection may be severe or even fatal. Because the immune systems in these infants are not fully developed, every precaution must be taken to avoid infection. Scientific studies have shown blood lacking this virus (CMV negative blood) is safer for pediatric patients. Therefore, hospitals prefer to use CMV negative pediatric units to ensure the safety of blood transfusions to newborns. (The Blood Connection)

I can and will quote and reference articles that CLEARLY STATE that CMV-positive blood is still safe and widely used in the general population.

I have already quoted and referenced articles that CLEARLY STATES that CMV-positive organs are used (with appropriate prophylactic antivirals) for organ donation.

Yes, CMV-status is important to blood donation. HOWEVER, being CMV positive does not preclude an individual from donating blood or organs.

And now, to check with the Secretariat whether RL stats are allowable in a repeal text. I'm guessing probably not, but I wouldn't mind a ruling since that will only strengthen my case ...

(more posts to come, as I continue to reply to everything here ... )

[Mousebumples]

According to an actual doctor, you're wrong.

Appeal to authority?

Maybe a doctor of pharmacy . . . not a doctor of medicine (or so it seems).

I may not be a doctor of medicine, but my (RL) sister is. (She's currently an internal medicine resident.) I can ask her opinion, if you'd like. Or, you know, I can keep citing sources that refute your "grasping at straws" arguments.

Otherwise, my thanks to Linux and Sen. Sulla for your support.

[Mousebumples]

I agree you don't have to define 'disease'. That can be left to nations.

The definition from Merriam-Webster seems to fit best with my understanding of disease. I would say that the distinguishing characteristics of a disease are (1) impairment of bodily or mental function, (2) a specific cause or set of causes, such as an infection, (3) excluding accidents, trauma.

NB in real life, the WHO has its "International Statistical Classification of Diseases and Related Health Problems", or ICD-10, which constitutes a list of all 'diseases'. You could then define disease as 'any of the conditions listed in the ICD-10'.

There's also the ICD-9, which is what I use more commonly with work. (Yaaaay, insurance billing!) However, from what I can see, the ICD-9 is the 9th Revision. ICD-10 is probably the 10th revision, if I had to guess.

I think the resolution's text does bear out what I've said, without using dodgy definitions. If the tissue/organ/blood is diseased or infected, it can't be transplanted. If the person's disease is strictly limited to one part of their body, as for example in the case of a cataract, the rest of their body is fair game for transplantation (to put it crudely).

I guess the problem is, when you start "segmenting off parts of the body" is that ... it gets complicated. What if someone has lung cancer that doesn't appear to have spread to their other organs (yet) ? Are we okay to transplant their kidney, liver, heart, etc. ? Or, even though it's lung cancer, can we/do we accept that there's a possibility for accidentally transplanting someone with an organ that could cause cancer?

I am BY NO MEANS advocating for transplanting organs from an individual with cancer. However, cancer (like hyperthyroidism, high cholesterol, etc.) is not always visible when looking at a given organ or tissue - provided that is not the source of the cancer. As you likely know, cancer can (and often does) spread throughout the body, thanks to the lovely network of blood vessels within our systems. Yes, hyperthyroidism is not going to "spread" and turn into hyper-kidney-ism or anything. Still, the resolution in question does not clarify or differentiate or allow for "medical determination," in my mind.

If you're going by "whether or not the disease is strictly limited to one part of their body" ... do localized conditions like hyperthyroidism and lung cancer count as being localized? Does only one and not the other? And, if it's the latter, how do you differentiate between the two? The resolution doesn't give any detail or guidance, so I'd argue that that clause is either being (1) loopholed to fit with what's logical, or (2) subject to non-compliance.

Yes, the resolution does forbid your hepatitis B transplant. This is the same sort of argument as for allowing CMV-infected transplants, and I've agreed that this argument is fair.

I note that Christian Democrats is beginning to mount a defence along the lines of 'CMV isn't that bad'. I will have to take this development into account.

I hope that when you consider CD's "CMV isn't that bad" defense, you will take my medical details (see the above posts) into account as well. CMV affects over half the population and due to the nature of the disease itself, it's very VERY difficult to tell if an individual has an "active" case of CMV since most otherwise-healthy adults have no symptoms when they are infected.

As I stated previously, CMV is a virus that "re-activates" in those that have been exposed in the past, and it is NOT something like ... chicken pox, where you get the disease once (and have symptoms) and then just have antibodies forever. CMV is more like Herpes Simplex (which causes cold sores, among other things) - although Herpes Simplex tends to be symptomatic. Just like an individual who gets a cold sore once can get them over and over again going forward, the same is true for CMV. However, as CMV is generally asymptomatic, it's difficult to know with any amount of certainty whether or not someone has an active case. Yes, there are tests, but they are not instantaneous and - by the time you get results back - it's possible that the virus may now be active, even though it wasn't when the blood was originally drawn.

Yes, a better wording of that clause would have said something like 'in order to prevent infection or a serious threat to life or health', or 'where the benefits outweigh the risks'.

Yeah, definitely true. Of course, I can't just edit the resolution and resubmit - although, honestly, I like my replacement approach better than that one, anyhow.

This is a hypothetical situation, and I don't think the resolution should be repealed solely on the basis that it creates a problem like this. (There's no hospital or lab nearby, but you have plenty of fresh blood to pump into the victims? The only thing stopping you is a bit of international law?) Realistically, the first responders would arrive at the scene, triage, and have basic resources (saline, sterile water for infusion, bandages) to help the victims. Maybe the ambulance carries some blood, I'm not sure if they routinely do. I would expect that the patients could be stabilised and transported to hospital with the response team's existing resources, and then blood could be tested and transfused. It's not perfect, but I am not expecting the WA to create perfect legislation. (Imperfect legislation is hard enough. )

My understanding is that if a call goes out to the EMS regarding a "trauma event" they make a point of transporting blood and other resources that are required with one of the responding units. Yes, it may not be the first unit (or first responders), but that is something that is possible to transport - although I'd expect that only limited amounts are likely kept within most ambulance on a regular basis - with the potential of stopping off at the blood bank, hospital, wherever, to replenish or restock as needed.

Again, my issues with this clause is its rigid wording. I'll admit that this scenario is (hopefully) infrequent in occurrence. However, due to the nature of the REQUIRES clause (which is pretty non-negotiable, I'd think), there's not really any room to fudge the details without falling into non-compliance.

I thought about making a similar argument regarding military transfusions, but it seems likely that soldiers could probably have their blood already typed and such prior to battle. If it's known that this person is blood type A-, then appropriate blood can be transfused. Of course, civilian casualties could also be a concern (although, depending on the nation in question and the location of the battlefield, some nations may not care about civilian casualties), but I suppose it's possible that military medic units could have compatibility testing capabilities. (Although, man, can you imagine the expense to have one of those machines for every medic unit in the military? Yikes!)

If the repeal does pass, then yes, you could improve on the existing wording. I don't think the wording is so bad that it justifies repeal.

To clarify: you don't think the wording is to bad WITH REGARDS TO COMPATIBILITY TESTING? ... Or in general? *hopes for the former*

Anyhow, after further consideration, I'll probably be bringing out another new draft here, so stay tuned for that.

I've peeked at your replacements. I may make suggestions in due course.

Thanks - I look forward to hearing from you again.

Yours,
Nikolas Eberhart
Ambassador from the Doctoral Monkey Feet of Mousebumples
WA Delegate for Monkey Island

[Mousebumples]

New draft! I didn't bother with editing markup at all this time because there's some fairly significant revisions on all of this. (I'll be editing it into the OP shortly.)

I decided to focus on the CMV-positive stuff more and briefly cover the no HepB-to-HepB transplantation angle as well. Comments, concerns, clarifications, etc., are welcome.

Repeal "Organ and Blood Donations Act"
Category: Repeal | Resolution: #175 | Proposed by: Mousebumples

Argument:
THE WORLD ASSEMBLY:

LAUDS the intent of GA#175, "Organ and Blood Donations Act" to provide access to blood and organ donations.

BELIEVES, however, that a number of faults in this resolution's text may limit the effectiveness of the resolution in question.

UNDERSTANDS the meritorious intent of Clause 7, which states: Forbids transplantation or transfusion of infected and/or diseased blood, organs, tissues, or components thereof from one person (a donor) to another person (a recipient);

DOCUMENTS that as the resolution in question fails to differentiate between life-threatening infections and diseases, as there are some infections and diseases that will not put recipients at risk. However, due to the unfortunate wording of this clause, individuals with some non-life threatening diseases or infections would be prohibited from donating as signs of their condition(s) may be detected in blood, organs, tissues, and/or components.

DETAILS that cytomegalovirus (CMV) is such infection that affects well over half of most adult populations.

• CMV is a virus that periodically re-activates throughout an individual's lifetime after they have been exposed. Most healthy individuals do not have any symptoms when they have an active CMV infection.
• CMV-positive blood can be safely donated to otherwise healthy individuals, but such blood donations would be prohibited under this resolution.
• CMV-positive organs can and have been safely donated to those in need of transplants when associated with appropriate preventative anti-viral treatments. However, such transplants would be prohibited under this resolution.
• Many individuals in need of a transplant may have already been exposed to CMV, which puts them at risk for future re-activation of CMV whether or not their newly transplanted organ was CMV-positive or CMV-negative.

RECOGNIZES that because such a large segment of the population is prohibited from donating blood, organs, tissues, and/or components due to their CMV-positive status, the scarcity of resources for transfusion and transplantation is adversely affected by this resolution and makes it more likely that those in need of an organ transplant will die prior to receiving an organ that can save their life.

REALIZES, additionally, that there are some infections that could be safely transplanted from one diseased individual (the donor) to another with the same disease (the recipient). These may include: Hepatitis B, Hepatitis C, and Herpes Simplex Virus – among others.

REGRETS that such organ transplants, for example from a Hepatitis B-positive donor to a Hepatitis B-positive recipient, are outlawed under this resolution, which may result in wasting organs that could otherwise have gone to help save the lives of those in need.

HOPES that the WA will consider future legislation on blood and blood component donation and organ and tissue transplantation to rectify the aforementioned flaws.

REPEALS GA#175, "Organ and Blood Donations Act."

I still have a few hundred characters to work with, so let me know if there are any further comments or concerns. Thanks to everyone for your help so far. Your questions have helped me to figure out what text needs to be included within the argument section (which, admittedly, "explains" a lot more than I'd prefer) so as to make the issues as clear as possible for voters.

Yours,
Nikolas Eberhart
Ambassador from the Doctoral Monkey Feet of Mousebumples
WA Delegate for Monkey Island

ETA: Another argument that I'm thinking of adding is regarding the fact that the "informed consent" in the resolution in question does not have to be uncoerced. Arguably, an "evil" nation could coerce their citizens (or next of kin, etc.) to donate organs, blood, etc., when the individual in question may not really want to do so. However, I'm not sure what people's thoughts are on that, so opinions would be welcome!

[Scion Lop On]

ETA: Another argument that I'm thinking of adding is regarding the fact that the "informed consent" in the resolution in question does not have to be uncoerced. Arguably, an "evil" nation could coerce their citizens (or next of kin, etc.) to donate organs, blood, etc., when the individual in question may not really want to do so. However, I'm not sure what people's thoughts are on that, so opinions would be welcome!

At first, I thought that an argument like this might contradict GAR#29, but then after rereading it, I saw this:

(IV) Patients may refuse treatment, provided that such refusal does not endanger the health of others. In non-emergency circumstances, treatment may be given without the patient's consent only in the presence of a legal instrument issued by a court of jurisdiction stating that the patient is not competent to make decisions

.

In theory, a patient refusing to give up a kidney could be life or death for another patient undergoing dialysis. If I happen to be wrong, please correct me, but I do think you have a pretty strong argument here. Although there's always the question of whether or not organ donation is a "treatment," in which case coerced consent for organ donation isn't covered anywhere, and you still have a valid argument.

[Mousebumples]

ETA: Another argument that I'm thinking of adding is regarding the fact that the "informed consent" in the resolution in question does not have to be uncoerced. Arguably, an "evil" nation could coerce their citizens (or next of kin, etc.) to donate organs, blood, etc., when the individual in question may not really want to do so. However, I'm not sure what people's thoughts are on that, so opinions would be welcome!

At first, I thought that an argument like this might contradict GAR#29, but then after rereading it, I saw this:

(IV) Patients may refuse treatment, provided that such refusal does not endanger the health of others. In non-emergency circumstances, treatment may be given without the patient's consent only in the presence of a legal instrument issued by a court of jurisdiction stating that the patient is not competent to make decisions

.

In theory, a patient refusing to give up a kidney could be life or death for another patient undergoing dialysis. If I happen to be wrong, please correct me, but I do think you have a pretty strong argument here.

I'd argue that PRA doesn't necessarily apply - or, at least, that clause - as prospective organ/tissue/etc., donors are not being treated when they are consenting to give up a kidney or whatever. Sure, refusal may endanger the health of others, but since the patients own condition is not being improved, I'm not sure that it can/should count as "refusing treatment" and thereby be subject to that clause.

Of course, given other WA laws on the books (i.e. Habeas Corpus, for one), it gets a bit murky, I'd think. After all, a government can't threaten to hold someone in prison for not consenting to donation. However, I'd appreciate some thoughts as to whether or not the use of manipulation or blackmail could be considered "coercion." i.e. Let me introduce you to Sick Johnny's 5 year old son. Sick Johnny really needs your spare lung so he's able to play with his kid as he grows up. Won't you please let us give him your extra lung? or I saw you doing XYZ scandalous activity the other day. If you don't agree to give my sick daughter your spare kidney, I'll tell EVERYONE about it.

Coercion generally involves using "force" or "intimidation." Those methods don't seem to fit that definition, but they are still methods of gaining consent that may not be willingly given otherwise.

Thoughts?

[Scion Lop On]

I'd argue that PRA doesn't necessarily apply - or, at least, that clause - as prospective organ/tissue/etc., donors are not being treated when they are consenting to give up a kidney or whatever. Sure, refusal may endanger the health of others, but since the patients own condition is not being improved, I'm not sure that it can/should count as "refusing treatment" and thereby be subject to that clause.

Of course, given other WA laws on the books (i.e. Habeas Corpus, for one), it gets a bit murky, I'd think. After all, a government can't threaten to hold someone in prison for not consenting to donation. However, I'd appreciate some thoughts as to whether or not the use of manipulation or blackmail could be considered "coercion." i.e. Let me introduce you to Sick Johnny's 5 year old son. Sick Johnny really needs your spare lung so he's able to play with his kid as he grows up. Won't you please let us give him your extra lung? or I saw you doing XYZ scandalous activity the other day. If you don't agree to give my sick daughter your spare kidney, I'll tell EVERYONE about it.

Coercion generally involves using "force" or "intimidation." Those methods don't seem to fit that definition, but they are still methods of gaining consent that may not be willingly given otherwise.

Thoughts?

You ninja'd my edit.

Anyways, Habeas Corpus only applies if the intended punishment is unjustified detainment, which might not be the case. And while I would definitely want to give Sick Johnny my lung, I don't know if emotional blackmail is the strongest form of coercion. I think that due to a lack of WA coverage on coerced organ donation, more threatening forms of coercion such as fines and manipulation are both plausable, and realistic. To the best of my knowledge, I think that nations can still pass domestic laws that punish people for refusing to consent to organ donations. Please do correct me if I'm wrong - my main interest is seeing this resolution pass!

[Discoveria]

I am BY NO MEANS advocating for transplanting organs from an individual with cancer. However, cancer (like hyperthyroidism, high cholesterol, etc.) is not always visible when looking at a given organ or tissue - provided that is not the source of the cancer. As you likely know, cancer can (and often does) spread throughout the body, thanks to the lovely network of blood vessels within our systems. Yes, hyperthyroidism is not going to "spread" and turn into hyper-kidney-ism or anything. Still, the resolution in question does not clarify or differentiate or allow for "medical determination," in my mind.

If you're going by "whether or not the disease is strictly limited to one part of their body" ... do localized conditions like hyperthyroidism and lung cancer count as being localized? Does only one and not the other? And, if it's the latter, how do you differentiate between the two? The resolution doesn't give any detail or guidance, so I'd argue that that clause is either being (1) loopholed to fit with what's logical, or (2) subject to non-compliance.

Is hyperthyroidism localised? I would argue yes, the thyroid is diseased and the rest of the body is not intrinsically diseased.

Cancer is less clear-cut. For lung cancer I would probably say that the lung containing the primary tumour is diseased; any lung or other organs/tissues containing secondary metastatic deposits of cancer would be diseased also. A transplant team could still get away perhaps with transplanting segments or lobes (if that's possible) which do not contain any suspicious masses. I don't think that 'cancer isn't always visible' makes a difference. That detail would be dealt with by the medical team using diagnostic tests, CT, X-rays etc.

Beyond the forbidding of diseased tissue transplantation, the rest of the detail is left to nations' medical teams, so I don't see a problem. It's not exactly 'non-compliance', right? I'm not sure I'd call it a loophole either, though I can see why one might, if you have a particular meaning of 'diseased' in mind.

If the repeal does pass, then yes, you could improve on the existing wording. I don't think the wording is so bad that it justifies repeal.

To clarify: you don't think the wording is to bad WITH REGARDS TO COMPATIBILITY TESTING? ... Or in general? *hopes for the former*

The former.

Another argument that I'm thinking of adding is regarding the fact that the "informed consent" in the resolution in question does not have to be uncoerced. Arguably, an "evil" nation could coerce their citizens (or next of kin, etc.) to donate organs, blood, etc., when the individual in question may not really want to do so. However, I'm not sure what people's thoughts are on that, so opinions would be welcome!

I wouldn't be persuaded by this, but others might. In RL, informed consent is by definition uncoerced. Some sources disagree (you made me look up definitions, grr) but I would argue that the term generally refers to voluntary informed consent meeting defined standards.

• consent [kon-sent´] - in law, voluntary agreement with an action proposed by another. Consent is an act of reason; the person giving consent must be of sufficient mental capacity and be in possession of all essential information in order to give valid consent. A person who is an infant, is mentally incompetent, or is under the influence of drugs is incapable of giving consent. Consent must also be free of coercion or fraud. ... informed consent - consent of a patient or other recipient of services based on the principles of autonomy and privacy; this has become the requirement at the center of morally valid decision making in health care and research. Seven criteria define informed consent: (1) competence to understand and to decide, (2) voluntary decision making, (3) disclosure of material information, (4) recommendation of a plan, (5) comprehension of terms (3) and (4), (6) decision in favor of a plan, and (7) authorization of the plan. A person gives informed consent only if all of these criteria are met. If all of the criteria are met except that the person rejects the plan, that person makes an informed refusal. (Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition. © 2003; quoted at TheFreeDictionary.com)
• Elements of valid informed consent. For an individual to give valid informed consent, three components must be present: disclosure, capacity and voluntariness.
  While Disclosure requires the researcher to supply the subject with the information necessary to make an autonomous decision, the investigators must ensure that subjects have adequate comprehension of the information provided. This latter requirement implies that the consent form be written in lay language suited for the apprehension skills of subject population, as well as assessing the level of understanding during the meeting.
  Capacity pertains to the ability of the subject to both understand the information provided and form a reasonable judgment based on the potential consequences of his/her decision.
  Voluntariness refers to the subject’s right to freely exercise his/her decision making without being subjected to external pressure such as coercion, manipulation, or undue influence. (Wikipedia)
• NHS Choices makes a distinction between consent, informed consent and voluntary consent.

[Christian Democrats]

If the moderators rule that you are allowed to use real-world statistics (which I doubt will be permitted), then at least use the actual numbers and be truthful with the data.

At some point during their lives, 40 percent of humans are infected with cytomegalovirus; though, at any given point, only a small portion (probably in single digits regarding percentage) of the population actually has an active infection.

Unless the existence of an active infection definitely can be proven in the organ, tissue, or blood in question, I do not believe that the Organ and Blood Donations Act prohibits donation if someone had been infected in the past.

I continue to believe that the HCMV "reasoning" is faulty. By that logic, anyone who has had a rhinovirus (the common cold) should be banned from donating organs, tissues, or blood because of the presence of rhinovirus antibodies and the minuscule chance that the virus still might be active in the body. It is absurd to say that someone who had a virus ten years ago should not be allowed to donate. The Organ and Blood Donations Act does not say this. Donations from people who suffered from past infections or diseases are not prohibited by the resolution, which is a good piece of legislation.

[Krioval]

If the moderators rule that you are allowed to use real-world statistics (which I doubt will be permitted), then at least use the actual numbers and be truthful with the data.

OOC: I would hope that an objection to "real-world statistics" wouldn't be grounded in a rejection of basic scientific fact. Personally, I reserve the right to reject RWS when used to demonstrate a political opinion. We know certain things about the way viruses work IRL, and there is no compelling reason to assume that they would work otherwise in NS. Further, I tend to invoke a modified reasonable nation theory here when I claim that a vast majority of NS nations will not assert a total lack of disease within their borders, thus making the discussion of "disease" irrelevant.

At some point during their lives, 40 percent of humans are infected with cytomegalovirus; though, at any given point, only a small portion (probably in single digits regarding percentage) of the population actually has an active infection.

Still OOC: I have formal training as an immunologist (a MS degree) and am working toward a PhD (technically in Chemical Engineering, though the research is almost exclusively biological in nature). HCMV can (and does) enter latency in most people exposed to it, thus making it almost impossible to eliminate the virus through an immune response. It's sort of like an "immune standoff" - if the virus leaves its protected niche, the immune system destroys it, but the immune system can't get ready access to that niche to eradicate the virus. So "active infection" becomes a problematic term for the majority of people (us?) with latent HCMV. Hence the necessity of testing.

At the same time, I don't see why an individual who tests positive for CMV can't donate organs to another individual who is either already experiencing latent CMV or who will be properly treated for the potential of post-donation CMV infection - with the recipient's consent, of course. And to be completely honest, while CMV latency tends to be in the salivary glands, I'm not 100% certain that it can't travel (via its host cells) elsewhere without incident.

I continue to believe that the HCMV "reasoning" is faulty. By that logic, anyone who has had a rhinovirus (the common cold) should be banned from donating organs, tissues, or blood because of the presence of rhinovirus antibodies and the minuscule chance that the virus still might be active in the body. It is absurd to say that someone who had a virus ten years ago should not be allowed to donate. The Organ and Blood Donations Act does not say this. Donations from people who suffered from past infections or diseases are not prohibited by the resolution, which is a good piece of legislation.

This is why CMV is different. It doesn't go away in the majority of people infected, and for most of them, it remains asymptomatic forever. Yet "Organ and Blood Donations Act" could prevent perfectly serviceable organs from being transplanted for this reason, even if the primary infection was "ten years ago".

[Christian Democrats]

This is my problem.

If you cannot prove an active infection in Organ X, then there is no prohibition on donating that organ under the terms of the resolution.

How would one go about proving an active HCMV infection in a donated heart?

[Mousebumples]

This is my problem.

If you cannot prove an active infection in Organ X, then there is no prohibition on donating that organ under the terms of the resolution.

How would one go about proving an active HCMV infection in a donated heart?

Yes, this is definitely your problem. However, due to the unfortunate wording of your resolution, your problem has become our problem.

So far as testing for an active infection, a simple blood test is generally sufficient. After all, that's the same way that other diseases (i.e. HBV, HCV, HIV, etc.) are generally tested for.

As stated by Krioval - and I do welcome his expertise in this area - even if the infection is latent, it's still present and quite possibly infecting the donated heart.

THAT is why your resolution is so dangerous and needs to be repealed. We can't disprove - beyond a shadow of a doubt - that a potential donor heart is not infected. As such, since blood tests would indicate an infection for this individuals, we are not allowed to use those organs.

Now, I'm sure you'll do have hand-wavey "but that's not fair/not what I meant/etc." response, but facts are facts. It is because of this conundrum (and the prevalence of CMV within the RL human population) that workarounds have been engineered. The first CMV treatments were IV only and required that a port be inserted into the patient's chest or arm. Now, thanks to further developments and innovation and medical research, there is an oral tablet that is effective for most cases of symptomatic CMV.

If you had written this resolution, say, 30 years ago, the clause in question wouldn't have been as much of an issue. Back then, there wasn't really any effective treatment for CMV. (Ganciclovir was first discovered in 1982.) Much of medical development, however, is driven by the need for a "solution." Money (and interest) is often driven by a growing Need in a particular area. Cancer treatments, for example, have changed massively over the past decade. The same could be said for HIV/AIDS treatment. Given the prevalence of CMV in the population, I would expect that a similar "need" drove the development of the CMV treatments and prophylaxis.

Your resolution needs to be repealed because it is actively harming the ability of my own nation's health care professionals to do their jobs and save lives. The end, that's it.

You can squint at what I'm saying and continue to ignore the facts that don't fit with what you're willing to accept. That's fine. But that doesn't mean that I'm going to drop a medically valid argument merely because you don't care for it.

[Mousebumples]

Updated draft!

Repeal "Organ and Blood Donations Act"
[size=125]Category: Repeal | Resolution: #175 | Proposed by: Mousebumples

Argument:
THE WORLD ASSEMBLY:

LAUDS the intent of GA#175, "Organ and Blood Donations Act" to provide access to blood and organ donations.

BELIEVES, however, that a number of faults in this resolution's text may limit the effectiveness of the resolution in question.

UNDERSTANDS the meritorious intent of Clause 7, which states: Forbids transplantation or transfusion of infected and/or diseased blood, organs, tissues, or components thereof from one person (a donor) to another person (a recipient).

REGRETS that the unfortunate wording of this clause does not allow for flexibility in the handling of donations and transplants, which prevents member states from instituting common-sense practices that do not harm public health and may provide a net benefit for individual patients.

DETAILS that individuals who test positive for cytomegalovirus (CMV) will be forbidden from donating any blood, organs, tissues, or components under this clause, despite the following:

• CMV-positive blood can be safely donated to otherwise healthy individuals, but such blood donations would be prohibited under this resolution.
• CMV-positive organs can and have been safely donated to those in need of transplants when associated with appropriate preventative anti-viral treatments.
• Many individuals in need of a transplant may have already been exposed to CMV and are already CMV-positive, whether or not their newly transplant or transfusion contains CMV-positive materials.

RECOGNIZES that CMV may affect a substantial portion of a given nation's population and that these individuals are prohibited from donating blood, organs, tissues, and/or components due to their CMV-positive status.

LAMENTS that the scarcity of resources for transfusion and transplantation is adversely affected by this resolution and increases the possibility that those patients in need of an organ transplant will die prior to receiving an organ that can save their lives.

HOPES that the WA will consider future legislation on blood and blood component donation and organ and tissue transplantation to rectify the aforementioned flaws while still assuring safety and availability of blood, blood components, organs, and tissues.

REPEALS GA#175, "Organ and Blood Donations Act."

I simplified things a bit (I think?) which should make it more accessible to the non-medical types. As always, comments and questions are welcome to help improve the content of this draft.

[Christian Democrats]

THAT is why your resolution is so dangerous and needs to be repealed. We can't disprove - beyond a shadow of a doubt - that a potential donor heart is not infected. As such, since blood tests would indicate an infection for this individuals, we are not allowed to use those organs.

Firstly, the resolution does not mandate a "beyond a shadow of a doubt" standard. It prohibits the transplantation of an organ that is infected. If an infection in the organ itself cannot be proven (nations are free to adopt whatever standards they want), then the resolution does not prohibit the organ's transplantation to a new individual. The resolution does not require doctors to prove a negative (i.e., this organ is not infected). It merely prohibits the transplantation of an organ that is proven to be infected (proving a positive, i.e., this specific organ is infected). Unless a given organ is proven to be infected, transplantation of that organ is allowed under the terms of the resolution.

Secondly, does the solution in which an organ is washed after it is removed from the body not kill whatever could be infecting that organ (that is, an infection potentially transferable to the future recipient)?