Organ donation and presumed consent the mantra is that presumed consent will quite obviously improve the organ donation rate and save lives. As the gap between the need for organ transplants and the supply of organs has increasingly widened, many scholars have urged the adoption of presumed consent to organ donation. Organ donation essay ethical issues, presumed consent. Through a provocative clinical case, we examine how strict guidelines can impact a patients status on the transplant list. Organ transplantation is unique in that it involves two patients, donor and recipient, both of whose interests must be protected. Virtue ethics, utilitarianism and the problem of consent. Presumed consent is sometimes described as an optout system for organ donation.
Altruism or commercial dealing is now a live issue. So, presumed consent obeys public health imperatives and maximises distributive justice. Similar nudge theories are thought to lie behind the use of presumed consent in organ donor registration policy. Is an ethical and effective way of dealing with organ donation shortages last year, people in the united kingdom died while on the organ transplant list or after being removed from the list because they became too ill. On a moral level, the debate between presumed refusal and presumed consent seeks to achieve the fundamental goal of organ donation. The ethical and policy considerations in organ donation after circulatory determination of death outline criteria for death and organ retrieval. Proposed presumed consent legislation to the editor. It works by assuming that, unless people express a wish otherwise.
I argue that a policy of presumed consent for cadaveric organ procurement, which assumes that people do want to donate their organs for transplantation after their death, would be a moral improvement over the current american system, which assumes that people do not want to donate their organs. Presumed consent, autonomy, and organ donation michael b. Presumed consent is also referred to as the optout system because individuals would have the option of opting out of the system and not donating their organs. There is clear acceptance in the domain of behavioural economics that when presented with alternatives, people who are unsure tend towards the default status quo bias or default bias. Autonomy is what must be preserved in any legislation concerning organ donation, but how it is defined and viewed will alter the variations of presumed consent, refused consent, and mandatory choice. Ben saunders claims that actual consent is not necessary for organ donation due to normative consent, a concept he borrows from david estlund. Medical anthropology presumed consent for organ donation. Despite support among the uk population for organ donation an attempt to introduce a system of presumed consent might provoke antidonation feelings and even active antidonation campaigning among some vocal groups. Ethics of organ transplantation center for bioethics february 2004. Organ recovery teams do not have to consult with the family. Both presumed consent and mandated choice models contrast with the prevailing traditional model of voluntary consent to donation, in which prospective donors indicate their preferences, but the models raise distinct ethical concerns. Presumed consent is an attractive concept with unattractive results. 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.
Although transplantation legislation in chile is not ideal, it sets a precedent. Although recent scholarly work and the laws in some of these countries frequently use the terminology of presumed consent to represent this model of deceased organ recovery, several members of the ethics committee argue that this terminology is inaccurate 33. Presumed consent and organ donation hugh upton, 2012. At present, organs may be procured from a dead body without the familys consent if the deceased had actively optedon to a national organ donation register. Combining normative consent with peter singers greater moral evil principle, saunders argues that it is immoral for an individual to refuse consent to donate his or her organs. Presumed consent and other predictors of cadaveric organ donation in europe. Is presumed consent an ethically acceptable way of. A full informed consent is the minimum prerequisite for an altruistic living donor, and this consent can only be obtained if the donor has a proper understanding and correct information about the risk for the donation procedure and the donor mortality rate is up to approximately 12 per 6,000 cases 0. At present, there is a house bill in the texas legislature that would shift texas from an optin organ donation modela model requiring explicit consent for organ donation from the donor or donors familyto an optout, or presumed consent, model. The ethics and implications of presumed consent organ donation in wales july 4, 20 by fr stephen wang if you live in wales there will now be a presumption that you are willing for your organs to be donated, unless you explicitly opt out of the scheme. Like presumed consent this approach would eliminate the familyconsent barrier and the added stress experienced by families and staff when forced to decide about organ donation. It is a heroic banner for politicians and journalists, and. The state or society has the right of access to the organs of deceased individuals policies may still allow opting.
It works by assuming that, unless people express a wish otherwise, they are willing to donate their organs. Presuming consent rests on the moral premise that consent justifies an invasion. This article explores the meaning and moral significance of presumed consent with particular reference to an optout policy for postmortem organ donation. Wales presumed consent organ donation system assumes people want to. In the conscription model, every individual is under compulsion to donate organs 29. The waiting list for organ transplants has exceeded 117,000 i and is growing roughly 10% a year, despite more than 28,000 ii transplants being performed annually, and with the diseases of aging and obesity that damage organs, this trend is expected to worsen. Presumed consent for organ donation is a powerful tide driven by a curious mixture of good intentions, ignorance and uncritical zeal. I address what i take to be the most important objection to presumed consent. July 2006 bma cymru wales calls for the first law to be made in wales to change the organ donation system to optout. The concept of presumed consent for organ donation is not new and dates to an idea first mooted by dukeminier and sanders. You may also hear it referred to as max and keiras law. This view has been supported by some faith leaders who under the current system support organ donation. November 2007 a waleswide debate about organ donation is launched.
Earlier this month, gordon brown, writing in the sunday telegraph, voiced his support for a presumed consent system for postdeath organ donation in the uk. October 2007 wales health minister edwina hart reveals she is personally in favour of presumed consent. From 20 may 2020, organ donation in england will move to an opt out system. The case for presumed consent in organ donation i kennedy, r a sells, a s daar, r d guttmann, r hoffenberg, m lock, j radclifferichards, n tilney, for the international forum for transplant ethics department of ethics 1650 thelancet vol 351 may 30, 1998 lancet1998. The impact of presumed consent legislation on cadaveric organ donation.
Presumed consent laws prevalent mostly in european countries maintain that the default choice of an individual. Organ donation for an organ transplant essay the organ transplant list has grown to exceed 120,000 in the united states and continues to grow everyday organ donation. Presumed consent not answer to solving organ shortage in u. The ethics and implications of presumed consent organ. Undeniably, the quality of life of transplant patients is improved and, from a financial point of view, organ grafting is more costeffective than very expensive organ replacement technologies such as chronic dialysis. Presumed consent and americas organ donor shortage us news. Pdf ethical dilemmas related to presumed consent optout. A presumed consent system for organ donation practical.
The individuals body and organs are owned by the state. Presumed consent systems are in place in a number of countries, including spain, belgium, france, austria and, as of late 2015, wales. Some ethicists feel that a duty to donate or feeling of obligation to the society aids transition from presumed consent to conscription for organ donation 28. Organ transplant specialist sam shemie, and ethicist mildred z. Presumed consent legislation has not necessarily improved the rate of organ donation from the deceased some of the lowest donation rates in the world belong to countries with presumed consent. The potential impact of an opt out system for organ donation in the uk contents introduction by the chair of the organ donation taskforce 3 1. Ethical donation is by consent, explicit or presumed, spontaneously offered or procured by request. Consent for body organs cannot be presumed in the same way that presumption is used in law or science. The presumed consent subcommittee of the unos ethics committee was charged with evaluating the ethics of presumed consent as a legalpolicy regime for the regulation of the donation of cadaveric organs and tissues for transplantation. He believes that many more lives will be saved if the uk adopts the same system as countries such as spain and austria. However, the system proposed for the uk would continue to involve the family.
Gill university of arizona, tucson, az, usa abstract i argue that a policy of presumed consent for cadaveric organ procurement, which assumes that people do want to donate their organs for transplantation after their death, would be a moral. Normative consent and presumed consent for organ donation. Presuming consent for organ donation places the value of body organ function above the requirement for permission from the donor and raises a number of related ethical and legal questions about ownership and sale of body organs, rights of refusal for children and mentally incompetent adults. Ethics an evaluation of the ethics of presumed consent. Organ donation rates in spain, belgium, and austria suggest that presumed consent might have a positive effect on rates of organ donation. The potential impact of an opt out system for organ. Because demand for organs outstrips the supply, organ distribution has become a contentious issue in medical ethics.
Solomon, discusses the issues around organ donation and presumed consent in. If a presumed consent policy were thus adopted, it would be. Presumed consent is often portrayed in its extreme form where, if an individual has not opted out, the organs will automatically be available for donation. Had a system of presumed consent been in place, whereby adults are automatically registered as organ donors unless they opt out, many of these deaths may have been. Are we ready for presumed consent for organ donation. Ethical problems with proposed presumed consent legislation. Ethical dilemmas related to presumed consent optout. Under presumed consent, deceased individuals are presumed to be organ.