Friday, January 23, 2009

Presumed Consent for Organ Donation? An Unlikely Fix

Tarris Rosell, PhD, DMin
January 23, 2009

Would changing the way we ask for organ donations—i.e., by not asking—make a dent in the transplant waiting list? “Presumed consent” is policy in a few nations less individualistic than our own. Has it helped? Our British cousins want to know.

The United Kingdom may be considering a change from their current opt-in system of organ donation after death, to one that would presume donor consent unless the donor or next of kin specifically were to opt-out prior to surgical recovery of usable body parts.

Science Daily reports optimistically on a systematic review of 26 studies and opinion surveys currently posted on the website of the British Medical Journal.

The review, compiled by the Centre for Reviews and Dissemination at the University of York in the U.K., suggests a correlation between presumed consent policies and higher donation rates. However, the report carries significant caveats to these findings, as well.

We keep looking for ways to balance supply with demand in the currently lopsided system of donate and wait. Some donate while many nonetheless continue to wait.

“First person consent” laws passed in most states of the United States have done little to change the negative ratio. “Presumed request” protocols—a way of asking potential donors that presumes a favorable response—reportedly have yielded some success, but not without a turn-off factor due to an unfortunate association with high pressure marketing techniques.

Living donation of kidneys and other paired organs increased significantly over the past two decades, but tapered off more recently. Living donation too is not without ethical complications and statistical limitations relative to the shortage of donor organs.

LifeSharers ( innovatively and controversially aims to incentivize cadaveric donation by means of what their local business journal called an “organ club.” “Organs for organ donors,” is the LifeSharers tagline.

But after seven years and much national publicity, there are only about 12,000 members and a net gain of zero donors and recipients (

I think presumed consent laws also are no panacea to a growing and complex problem.

In any case, the U.K. is not the U.S.A. Even if the British buy into an opt-out system for organ donation, it seems unlikely that Americans will follow suit any time soon.

We retain a strong individualism that places less value on solidarity than on autonomy. It is not so everywhere, of course, and might not be descriptive of this society when a seemingly more communitarian Boomer Babies generation takes the reigns of power within the next 20 years or so.

By then, we hopefully will have discovered radically new clinical responses to end-stage organ disease, something less morally messy perhaps than organ donation and transplantation.

If not, will either the U.S. or the U.K. have presumed consent laws in place? Were this to happen, it is possible that donation rates could rise a bit, and that a few more lives could be improved and extended by transplant medicine. And if one of the few is your life or mine or that of our loved one, it surely will seem worth it.

Yet, it is not possible to meet the rising demand for transplantable organs by means of presumed consent, whether here or across the pond. The need is simply too great, and growing exponentially just for renal organs alone. The cadaveric donor pool is too small, no matter what laws are passed in the near or distant future.

Might there be a more fitting response to this shared dilemma?

What do you think? To view and share comments click here.

Link: Redefining death: A new ethical dilemma, American Medical News, January 19

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Blogger Dave said...

If UNOS adopted the LifeSharers approach, allocating organs first to registered organ donors, then just about everyone in the United States would register as a donor. Few people would refuse to donate if they knew it would put them at the end of the waiting list if they ever needed a transplant.

UNOS has the authority to change its allocation rules to put registered organ donors first. No legislative action is required. Presumed consent needs legislative action for implementation in the United States.

There is about a 45% chance that one or more current LifeSharers members will die and become an organ donor in the next 12 months. When LifeSharers arranges the first transplant from one member to another, we expect our membership to explode.

Anyone who wants to donate their organs to other organ donors is welcome to joinn LifeSharers at Membership is free. No one is excluded due to any pre-existing medical condition.

Friday, January 23, 2009  

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