Controversy: Should We Take Organs Without Consent?

Posted: January 22, 2008 in Presumed Consent

In my on-going effort to promote organ donation I’ve found that the altruistic approach, (doing one’s civic duty) while admirable, has not done enought to increase the number of available organs.  Thousands are dying each year because the number of people needing organs is outpacing availability.  Something must be done!  In that light I have embarked on an effort to explore alternatives to altruism.  Today’s blog explores one of them. 

Implied or presumed consent is the norm in several European countries and the Prime Minister of England has stated that he would like the system in place by the end of the year.  In effect presumed consent means that unless you have pre-registered your desire NOT to be an organ donor, your organs may be taken upon your death with permission from no one.  The idea is has been studied in the U.S. for some time with the idea that adopting such a policy might cause a significant increase in the number of available organs.

OPTN (The Organ Procurement and Transplantation network) is a part of UNOS (United Network for Organ Sharing) the Government regulated organization that matches available organs with those who need them.  

In 1993 an OPTN committee determined that such a policy was not appropriate at that time.  But now, it is 15 years later and the need for organs is far outpacing the supply.  Is it time to begin considering presumed consent again?  Below are the OPTN pros and cons.

OPTN URL:   http://www.optn.org/resources/bioethics.asp?index=2

 Excerpt from OPTN, the Organ Procurement and Transplantation Network:

Advocates of presumed consent advance the following in support of their position:

  • Efficiency is Good. Increasing the supply of organs — that is, supply-side efficiency — is a worthwhile goal. It is sufficiently important to collect more organs that other goals and values, within limits, may be compromised;
  • Asking for Consent can be Cruel. Presumed consent would obviate the need to ask the donor’s family for consent at a time of family’s painful grieving.
  • Individual Conscience Can be Respected. Presumed consent respects the principle of individual choice by giving objectors to organ donation an opportunity to empower their anti-donation preference;
  • Individuals Owe Society the Effort to Register their Objection. Individuals who object to organ donation should be burdened with the task of registering their preference to the public authorities because organ donation is, presumptively, socially desirable. The burden of communicating objection should be placed on objectors to organ donation.

Presumed consent, advocates argue, combines the principles of supply-side efficiency, respect for individual conscience, and individual’s positive, yet qualified, duty to promote the good of society.

Opponents of presumed consent base their position on the following presuppositions:

  • There will be false positives, that is, persons who were ‘presumed” to consent but who, in fact, objected to donation. Under a policy of “presumed consent,” some individuals who do object to organ donation in principle will not register their preference with public authorities because of one of many factors. For instance, individuals on the margins of society might not learn of their option to register their refusal. Furthermore, individuals have differential access to the mechanism for registering refusal, as in the case of itinerant persons who may not receive a postcard informing them of the opting-out alternative
  • Problems in Registering and Transmitting Objection Status. The mechanism for registering and transmitting objection status is likely to be inadequate. Only a nationwide database of objectors is ethically justified because individuals may suffer irreversible cessation of brain function outside their state of residence. There is uncertainty whether mailed-in objection notices will be entered on the database and whether the information will be distributed to organ procurement organizations in a timely fashion.
  • Individual Autonomy Speaks to a Core Value. Asking individuals to publicly express their objection to donation does not respect the individual’s right not to choose. Individuals do not have a social duty to express an objection.
  • To Decide Whether to Consent is Not a Dichotomous Choice. Individuals should have the right to delegate the decision to family members. Presumed consent would authorize collection of organs of a non-objector who had trusted his family to make the decision.”

Once again I am asking for your comments.  Increasing the number of organs is a real matter of life and death.  One over which we have total control.  We must continue to talk, but we also need to do something — we need action.  My action is to get people to think and then pass your comments on to policy makers and opinion leaders across the U.S.  What’s yours?  What are you going to do?

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  1. [...] Controversy: Should We Take Organs Without Consent? Implied or presumed consent is the norm in several European countries and the Prime Minister of England has stated that he would like the system in effect by the end of the year. In effect presumed consent means that unless you have … [...]

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  2. Dave Undis says:

    If presumed consent was implemented in the United States, the supply of organs for transplant operations would increase significantly. According to polls, about 90% of Americans support organ donation but only about 50% have bothered to register. If everybody was automatically registered, few people would bother to un-register.

    Presumed consent can only be implemented in the United States through legislative action — Congress would have to pass a law. The chances of this happening in the foreseeable future are somewhere between very slim and none, because there is wide-spread opposition to the idea of presumed consent.

    Fortunately, there is an already-legal way to put a big dent in the organ shortage — allocate donated organs first to people who have agreed to donate their own organs when they die. The United Network for Organ Sharing, which manages the national transplant waiting list in the United States, has the power to make this common-sense policy change. No Congressional action is required.

    In the absence of action by UNOS, anyone who wants to donate their organs to others who have agreed to donate theirs can join LifeSharers. LifeSharers is a non-profit network of organ donors who agree to offer their organs first to other organ donors when they die. Membership is free at http://www.lifesharers.org or by calling 1-888-ORGAN88. There is no age limit, parents can enroll their minor children, and no one is excluded due to any pre-existing medical condition.

    Giving your organs first to organ donors will convince more people to register as organ donors. It will also make the organ allocation system fairer. People who aren’t willing to share the gift of life should go to the back of the waiting list as long as there is a shortage of organs.

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  3. Annette Watson says:

    I have always been a huge advocate for organ donation….until May 2007. Now, thanks to The Gift of Life (Ann Arbor, MI) and our only local hospital, I began to view another perspective on this issue. The potential donor’s family perspective. Long story short. I was my father’s POA, my mother has been in renal failure for close to six years. My father was on a ventilator for one week. After agonizing over the inevitable decision, we took my father off the vent on 5/5/07, he passed away at 4:30 p.m. It had been a very long, sad and difficult week to say the least. I handled all of the paperwork, guilt, preparations, etc, trying to minimize my mother’s heartache and worried that she would, herself maybe have another stroke, etc due to the hard blow my family was experiencing. My husband and father, two years prior had made prearrangements for both of my parents. Hearing this, the nurse assured me that they would contact the funeral home ASAP and should have him transported within a couple of hours. This was our only solace at this time, knowing that my father would finally be on his way to being at peace. WELL, we were very mistaken. At 11:00 that night, The Gift of Life would begin contacting me, which I was totally blindsided. I had just got my family settled and was attempting to sleep for the first time in the past couple of weeks, all while awaiting a phone call from my niece driving ten hours with small children to come in for the funeral. Still attempting to comprehend what actually occurred earlier in the day. I didn’t answer the phone, I was appaled. They would continue calling at 12:00 am-5:00 am, at which time I finally answered the phone and politely explained that I would need to discuss this with my mother and would call back by the given time frame if we so decided. They also preceeded to paint a very vivid, horrifying picture of what organs my dad would be eligibile to donate, which did not help my sleeping at all. I called the funeral home first thing in the morning, finding it odd that I hadn’t received a call from them yet. They hadn’t been notified of my father’s death yet! They were only notified of one death, which they were sure couldn’t have been my dad, that had been 18 hours earlier. No name was given, just that they were waiting for a decesion from the family….. Had I been told this decision would delay my dad’s funeral due to not even arriving to the funeral home until the next day? Absolutely not. But they did manage to call me one last time after I spoke with the funeral home to see if I had reached a decision.

    Also, after speaking with all the involved parties, I was told by the hospital that after my dad’s passing, (when I filed an official complaint) that this happened to three more families! They recognized that there was a problem in their current procedure and were working on implementing new policies. EIGHTEEN HOURS AFTER PASSING, MY DAD LAID IN THE COLD MOGUE AT THE HOSPITAL!!! Talk about being kicked when you are down.

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  4. [...] clear to me that presumed consent makes more sense to me than the opt-in system.  If someone is so bothered by the donation of their [...]

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