Controversy: Should We Take Organs Without Consent?
Posted by Bob Aronson
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.
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?