Like all policy discussions, there are multiple points of view.
Here are some common discussions and questions.
Presumed Consent means doctors won’t try to save my life.
Answer: This is a common misperception about organ donation. Read here to learn more.
What countries have Presumed Consent?
Answer: Presumed consent countries include Australia, Austria, Belgium, Bulgaria, Croatia, Cyprus, Czech Republic, Estonia, Finland, France, Greece, Hungary, Israel, Italy, Latvia, Luxemburg, Norway, Poland, Portugal, Slovak Republic, Slovenia, Spain, Sweden and Turkey (Abadie & Gay, 2006). Belgium, for example, has had presumed consent since before 1991.
Presumed Consent doesn’t work in other countries.
Answer: Epidemiological research indicates that organ donation is influenced by a variety of determinants. A quantitative study by Abadie and Gay is one of few empirical studies on organ donation rates. The researchers analyzed data for 22 countries over a ten-year period. They sought to control for potential confounding factors in measuring the impact of presumed consent on organ donation. Specifically, they “obtained information on a number of factors that are thought to affect donation rates and legislative defaults on organ donation, such as per capita GDP, health expenditures per capita, religious beliefs, the legislative system and the number of deaths caused by motor vehicle accidents and cerebro-vascular diseases.” Regression analysis was applied to understand the relation of consent legislation to organ donation rates after controlling for the above determinants. The conclusion was that when other determinants are accounted for, presumed consent countries on average experience approximately 25–30% higher donation rates than informed consent countries.
Examining cadaveric donations made per million (DPMP) in 17 European countries over a nine year period, Johnson and Goldstein (2003) concluded that presumed consent has a strong effect on donation rates. “When donation is the default, there is a 16.3% (P < 0.02) increase in donation, increasing the donor rate from 14.1 to 16.4 million.” The study utilized a multiple regression analysis and also controlled for other determinants (similarly to Abadie and Gay) such as transplant infrastructure, education, and religion.
A study published in the British Journal of Medicine, in May 2010, statisticians concluded that presumed consent could produce an extra 2,880 donors over ten years in the UK.
When reading other research that claims that presumed consent countries do not produce significantly higher organ donation rates, look to see if the research is a quantified, statistical study that controls for a variety of determinants.
Presumed Consent doesn’t change attitudes.
Answer: Families in informed consent countries assume that if the deceased was not registered the deceased therefore had weak preference for donation. In presumed consent countries, the families made the opposite inference, assuming that non-registered individuals had strong preferences for donation. The end result being that family donor consent rates were equal to or higher in presumed consent countries (Abadie and Gay, 2006).
It is often difficult for bereaving relatives to move beyond the abstract support of organ donation as a societal benefit and think about how they feel for donation for a family member (Mossialos, Costa-Font and Rudisill, 2008). A cross-sectional study by Mossialos, Costa-Font and Rudisill (2008) found that relatives in presumed consent countries expressed a higher willingness to donate both their own and relative’s organs.
Since we have first-person consent laws in every state, don’t we already have presumed consent?
Answer: Clearly, family preferences are a key determinant in donor rates. Today, even in first-person consent states, Organ Procurement Organizations (OPO) defer to family wishes regarding donation. This practice is attributed to fear of litigation and is a violation of the Federal Uniform Anatomical Gift Act. Read the Texas Attorney General’s opinion on the right to enforce first person consent here. In practice, a person who registered as a donor may still end up not being a donor.
When an individual dies, the family assumes responsibility for not only providing information on what the patient may have preferred, but also to make decisions on behalf of the deceased. It can be argued that presumed consent creates a better balance in public policy between duties to the deceased and to patients waiting for an organ transplant (English and Sommerville, 2003).
Presumed Consent violates my right to have control over my body.
Answer: Control of one’s body is considered a fundamental right in western law and generally regarded as part of the principle of self determination. So regarded is this right that law provides for competent adults to be allowed to die versus prolonging life by medical technology when this has been expressly consented (English and Sommerville, 2003). In theory, this same right would extend to the consent of organ donation, if consent was clearly expressed.
Additionally, presumed consent does not override the individual’s right to “opt-out” of organ donation which therefore protects the right to control one’s body.
Presumed Consent is immoral because we will remove organs from the bodies of people who did not want their organs removed.
Answer: Removing organs from the bodies of people who did not want them removed would be unfortunate but it is less morally reprehensible than to let people die because we are failing to act upon the desire of most people to do the right thing. Surveys have shown that most people favor organ donation. Read an entire paper here on this debate, that concludes presumed consent is more morally fair than our current system.
Abadie, A., & Gay, S. (2006). The impact of presumed consent legislation on cadaveric organ donation: A cross-country study. Journal of Health Economics, 25(4), 599-620.
English, V., & Sommerville, A. (2003). Presumed consent for transplantation: A dead issue after Alder Hey? Journal of Medical Ethics, 29(3), 147-152.
Johnson, E., & Goldstein, D. (2003, November 21). Medicine. Do defaults save lives? Science (New York, N.Y.), 302(5649), 1338-1339. Retrieved November 16, 2008, from MEDLINE database
Mossialos, E., Costa-Font, J., & Rudisill, C. (2008). Does organ donation legislation affect individuals’ willingness to donate their own or their relative’s organs? Evidence from European Union survey data. BMC Health Services Research, 8, 48.