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Saturday, December 10, 2011

No reason to switch to presumed consent


There’s a severe shortage of organs available for donation in the United States.  According to the U.S. department of Health and Human Services, there are over 100,000 people currently waiting for an organ.  One suggestion for how to alleviate that situation has been to change our consent policy so that potential donors have to opt out rather than in.  However, a new study led by Dorry Segev of Johns Hopkins suggests that this would be of little help.

In the U.S., we have an opt in system of donation consent.  In other words, you have to actively agree to become a donor.  Many other countries choose an opt out system, also called presumed consent.  In those nations, each person is assumed to be a donor unless they specifically refuse while alive.  At first glance, it seems that presumed consent would have to garner more donations since many people with no objection to donating organs may never have bothered to opt in.  However, comparisons with donation rates in other countries show that this is not the case.  In fact, the U.S. ranks third in donation rates, well above many countries with opt out policies.

Apparently, the type of legal consent obtained makes little difference.  This may be because even in countries with presumed consent, family members are consulted prior to donation.  Only in Portugal (with the second highest donation rates, below only Spain) would doctors ignore family objections. 

Rather than switching to a presumed consent system, which would be costly and of dubious value, the authors suggest that the U.S. copy other aspects of Spain’s system.  Spain has dedicated transplant physicians at hospitals, ready to approach families and to assess and prepare patients.  Beyond that, the most important thing is to educate the public to discuss their wishes with their next of kin.