US Organ Shortage - Presumed Consent Not The Solution

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Main Category: Transplants / Organ Donations
Article Date: 01 Dec 2011 - 9:00 PST

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According to new John Hopkins research, organ donation rates in the United States are not likely to increase by changing from an opt-in process, whereby individuals check a box on their driver's license application for example, to an opt-out process, known as presumed consent, in which a person will automatically donate their organs unless they explicitly object whilst they are alive.

Some organ donation advocates press to change the opt-in process to implement a system of presumed consent, as it would be a positive effort to tackle the nation's profound organ shortage. They reason that although most people are in support of donation, they just never formally record their wishes, and that it might ease the problem of having to confront grieving families about the issue of donating organs at the time of their loved one's death.

Each year, several thousand people die whilst waiting for organs that never come, and many viable organs are never made available for donation.

Dr Dorry L. Segev, an associate professor of surgery at the Johns Hopkins University School of Medicine and leader of the study published online in the journal Transplantation comments:

"Opt-out is not the magic bullet; it will not be the magic answer we have been looking for. With opt-out the perception becomes, 'We will take your organs unless you take the time to fill out a form.' That's a dangerous perception to have. We only want to use donated organs from people who intended to donate."

He adds that enforcing a policy of presumed consent will raise complex ethical questions and could disturb the relationship between the transplant community and the general public, which should be one of mutual support.

Segev and his colleagues held in-depth interviews with transplant experts in 13 European nations with presumed consent legislation and discovered that, despite the law, the opt-out organ donation process did not significantly differ in these countries compared to the opt-in policy in countries such as the U.S.

Their findings also revealed that amongst the nations surveyed in rates of organ donation, Spain had the most with 34.1 deceased donors per million population, followed by 26.7 in Portugal and thirdly 26.3 donors in the U.S. respectively.

Brian J. Boyarsky, the Hopkins researcher who conducted the interviews states:

"It does not appear that by simply having presumed consent legislation on the books that donation rates will rise."

According to Segev, physicians in the United States will approach family members and ask whether they would still like to donate their loved one's organs irrespective of whether or not the deceased was registered as an organ donor or not. It is the family who gets to make the final decision irrespective of the deceased's declared intentions.

The researchers also discovered that even in countries with presumed consent, physicians still discussed donation issues with the family at the time of death of their loved ones, despite the fact that they were legally permitted to transplant those organs. Six of the 13 countries actually legally require that doctors consult with the deceased's relatives to maintain transparency regarding the donation process and to obtain a complete medical and social history of the potential donor. Participants reported that for fear of negative press but also to respect the wishes of the grieving family to prevent psychological harm, the donation would not proceed if the family objected in all but one (Portugal) of the countries surveyed.

Segev argues that implementing presumed consent legislation would be an immensely time consuming exercise with minimal payoff. He points out that many countries with presumed consent have much lower numbers of organ donations than the U.S. and says that lessons should be learned from countries like Spain, the leading country in Europe in terms of organ donations.

Every hospital in Spain has dedicated physicians who know about transplant issues and screen for potential donors, manage their care and approach families. According to Segev, the main reason for Spain's higher donation rates are these dedicated physicians, and not simply the existence of presumed consent.

He states: "We need to foster more awareness of transplantation and transplant issues to procure more organs for lifesaving transplants rather than force people to donate their relatives' organs if they fail to opt-out before death," adding that the most important fact "is that people need to be very clear with their next of kin while they are still alive about whether or not they want to be organ donors. That's who will ultimately make the decision."

Other Johns Hopkins researchers involved in the study include Erin C. Hall, M.D., M.P.H.; Neha A. Deshpande, B.A.; R. Lorie Ros, Sc.M.; Robert A. Montgomery, M.D., D.Phil.; and Donald M. Steinwachs, Ph.D.

Written by Petra Rattue
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

Additional References Citations Visit our transplants / organ donations section for the latest news on this subject. Transplantation

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