The authority of next-of-kin in explicit and presumed consent systems for deceased organ donation: an analysis of 54 nations

In an effort to solve the shortage of transplantable organs, there have been several proposals to introduce an opt-out approach to deceased organ donation in England (also termed ‘deemed’, or ‘presumed’ consent). In seeking to enact the so-called ‘opt-out proposal’ via an amendment to the Human Tissue Act 2004, The Organ Donation (Deemed Consent) Bill 2017–19 represents the most recent attempt at such legal reform. Despite popular calls to the contrary, I argue in this paper that it would be premature for England, or, indeed, any country, to adopt an opt-out approach at this time. Not only is the available evidence inconclusive on whether introduction of the opt-out proposal would increase the supply of transplantable organs (a common misconception), but there is also a chance that doing so might bring about an otherwise avoidable moral harm through an unjustified interference with individual autonomy. I maintain that the resources required to change the law to such effect would be better expended on alternative, provenly efficacious and less contentious mechanisms for increasing the supply of transplantable organs, such as: improving communication with the family of the deceased, developing infrastructure, raising public awareness and enhancing staff training, attitudes and understanding towards organ donation.

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The Failure to Give

Public Bioethics ◽

10.1093/med/9780199798483.003.0009 ◽

2020 ◽

pp. 177-211

Author(s):

James F. Childress

Keyword(s):

Organ Donation ◽

Financial Incentives ◽

Cost Benefit ◽

Deceased Donor ◽

The United States ◽

First Person ◽

Presumed Consent ◽

Opt Out ◽

Deceased Organ Donation ◽

Risk Cost

After considering the huge and persistent gap between the supply of deceased donor organs for transplantation and the number of patients on the waiting list for a transplant, this chapter considers different ethical frameworks for evaluating first-person failures to donate organs after death and then assesses selected public policies designed to overcome these failures. Policies to facilitate first-person deceased organ donation often seek to alter the individual’s risk/cost-benefit calculations in deciding whether to register as a donor (for instance, by providing financial incentives); financial incentives can be ethically justifiable under some circumstances if they encourage and facilitate donation but do not implicate the sale of organs. Other proposed policies seek to nudge the individual’s declaration of organ donation through mandated choice or required response or through opt-out policies, often called “presumed consent,” under which not opting out counts as a donative decision. Available evidence suggests that mandated choice, required response, and presumed consent would probably be ineffective and perhaps even counterproductive in the United States at this time, but that some carefully designed combination could possibly be both ethically acceptable and effective.

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Deceased organ donation in Nova Scotia: Presumed consent and system transformation

Healthcare Management Forum ◽

10.1177/0840470420919129 ◽

2020 ◽

Vol 33 (5) ◽

pp. 210-213

Author(s):

Kristina Krmpotic ◽

Cynthia Isenor ◽

Stephen Beed

Keyword(s):

Nova Scotia ◽

Health System ◽

Organ Donation ◽

Professional Education ◽

Provincial Government ◽

System Transformation ◽

Presumed Consent ◽

Awareness Campaigns ◽

Deceased Organ Donation ◽

Education Performance

In recent years, rates of deceased organ donation in Nova Scotia have remained stagnant, falling behind provinces that have invested in their organ donation programs. The Nova Scotia provincial government has recently committed to health system transformation, which will include enactment of presumed consent legislation in 2020. Although impressive rates of deceased organ donation are often observed in countries with presumed consent legislation, improvements in performance can more often be attributed to the accompanying health system transformation. Key components of high performing deceased organ donation systems include highly trained organ donation specialists, practice guidelines, healthcare professional education, performance metric reviews, accountability frameworks, and public awareness campaigns in addition to adequate legislation. For Nova Scotia’s organ donation program to succeed, the provincial government must also invest the frontline financial resources required to develop and maintain adequate program infrastructure and implement key strategies to support a culture of donation.

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A systematic review of presumed consent systems for deceased organ donation

Clinical Governance An International Journal ◽

10.1108/cgij.2009.24814dab.002 ◽

2009 ◽

Vol 14 (4) ◽

Keyword(s):

Systematic Review ◽

Organ Donation ◽

Presumed Consent ◽

Deceased Organ Donation

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A systematic review of presumed consent systems for deceased organ donation

Health Technology Assessment ◽

10.3310/hta13260 ◽

2009 ◽

Vol 13 (26) ◽

Cited By ~ 41

Author(s):

A Rithalia ◽

C McDaid ◽

S Suekarran ◽

G Norman ◽

L Myers ◽

...

Keyword(s):

Systematic Review ◽

Organ Donation ◽

Presumed Consent ◽

Deceased Organ Donation

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The Relative Impact of Presumed-Consent Legislation on Thoracic Organ Donation in the Eurotransplant Area

Journal of Transplant Coordination ◽

10.1177/090591999600600405 ◽

1996 ◽

Vol 6 (4) ◽

pp. 174-177 ◽

Cited By ~ 2

Author(s):

Leo Roels ◽

Johan De Meester

Keyword(s):

Organ Donation ◽

Healthcare Professionals ◽

Organ Procurement ◽

Relative Impact ◽

Next Of Kin ◽

Presumed Consent ◽

The Public ◽

Explicit Consent ◽

The Right ◽

Thoracic Organ

A country's organ donation rate and hence the availability of thoracic organs can be increased by organizational measures, by legislative incentives, and by increasing awareness among the public and healthcare professionals. We analyzed the relative impact of organ procurement legislation or policy on heart and lung donation rates per million population per year in the four countries participating in the Eurotransplant organization (population, 112.7 million) between January 1992 and December 1994. Within this organization, Austria and Belgium have presumed-consent legislation, whereas Germany and the Netherlands have an opting-in (explicit-consent) policy. Although practices vary even among countries with similar policies (eg, in Belgium, relatives of the donor retain the right to object to procurement of organs in the absence of an explicit consent from the deceased before death), rates of heart and lung donation were at least twice as high in the two countries with presumed-consent legislation as in the two countries that rely on a policy of explicit consent from the donor's next of kin.

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‘Pass it on’ - New Organ Donation Law in England May 2020

The Physician ◽

10.38192/1.6.1.7 ◽

2020 ◽

Vol 6 (1) ◽

Author(s):

Sunil Daga ◽

Rakesh Patel ◽

Dane Howard ◽

Kirit Mistry ◽

Veena Daga

Keyword(s):

Health Policy ◽

Organ Donation ◽

Cultural Sensitivity ◽

Legal Status ◽

Next Of Kin ◽

Presumed Consent ◽

Lack Of Information ◽

Life Saving ◽

The Gift ◽

The Uk

Editorial Commentary From 2020, a new legislation comes into force in the UK providing legal status to the concept of presumed consent, extending this from Wales. In essence, consent for organ donation will be assumed unless the donor had actively opted-out. For Black Asian and minority ethnic communities, there is a widening gap between the availability of donors and those that are waiting on transplant lists. A particular stumbling block seems to be the denial of consent by next-of-kin, which appears to be disproportionately high. Exploration of the reasons behind such withholding of consent appears to be lack of information, myths, a lack of cultural sensitivity more than any religious decree [1-2]. Hence, this article will explore in-depth the current scenario, the causes behind these disproportionate representation and leadership that community leaders need to take to improve the access to this life-saving treatment option. 1 Chakravorty, I. (2020). The Gift of Life: Social & Cultural Perspectives on Organ Donation. SUSHRUTA Journal of Health Policy & Opinions, 13(1), 10-12. https://doi.org/10.38192/13.1.2 2 Krishnan, N., & Modi, K. (2020). Organ Donation Law & Its Impact on BAME Communities. SUSHRUTA Journal of Health Policy & Opinions, 13(1), 13-15. https://doi.org/10.38192/13.1.4

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