The ‘opt-out’ approach to deceased organ donation in England: A misconceived policy which may precipitate moral harm

2019 ◽  
Vol 14 (2) ◽  
pp. 63-69
Author(s):  
Tobias K Cantrell
Keyword(s):  
Organ Donation ◽  
Public Awareness ◽  
Recent Attempt ◽  
Individual Autonomy ◽  
Presumed Consent ◽  
Opt Out ◽  
The Family ◽  
Deceased Organ Donation ◽  
Tissue Act ◽  
Human Tissue Act

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.

The Failure to Give

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.

7. Organ transplantation

2021 ◽  
pp. 114-133
Author(s):  
Jo Samanta ◽  
Ash Samanta
Keyword(s):  
Organ Donation ◽  
Organ Transplantation ◽  
Human Tissue ◽  
Ethical Issues ◽  
Artificial Organs ◽  
Court Cases ◽  
Presumed Consent ◽  
Tissue Act ◽  
Alternative Sources ◽  
Human Tissue Act

This chapter deals with statutory provisions governing human tissue and organ transplantation, with particular reference to the Human Tissue Act 2004. It first considers the position at common law with regards to property in the human body, followed by a discussion of appropriate consent given by potential donors prior to their death or by deceased donors. It also considers the change in law to presumed consent under the Organ Donation (Deemed Consent) Act 2019. Organ donation from living persons and ethical issues surrounding organ transplantation are then explored. The chapter concludes by looking at alternative sources of organs, including xenotransplantation and artificial organs. Relevant court cases are cited, where appropriate.

scholarly journals Opt-out policies capacity to increase organ donors is limited

2021 ◽  
Author(s):  
Alberto Molina Pérez ◽  
David Rodríguez-Arias ◽  
Janet Delgado
Keyword(s):  
Decision Making ◽  
Organ Donation ◽  
Default Rule ◽  
Relative Impact ◽  
Post Mortem ◽  
Presumed Consent ◽  
Organ Retrieval ◽  
Opt Out ◽  
The Family ◽  
The Impact

Objectives: To increase post-mortem organ donation rates, several countries are adopting an opt-out (presumed consent) policy, meaning that individuals are deemed donors unless they expressly refused so. However, studies on the relative impact of opt-in or opt-out on deceased organ donation rates are inconclusive. Although opt-out countries tend to have higher donation rates, there is no conclusive evidence that this is caused by the policy itself. The main objective of this study is to better assess the impact of consent policies when considering the role of the family in decision-making. Design: By systematically combining the three components of the decision-making process --the default rule, the deceaseds preferences, and the family s preferences,-- we identify all situations that affect the retrieval outcome under opt-in and opt-out policies. Then, by gathering empirical data from a wide array of countries, we estimate the relative frequency of these situations. Main outcome measures: We measure the relative impact that opt-in and opt-out policies have per se on post-mortem organ retrieval. Results: Our analysis shows that opt-in and opt-out have strictly identical outcomes in eight out of nine situations. These policies only differ when neither the deceased nor the family have expressed a preference and defaults therefore apply. The actual impact of consent policies is typically circumscribed to a range of 0% to 5% of all opportunities for organ retrieval. Conclusions: This study may warn contemporary organ retrieval policymakers that, by emphasizing the need to introduce presumed consent, they might be overestimating the influence of policy defaults and underestimating the power granted to families in expressing their preferences and making decisions about organ donation. Governments should reassess the opportunity and effectiveness of adopting opt-out policies for organ retrieval.

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

2011 ◽  
Vol 27 (6) ◽  
pp. 2533-2546 ◽  
Author(s):  
Amanda M. Rosenblum ◽  
Lucy D. Horvat ◽  
Laura A. Siminoff ◽  
Versha Prakash ◽  
Janice Beitel ◽  
...  
Keyword(s):  
Organ Donation ◽  
Next Of Kin ◽  
Presumed Consent ◽  
Deceased Organ Donation

12. Organ Transplantation

Medical Law ◽  
2019 ◽  
pp. 625-690
Author(s):  
Emily Jackson
Keyword(s):  
Informed Consent ◽  
Organ Transplantation ◽  
Human Tissue ◽  
Similar System ◽  
Uterus Transplantation ◽  
Organ Retrieval ◽  
Opt Out ◽  
Tissue Act ◽  
Human Tissue Act ◽  
The Uk

All books in this flagship series contain carefully selected substantial extracts from key cases, legislation, and academic debate, providing students with a stand-alone resource. This chapter discusses organ transplantation. It first considers cadaveric donation, looking at who may become a donor, and which organs can be taken. It also includes discussion of the issues raised by novel transplants, like face and uterus transplantation. The chapter summarizes the system of organ retrieval in the UK, looking at the consent-based model adopted in the Human Tissue Act 2004; the introduction of an opt-out system in Wales, and the government’s plan to introduce a similar system in England. It then turns to living organ donation, looking at informed consent and the legitimacy, or otherwise, of incentives. Finally, it considers the ethical, practical, and legal obstacles to xenotransplantation, i.e. transplanting animal organs into human recipients.

scholarly journals A global pandemic is not a good time to introduce ‘opt-out’ for organ donation

2020 ◽  
Vol 20 (2) ◽  
pp. 155-166
Author(s):  
Jordan A. Parsons ◽  
Greg Moorlock
Keyword(s):  
Organ Donation ◽  
Media Coverage ◽  
Public Awareness ◽  
Good Time ◽  
Organ Donors ◽  
Resuscitation Orders ◽  
Global Pandemic ◽  
Opt Out ◽  
The Impact ◽  
New System

Following several international examples, England introduced a system of deemed consent for organ donation in May 2020. This had been planned for over a year. However, the unprecedented circumstances of the COVID-19 pandemic raise issues that make the timing of this change unfortunate. The planned public awareness campaign has thus far been overshadowed by media coverage of the pandemic, and will likely continue to be, creating a situation in which a significant portion of the population may be unaware of having become potential organ donors. Further, the immediate impact of the new policy is likely to be significantly weakened by the suspension of the majority of organ donation and transplant activity. In this article, we first outline the details of the new model introduced in England, before considering the impact of the pandemic on transplantation services. We put forward three ethical reasons why, given the unprecedented circumstances, the change should have been postponed. We argue that (1) COVID-19 dominating headlines will prevent widespread awareness of the change, thereby undermining the autonomy of those who do not wish to be donors; (2) a lack of transplant activity during the pandemic will make the impact of the change difficult to measure; and (3) trust in the new system may be damaged given controversial decisions regarding Do Not Attempt Cardiopulmonary Resuscitation orders and the allocation of scarce intensive care resources. These reasons combined make for a shaky start at best and present a risk of the new system failing to achieve its desired and essential effect of increasing the number of voluntary organ donors.

scholarly journals The ethical and legal implications of the Human Tissue Amendment Act 2020 (Vic)

2021 ◽  
Vol 23 (3) ◽  
pp. 245-247
Author(s):  
Steve Philpot ◽  
◽  
David Anderson ◽  
◽  
◽  
...  
Keyword(s):  
Organ Donation ◽  
Human Tissue ◽  
Medical Practitioner ◽  
Determination Of Death ◽  
Medical Practitioners ◽  
Legal Implications ◽  
Tissue Act ◽  
Human Tissue Act ◽  
Circulation Of The Blood

The Human Tissue Act 1982 (Vic) has recently been amended by the Human Tissue Amendment Act 2020(Vic). In an effort to better reflect the modern practice of organ donation, the intention of the amendment is to include a process for the authorisation of ante-mortem procedures in patients being considered for organ donation after circulatory determination of death(DCDD). As part of this process, the amendment introduces a new requirement for consent for such ante-mortem procedures, and specifies that: A designated officer for a hospital must not give an authority … in respect of a person unless, where the respiration or the circulation of the blood of the person is being maintained by artificial means, two registered medical practitioners, neither of whom is the designated officer and each of whom has been for a period of not less than five years a registered medical practitioner, have each certified in writing — ​ that the practitioner has carried out a clinical examination of the person while the respiration or the circulation of the blood of that person was being maintained by artificial means; and that, in the practitioner’s opinion, at the time of examination, death of the person would occur as a result of the withdrawal of the artificial means of maintaining the respiration or the circulation of the blood of the person.

Applying utilitarianism to the presumed consent system for organ donation to consider the moral pros and cons

2021 ◽  
Vol 30 (19) ◽  
pp. 1127-1131
Author(s):  
Jelena Morris ◽  
Janet Holt
Keyword(s):  
Informed Consent ◽  
Organ Donation ◽  
Philosophical Theory ◽  
Presumed Consent ◽  
Consequentialist Theory ◽  
Opt Out ◽  
Pros And Cons ◽  
The Uk

In May 2020, England adopted an opt-out approach for organ donation, also referred to as the deemed consent system, with the aim of alleviating the demand for organs in the UK. This system dictates that those who have not opted out will have their organs donated following their death, with the exception of those meeting certain criteria. This article applies the philosophical theory of utilitarianism to the deemed consent system for organ donation, focusing particularly on topics such as that of informed consent and family refusal. Utilitarianism is a consequentialist theory that attempts to determine whether an action is morally right or wrong based on whether or not it maximises the preferences of the greatest number of people, with each person's satisfaction being considered as equal to another's.

9. Organ Donation and the Ownership of Body Parts

2020 ◽  
pp. 472-531
Author(s):  
Jonathan Herring
Keyword(s):  
Organ Donation ◽  
Organ Transplant ◽  
Legal Protection ◽  
Body Part ◽  
The Body ◽  
The Self ◽  
Body Parts ◽  
Living Body ◽  
Tissue Act ◽  
Human Tissue Act

This chapter examines legal and ethical aspects of organ donation and body part ownership. Topics discussed include the Human Tissue Act 2004; liability for mishaps from organ transplant; the shortage of organs for transplant; xenotransplantation; selling organs; face transplants; and the living body as property. Running through this chapter is a discussion of whether it is preferable to see the body and parts of the body as property or whether they need their own system of legal protection through a statute. This debate ties into broader discussions about the nature of the self and what makes bodies valuable.

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