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.

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.

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.

Time to debate an opt-out system for organ donation in England as well as the rest of the UK

BMJ ◽  
2015 ◽  
Vol 351 (nov19 3) ◽  
pp. h6140-h6140 ◽  
Author(s):  
M. Hobday
Keyword(s):  
Organ Donation ◽  
Opt Out ◽  
The Uk

Fewer Mistakes and Presumed Consent

2021 ◽  
Author(s):  
Alexander Zambrano
Keyword(s):  
Organ Donation ◽  
Patient Autonomy ◽  
Organ Procurement ◽  
Major Premise ◽  
Presumed Consent ◽  
Procurement Policy ◽  
Opt Out ◽  
Explicit Consent ◽  
Major Argument ◽  
Better Than

Abstract “Opt-out” organ procurement policies based on presumed consent are typically advertised as being superior to “opt-in” policies based on explicit consent at securing organs for transplantation. However, Michael Gill (2004) has argued that presumed consent policies are also better than opt-in policies at respecting patient autonomy. According to Gill’s Fewer Mistakes Argument, we ought to implement the procurement policy that results in the fewest frustrated wishes regarding organ donation. Given that the majority of Americans wish to donate their organs, it is plausible that a presumed consent policy would result in fewer frustrated wishes compared to the current opt-in policy. It follows that we ought to implement a policy of presumed consent. In this paper, I first consider and find wanting an objection to the Fewer Mistakes Argument developed recently by Douglas MacKay (2015). I also consider an objection put forth by James Taylor (2012) but argue that there is a methodological reason to prefer my own argument to Taylor’s. Finally, I argue for two theses: first, that Gill’s major argument in favor of the crucial premise of the Fewer Mistakes Argument is flawed, and second, that the major premise of the Fewer Mistakes Argument is false.

Organ Donation after Circulatory Determination of Death: Lessons and Unresolved Controversies

2008 ◽  
Vol 36 (4) ◽  
pp. 766-771 ◽  
Author(s):  
James F. Childress
Keyword(s):  
Organ Donation ◽  
Organ Donor ◽  
Donation After Cardiac Death ◽  
Court Cases ◽  
Determination Of Death ◽  
Presumed Consent ◽  
Potential Organ Donor ◽  
Opt Out ◽  
The U.S

The several articles in this special issue on organ donation after circulatory determination of death or, as it is often put, donation after cardiac death (DCD), draw lessons from different kinds of experience in order to guide efforts in the U.S. to develop or refine policies for DCD. One lesson comes from a major and, by many measures, successful experimental DCD program in Washington, D.C. in the 1990s. Another lesson comes from European countries that have adopted presumed-consent legislation, a form of “opt out” that facilitates DCD as well as donation after neurological determination of death (DND). Another lesson, from the perspective of critical care medicine in Canada, attends to the implications of viewing a dying patient, undergoing resuscitative procedures, as a potential organ donor. A final lesson sketches implications of legislation and court cases in the U.S., often involving DND, for initiating temporary organ preservation (TOP) in DCD programs before consent has been obtained for organ donation. Some of these lessons are optimistic about the prospects for DCD, especially if certain steps are taken, while others are more cautious, particularly because of the costs and risks involved in DCD.

Organ donor registration in the UK: The need for informed consent for ante-mortem interventions to facilitate organ donation

2019 ◽  
Vol 19 (2-3) ◽  
pp. 113-135 ◽  
Author(s):  
Sarah-Jane R. Brown
Keyword(s):  
United Kingdom ◽  
Informed Consent ◽  
Organ Donation ◽  
Organ Donor ◽  
Best Interests ◽  
Duty Of Care ◽  
Specific Information ◽  
The United Kingdom ◽  
Donation Process ◽  
The Uk

A generic consent model for the organ donation process currently permeates organ donation policy in the United Kingdom. The National Health Service Blood and Transplant’s (NHSBT’s) strategy for increasing organ donation rates in the United Kingdom includes interpreting a person’s registration on the Organ Donor Register (ODR) as justifying changes to the end-of-life care of the ODR registrant once incapacitated. However, individuals registering on the ODR are not currently provided with specific information regarding any ante-mortem procedures that may be carried out to facilitate organ donation. In this article, I argue that a specific consent model for ante-mortem donor optimisation procedures is needed not only to facilitate the achievement of the best interests of ODR registrants once incapacitated but also to fulfil NHSBT’s obligations to ODR registrants under the law on informed consent. I argue that NHSBT owes a duty of care to ODR registrants and that the implications of this duty of care include incorporating informed consent standards into the process of ODR registration.

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.

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