Medical Consent and Organ Donation
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This past month, Dutch legislators narrowly passed a new law that would change the landscape of organ donation in the Netherlands (CNN). The law, to be implemented in 2020, would join countries such as Spain and France in an “opt-out” organ donation system. This would mean that instead of opting in and choosing to have your organs donated after death, you actually would have to manually opt out of having your organs donated after death. In the Netherlands, this would come in the form of a letter asking whether or not you would like your organs donated after death. Failure to respond after 6 weeks would result in the person being automatically on the organ donation list. In other countries, this can also be in the form of a question at the DMV, in which a person has to check a box to opt out of organ donation (in the United States, you have to check the box to opt into the donation program). This may seem like a small change, but does it have a larger effect on the amount of organ donors per country? Even if a country does get more organ donors through an opt-out system, is it right?
In the medical community, organ shortages are not uncommon. According to the United States Department of Health, 116,000 people are on the organ transplant waitlist as of August 2017, and on average, 20 people pass away waiting for a transplant per day. The rate at which people need transplants is growing higher than the donations. There also seems to be a gap between people wanting to donate and people choosing to donate. According to the Department of Health, 95% of American adults support organ donation, yet 54% of Americans are signed up to be organ donors. A way that other countries have raised their amount of organ donation participation is through changing how citizens sign up for organ donation. Instead of declaring that you would like to opt into donations, you actually have to elect to opt out of donating your organs. Statistics-wise, the switch seems to be working. In countries where you have to opt into organ donation, the average donation rate is normally lower than 15%, but the amount in opt out countries is often hovering around 90% (Forbes). How do we get such a large change? Behavioral economist Dan Ariely offers a solution in his Ted Talk “Are We in Control of Our Own Decisions?” The form of the opt-out system actually may change the way we think. Thinking about mortality and the complex notion of organ donation is hard to think about and the last thing we want to encounter when we’re at the DMV, so we end up avoiding the issue and skip over the organ donation box, leaving it unchecked.
The opt-out system argues that people have given their “presumed consent” when they don't respond within the 6 weeks' time. However, does this accurately portray someone’s wishes? While one can argue that an opt-out system might bring in more organ donations, is that the real percentage that would actually like to donate their organs? Is taking advantage of people's mental patterns like avoiding thinking about their death--causing them to not donate in opt-in systems and causing them to not say 'no' to organ donation in opt-out forms ethical? Is it ethical if it means possible organ donation against a person's heartfelt beliefs?
Organ donation is a personal question, but the answer has the chance to affect other people’s lives after death. In response to a worldwide organ shortage, countries such as France and the Netherlands have created opt-out systems as opposed to opt-in systems (like the United States). While the current statistics have proven that the opt-out system brings in a lot more organ donors, it’s hard to say whether or not presumed consent should be enough to warrant people okaying their organs to be donated after death. While the opt-out system may serve to save more lives, is it at a cost of something deeper?