Thursday, November 22, 2012

Organ Donation: To Opt In or Opt Out, That is the Question

Organ shortage is a serious problem in the United States. About 20,000 organ transplants occur every year in the U.S., and 116,689 Americans are currently on a waiting list for an organ, with kidneys being the most needed organs. Furthermore, the obesity epidemic is also contributing to the shortage; a quarter of prospective donors are too obese to donate their kidneys. People typically wait 3-5 years for an organ, and thousands die every year (an average of 18 people per day) because they do not get the organs they need. Research is being done using embryonic stem cells and engineered scaffolds to try to regrow organs, but the complexity of these organs and the number of different cells and tissues comprising each organ tell me that this is not a possibility in the near future. However, there is something that can be done right now. Here I will present my case for the U.S. switching from our current opt-in program (i.e. the default is non-donor, and you must physically give consent for your organs to be donated when you die) to opt-out or presumed consent (i.e. the default is donor, and you must request to be taken off the list if this is what you want).

One of the major problems with organ donation is that people don’t want to acknowledge their mortality. It’s difficult to think about what will happen when you are dead, and it may seem weird for someone to take your organs. Other people are indifferent, apathetic, or don't want to take the time to opt-in when they get their license.

Consider Germany and Austria, which are very similar countries. Germany has an opt-in system and a 12% donor rate, while Austria has an opt-out system and a 99% donor rate! Here’s another comparison: Spain, with an opt-out system, currently leads the world with 34.4 deceased donors per million people, while the U.S., with an opt-in system, has 21.9. Clearly the default matters in this situation. The government is taking a stance and telling people what it recommends, and this greatly affects how people respond. In opt-out programs where the default is being an organ donor, there are higher donor rates.

Illinois has an interesting system called “mandated choice,” in which people are required indicate their preference. As a result, they have a 60% donor rate compared with the national rate of 38%. This program is a step in the right direction, as it at least solves the problem of people being indifferent or not taking the time to consider organ donation.

One of the major criticisms of the opt-out program is that freedom and liberty are being compromised. However, this is not the case because you still give each person the opportunity to opt out, and it is ultimately his or her responsibility to make this choice. Another potential problem is that an opt-out program may not actually increase organ donation rates, as Johns Hopkins researchers suggest. They say that physicians always approach the family members of the deceased and ask whether they would still like to donate their loved one’s organs. The family gets to make the final decision, regardless of the deceased’s intentions. I can see where they are coming from because you want to be respectful of the grieving family. However, people don’t always think the most clearly when they are emotional and grieving. Further, this limits the autonomy of the deceased, as they may have wished to have their organs donated. If this were followed more strictly, perhaps we would have more organs donated, especially if we switched to an opt-out program.

Adopting an opt-out program in the U.S. would definitely increase the donor rate, which is a step in the right direction. More stringent enforcement of people’s wishes by doctors would enable this to be carried out, decrease the organ shortage, and save thousands of lives.

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