Should organ donation after death be mandatory? Facts, methods of consent, pros and cons

With millions of patients waiting for organ transplantation, many argue that making organ donation after death mandatory would help save many more lives. Do you agree with making organ donation mandatory?

Should organ donation be compulsory?

Thanks to technological progress, organ transplantation has become an increasingly common, effective and safe technique to treat certain health problems. Organ transplantation is a life-saving procedure that has revolutionized modern medicine. However, millions of people are in long waiting lists to receive an organ. Thousands of these patients die every year still waiting for organ transplants. In the United States every day 22 people die, waiting for a suitable organ. This persistent problem raises the issue of whether organ donation after death should be mandatory or, at least, there should be an opt-out system in place based on presumed consent.

Facts on organ donation and transplantation

Organ transplantation is a procedure by which organs or tissues are moved from one body to another - or from one body site to another body site - to replace the recipient's damaged or absent organ and tissues. What organs can be donated and transplanted? 

• Organs that can be transplanted are: heart, kidneys, liver, lungs, pancreas, intestine, stomach, and thymus.
• Tissues include: bones, stem cells, blood, tendons, cornea, skin, heart valves, nerves and veins.

Kidneys are the most commonly transplanted organs, followed by the liver and then the heart. The biological tissue or an organ transplanted to a living recipient may come from a living or dead person. Both the removal and the transplantation of the organ require a surgical procedure and the doctors need to determine whether a recipient is suitable for transplantation based on the donor’s and the patient’s medical history.

There are 3 different types of transplants:

• Autograft: transplant of tissue to the same person, usually skin, veins and stem cells.
• Allograft: transplant of tissues or organs between different members of the same species. The organ donor may be alive or dead.
• Xenograft: transplant of organs and tissues betwen members of different species. Porcine heart valves are commonly transplanted to humans.

Other interesting facts about organ donations and transplants:

• About 120,000 organs are transplanted annually worldwide.
• About 28,000 donations from deceased donors are registered annually.
• More than 20,000 livers are transplanted every year from deceased donors.
• One donor can save 8 lives and change the lives of more than 50 people.
• The cornea is the most commonly transplanted tissue. In the U.S. more than 40,000 corneal transplants take place every year.
• No major religion formally opposes organ donation.
• The buying and selling human organs for transplant is forbidden in most countries, it is estimated that up to 10% of transplant operations may be performed with illegally harvested organs.

Organ transplantation faces challenges of biological nature, such as organ rejection from the recipient. However, there is also an ethical or moral dimension to the problem.  The issue of consent for organ donation after death remains controversial.

Methods of obtaining consent for organ donation after death

There are two main methods for determining voluntary consent for organ donation after death. One of them is the "opt in" method by which only those who have given explicit consent are donors. The second method is the "opt out" or “by default”, which assumes that anyone who has not refused is a potential donor. It has been established that opt-out legislative systems dramatically increase effective rates of consent for donation. Germany, the UK and  the US have adopted an opt-in system. Germany, for example, has an organ donation consent rate of 12% among its population. By contrast, Austria, its neighboring a country with a very similar culture and economic development, has a consent rate of 99.98%.

Austria, as well as Spain - world leader in organ donations and transplants- and Belgium, have adopted an opt-out system which entails "presumed consent" from the deceassed donor. In the opt-out system, it is the deceased next of kin who ultimately make the decision on organ donation. Many claim however that, the opt-out or by default method does not solve the problem. Instead to really improve the current rates of organ donation after death, it should be made compulsory regardless of the deceased or the family consent and even if this goes against the person’s religious beliefs. Supporters of compulsory donation claim that a person’s right to live through organ transplantation is more important than the right of deciding what to do with the organs of a dead person.

Watch this video on the need and controversy about presumed consent (opt-out) systems:

Compulsory organ donation pros and cons

Pros:

• Increase the pool of donors. Currently in the U.S only about 45% of the adult population is registered as organ donors. Compulsory donation would largely increase the pool of donors. The lives of many people waiting for a transplant would be saved.
• Automatic organ donation after death would speed up the process of transplantation and contribute to save lives, as doctors would not need to verify the consent status of potential donors. This would contribute to saving more lives.
• Compulsory donation would help reduce the problem of illegal organ traffic. In some countries people have their organs extirpated (dead or alive) by gangsters who seek profit selling them to people in need of a transplant.
• Donors can still have open casket funerals and organ donation does not cost anything to the family.
• This system would also increase the number of donations for research purposes which would contribute to accelerating the process of finding cures for diseases.

Cons

• Automatic donation means that people lose the right to decide what is going to happen to their body after death. Thus, mandatory donation clashes with freedom and individual liberties.
• Personal, family or religious beliefs may contradict organ donation after death. For instance, some people wish to freeze their bodies after death with the hope of being brought back to life in the future.
• Opt-out systems can also increase the pool of donors without having to eliminate the right of those who oppose to organ donation for several reasons.
• Compulsory organ donation could make some doctors, aware of the needs of organs for transplantation, put less effort into saving the lives of some living patients.

Watch this video on how organ donation and transplantation works:

Emerging questions: Is the opt-in method the right approach? Is the opt-out method more desirable? Or do you think that, to improve organ donation rates, and therefore increase the rate of organ transplantations, should the State make organ donation mandatory? Does mandatory donation remove the element of solidarity and generosity from the act of donation?

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