United States
Over 100,000 Americans are on the waiting list in need of an organ. This crisis within the United States is growing rapidly because on average there are only 30,000 transplants performed each year. More than 6,000 people die each year from lack of a donor organ, an average of 19 people a day. Between the years 1988 and 2006 the number of transplants doubled, but the number of patients waiting for an organ grew six times as large. It has been estimated that the number of organs donated would double if every person with suitable organs decided to donate. In the past presumed consent was urged to try to decrease the need for organs. The Uniform Anatomical Gift Act of 1987 was adopted in several states, and allowed medical examiners to determine if organs and tissues of cadavers could be donated. By the 1980s, several states adopted different laws that allowed only certain tissues or organs to be retrieved and donated, some allowed all, and some did not allow any without consent of the family. In 2006 when the UAGA was revised, the idea of presumed consent was abandoned. In the United States today, organ donation is done only with consent of the family or donator themselves. The number of recipients is growing faster than there are donors.
The Argument for Opt-in Organ Donation in the United States
Many Americans believe that what happens to their bodies after death should be solely up to them and for a long time this is how it has been. However, this is actually a very common misconception. The U.S. government already conducts autopsies after ambiguous deaths in which they remove large pieces of the person's internal organs for analysis and criminal investigation. Some would argue that if procedures such as this one are already being done then why not change the system all-together; even if it means dramatically changing current and deep rooted beliefs about the sanctity of human bodies. Harvesting organs from cadavers is a solution but changing the United States to an opt-in system would be a more effective solution to the imbalance of those who are in need of organs and the amount donors. For every 90,000 people who need kidneys there are only about 14,000 people who are willing to donate. The organs that are harvested are sometimes wasted by hospitals when they wait too long to set up an in-house transplant. If there were a greater abundance of donors problems such as this one could be avoided. If the United States became an opt-in country its availability of organs could raise by up to 50%. There is already a push for a change in policy being made by several organizations such as The American Kidney Fund.
Europe
Within the European Union, organ donation is regulated by member states. As of 2010, 24 European countries have some form of presumed consent (opt-in) system, with the most prominent and limited opt-in systems in Spain, Austria, and Belgium yielding high donor rates. In the United Kingdom organ donation is voluntary and no consent is presumed. Individuals who wish to donate their organs after death can use the Organ Donation Register, a national database. The government of Wales became the first constituent country in the UK to adopt presumed consent in July 2013. In 2008, the UK discussed whether to switch to an opt-out system in light of the success in other countries and a severe British organ donor shortfall. In Italy if the deceased neither allowed nor refused donation while alive, relatives will pick the decision on his or her behalf despite a 1999 act that provided for a proper opt-out system. In 2008, the European Parliament overwhelmingly voted for an initiative to introduce an EU organ donor card in order to foster organ donation in Europe.
What Are The Pros?
On the positive side of the opt-in system, it has an almost consistently high success rate. Countries using the opt-in system, of which there are 24 in Europe, tend to have very high levels of organ donation. Our neighbor Austria has a 99.98% consent rate for the system.
This vast increase in organ donation has the knock-on effect of preventing corruption within the organ donation system. Incidences of doctors tampering with waiting lists to get certain patients higher up the list than others who are actually in greater need of an organ, tend to be more common in countries where there is a serious shortage of donated organs.
This year in Germany an investigation was launched into the case of the surgeon identified as Dr. Aiman O. who had unlawfully tampered with waiting lists on 23 occasions. Incidences in the past have also included the unlawful retention of 850 children's organs in Alder Hey Hospital in Liverpool. In 2007, a man in the UK tried to sell his kidney to pay off his gambling debts.
Furthermore, the opt-in system seems to tactfully overcome one of the most sensitive barriers to a high rate of organ donation that exists within the opt-in system. Most people simply don't want to think about their own death. Awareness of one's own mortality is unpleasant at all times and, particularly to young people, seems to be little more than unnecessary. Most people under the age of 65 tend to put off making concrete plans about their death.
It may well be that Germans are not becoming organ donors purely for this reason. Rather than having an actual aversion to the idea of becoming a donor, they simply don't want to have to think about anything to do with their death right now. This argument is given more weight when it is considered that 70% of Germans say they would donate their organs, but only 25% of the population have actually filled out the paperwork and gotten a card.
Ask yourself: do you have a problem with becoming an organ donor? Will you become one tomorrow? If you answered "yes" to the first and "no" to the second, do you think it would do great benefit and little harm for you to exist in a country that uses the opt-in system?
What Are The Cons?
Which brings us to the negative aspects of the opt-in system. Does it actually do harm? The system has been seen as giving the state an effective claim on the organs of all people. It could be interpreted as saying that "the state owns all your organs after your death, but it is willing to give them back to you if you like."
This can possibly be seen as an unlawful invasion of people's rights to control their own body. The opt-out system might therefore change the fundamental limits of what the state can or cannot do without your explicit permission. It has been argued that the state simply does not have the right to claim body parts in the same way that it can claim taxes.
Furthermore, it has been contested that doctors would be less likely to save an ailing patient if they believed that less resources would be spent in allowing that patient to die and using the patients organs to save someone else. One-third of respondents to a 2010 survey by the Federal Centre for Health Education believe that this is actually likely to happen.
Spain
Dr Matesanz rejects the idea of a Spanish miracle or a unique store of generosity in the hearts of his compatriots: “We have asked the same question in various surveys over the years and every time 56% or 57% say they would donate their organs after dying; roughly the EU average.” On the role of Spain’s transplant law, which presumes consent unless otherwise stated, Matesanz is also dismissive, pointing out that families always have the final say and that the only country in the world to enforce such a rule is Singapore. “Spain has not been a leader in surgery or research; we have hardly chalked up any firsts in transplant operations. What we have brought to this area is organisation. Following a philosophy that states that donors do not simply fall from the heavens, we have provided organisation and professionalisation.”
The Spanish model has been perfected by Matesanz since he took over the newly created ONT with a tiny staff in 1989, amid protests from kidney patients on endless waiting lists. In three years he took Spain to the perch of world leader, with donors per million rising from 14 to 22. It has stayed at the top ever since. “We decided to focus right away on the donation of organs. This might sound like a statement of the obvious, but all the other European transplant foundations of that time were focused on distribution.” Other countries’ donation organisations were, and in some cases still are, private foundations, whereas the ONT is part of Spain’s Health Ministry in a country where the importance of private hospitals in transplant surgery is minimal.
The key to Matesanz’s professionalisation of this medical sphere was the implantation of transplant coordinators in each hospital. Even then, he admits, the role was not an entirely new one. “All we invented was that the transplant coordinator must be an intensive care specialist,” as opposed to a technician or nurse. Coordinators receive special training and are often rotated to prevent psychological burnout. In total, the ONT has trained 16,000 health workers so that medics and nurses all the way down the line are aware of the opportunities to gain donors and follow the right protocols to protect organs and tissues.
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