Solving the Shortage: Opt-Out Organ Donation?

There are 4,500 people in Canada waiting for a transplant. Seventy-five percent of those are waiting for a kidney transplant. In 2012, 230 people on the transplant waiting list died before they could receive a transplant and 37 percent of the deaths were of people waiting for a kidney transplant.

Canada has what is regarded as a very poor deceased-donor rate of 15.5 deceased donations for every million Canadians. This compares poorly to Spain’s deceased donation rate of 35.1. What is the reason for the difference? Researchers observe that Spain’s approach to organ donation is one of “presumed consent,” a situation in which, at death, unless the deceased person has specifically opted out of donating their organs, the presumption is that consent has been given. This is different than the situation in Canada, where Canadians must deliberately “opt in” to the choice to donate their organs.

Canadian composer and music producer David Foster, through his foundation, is one of the more well-known advocates for presumed consent. A recent article in The Globe and Mail presents Foster’s campaign: “Automatic organ donation: A new campaign for ‘presumed consent’ gets a push from composer David Foster.”

The David Foster Foundation promotes organ donation especially for children

The David Foster Foundation promotes organ donation especially for children

In a related article, a former executive of the BC Transplant agency points out some of the challenges of presumed consent. BC Transplant’s own research found that the primary reason for differences between Spain and Canada’s deceased donation rates has to do with how people are dying. Spain has a death rate from motor vehicle accidents that is 50% higher than in Canada. Why? Spain does not require motorcyclists to wear helmets. Canada is a healthier and safer country in which to live, and as a result, there are fewer deaths that result in candidates for organ donation.

What of the ethics of presumed consent donation? In a 2009 issue of The Journal of Medical Ethics, Oxford philosopher Ben Saunders presented an essay on “Normative Consent and Opt-Out Organ Donation.” Here is the abstract of the essay to give you a flavour of the argument that he presents:

One way of increasing the supply of organs available for transplant would be to switch to an opt-out system of donor registration. This is typically assumed to operate on the basis of presumed consent, but this faces the objection that not all of those who fail to opt out would actually consent to the use of their cadaveric organs. This paper defuses this objection, arguing that people’s actual, explicit or implicit, consent to use their organs is not needed. It borrows David Estlund’s notion of ‘normative consent’ from the justification of political authority and applies it to the case of organ donation. According to this idea, when it is wrong to withhold consent to something, the moral force of that lack of consent may be null and void. If it is wrong of a person to refuse to donate their cadaveric organs to others, then it may be that their actual consent is not needed. This supports an opt-out system, which provides protection for those who have genuine reasons to refuse donation, and spares the worries as to what the deceased would actually have wanted.

What do you think? Should Canada move to a presumed consent model? Does an ethical dilemma arise if we should choose this path? Will it make a difference? If presumed consent is not the answer either because of ethics or because of efficacy, what should we as a society do about those who are waiting for years for a life-saving transplant? who are dying for lack of a life-saving transplant?

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