Indian Transplant Newsletter Vol. 8 Issue NO.: 26 (Feb-Jun 2008)
Presumed consent or mandated choice to overcome organ shortage
Indian Transplant Newsletter.
Vol. 8 Issue NO.: 26 (Feb-Jun 2008)
Print ISSN 0972 - 1568
The global organ shortage is a crisis, but is it a crisis with a cure? Some countries believe- it is. To overcome the problem of organ shortage many countries have used “Presumed consent” (PC) – as the method of consent for organ donation quite successfully. PC means that unless someone has ‘opted out, the state presumes that their citizens have said yes to organ donation. This means that official consent is not required for organ donation in the event of death (natural or brain death) and organs can be retrieved without delay. This type of consent is also called ‘Implied consent.’
Countries following presumed consent law include – Belgium, Austria, Finland, France, Norway, Spain and Singapore. The Success with Presumed consent law in these countries has been quite dramatic and to a large extent has overcome their immediate crisis of organ shortage.
Spain - The Organizacíon Nacional de Trasplantes (ONT) was established in 1989 to help with shortage of organs. Spain at that time had one of the lowest donation rate in the world but within a few years with the help of presumed consent and hospital based teams and transplant coordinators, its organ donation rate rose steadily to make it the ‘best procurement programme’ in the world . It today has 35 per million person donation rates. This has been achieved despite the fact that Spain also has one of the lowest road traffic accident rate in the European Union
France - France passed the law in 1976. Since it was passed the PC law produced increases in organ donation approaching 5,000%.
Austria – it accepted PC law in 1982. By the end of 1990, it helped to overcome shortage of kidneys.
Belgium – the law was passed in 1986. Its organ donation rate moved up by 183%.
Singapore- the law passed in 1986 changed the organ donation rate by almost 120%.The world shortage of organs is compelling many countries to look at PC as the answer. UK has been seriously debating this issue and may accept the law.
Our Health Minister also is keen to look at this as an option and has already declared that the Transplantation of Human Organ Act will be amended to use PC for eye donations. If the minister is planning to amend the law, is there likely to be any religious exclusion. We in India can only conceive to apply this law, if our masses have full faith in the healthcare system and are fully sensitized about organ donation and its beneﬁts. We must note in this context that Brazil too tried to implement the PC law but had to withdraw it as it aggravated the mistrust of the people in the healthcare system. Like Brazil, our masses too do not trust the doctors or hospitals; hence the ministry must carefully weigh this option when amending the law.
“Mandated choice” law is another way of increasing the donation rate and can be implemented in diff erent ways. This law requires citizens to declare their choice about organ donation. This can be done by registering with a national body for expressing their wishes during the issue of important documents like – Driving Licence, National Identity cards or Passport. Sweden and Denmark are the two countries that have implemented the legislation quite effectively. In 1996, when Sweden instituted the law and the potential national donor registry swelled by 600,000. Similarly in Denmark it instantly increased by 150,000. To help give a push to organ donation, we in India too can use this soft approach and use ‘mandated choice’ as the first step. We can be allowed to make our choices about organ donation when we are issued the Driving licences or Passport.
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- Keywords: Mandated choice, Overcome,Organ, Shortage