A New York assemblyman has introduced a bill aimed at making the state the first to presume people want to donate their organs unless they specifically say otherwise. Under current law, people give permission to donate their organs by checking a box on their driver’s licenses or filling out a donor card. The legislation, introduced by Assemblyman Richard Brodsky, a Westchester Democrat, is in two parts: the first step would end the right of the next of kin to challenge the decisions of their dead or dying relatives to donate their organs.
In a second measure, which is far more contentious, people would have to indicate in official documents — their driver’s licenses, most commonly — that they specifically don’t want to donate organs. If the box is not checked, it is presumed the person wants to donate.
What are the ethical and practical issues involved in changing the law? Is a “presumed consent” system an effective way to increase the number of organs available, and thus save lives, or will it deter public support for donation? While 90 per cent of people say they support organ donation, only 31 per cent have joined the NHS Organ Donor Register. Which begs a key question – if you would be willing to receive a transplanted organ, why would you not be willing to donate organs to save the lives of others? This position is morally indefensible.
There is an increasing gap between the number of organs available and patients needing a transplant. This is a clear indication the current ’opt-in’ system is not fully meeting service needs. Under presumed consent, every person living in that country is deemed to have consented to donation unless they specifically opt out by documenting in writing their unwillingness.
This could lead to a significant increase in potential donors. Several EU countries already have the system, including Spain and Austria. This would relieve the decision making burden for relatives at a difficult time and make the horrendously challenging work of transplant co-ordinators more straightforward.
In the UK, it would be a ‘soft opt-out’ system, where anyone not wishing to donate can easily make wishes known and clinicians would take active measures to ensure relatives have no objections. Having been an organ donor for over 30 years, I’ve made sure loved ones are aware of my wishes to opt-in in the event of my death. Presumed consent would at least encourage people to discuss the issue with families and there would be more clarification on an individual’s position.