University of Arkansas System
Type of paper: Thesis/Dissertation Chapter
Organ Donation and Presumed Consent
In the science of medicine, research has produced amazing medical advances such as organ transplantation which raise major ethical issues. Transplants give hope to patients whose organs are failing; they often feel that they are getting a second chance at life. Doctors and medical professionals continue to do the best they can with the resources given to them, however when comparing the number of registered donors to the number of patients waiting for organs, there is an extreme shortage. In response to this shortage, lawmakers and medical professionals have proposed a new law being introduced as presumed consent.
This policy has the potential to substantially increase the number of organs available and save lives. The current policy in place requires citizens to indicate their wishes to donate in advance, if sufficient proof of the deceased wishes cannot be provided, the next of kin has the power to decide. Presumed consent would allow doctors to use organs from someone who is pronounced dead at the hospital without express consent from the next of kin. If a family member is present, they can override this decision.
Anyone who did not want to be a donor would simply be required to “opt out” of the registry in advance, and their wishes would be honored. The policy does not take away any rights of donors. The central idea of organ donation would remain the same. The choice is still with the people, only the policy would require people to opt-out rather than requiring them to opt-in. This change in the default system would make organs more readily available for people who need them, since that number is growing exponentially. Currently, the number of registers organ donors cannot even begin to address the number of patients waiting to receive them.
In fact “More than 10 Americans die each day while awaiting organ transplantation”(Fentiman, 30). The need for organs is growing, while the number of donors stays, relatively, the same. The presumed consent system being proposed would dramatically increase the number of available organs for these patients, and also increase the probability of finding an organ that the patients body will accept. The presumed consent policy would also be likely to reduce the cost of some transplant surgeries and the anti- rejection medication that follows the surgery, since the operations would become more common and organs more available.
This would open up the option of organ transplantation to patients who, otherwise, might not be able to afford the surgery at the current cost. One problem with the current system is that most of the general public is not very educated about the process of organ donation, which prevents them from even considering opting in to the registry. If presumed consent were to go into effect, people would be required to opt out if they objected to having their organs removed, this would require people to actually think about the process as a whole, as opposed to the current policy.
The most common method is to have a sticker placed on the drivers license or identification card, where often, people are not even asked if they want to opt in to the registry. As highlighted in Andree Jacobs article in Bioethics, If presumed consent were to be implemented, a widely publicized method of opting out of the registry would be required not only to be fair, but to educate citizens about organ donation. (296). The presumed consent policy would alleviate a lot of problems with the current system of organ transplantation.
Like any medical controversy, it would also pose some ethical concerns. One of the major issues presented by those who oppose the presumed consent policy is that organs might be removed from someone who did not want them removed, however, as discussed in Michael Gill’s article in the Journal of Medicine and Philosophy: the same issue stands with the current policy: organs are not removed from someone whose wishes were to donate their organs to a patient in need (37). This issue leads up to another commonly misplaced fear of organ donation in general.
Some fear that with presumed consent, doctors will be more eager to harvest organs for transplantation, and less likely to do everything in their power to keep the patient alive. Here is where the true definition of death must be approached. Lawrence Howard outlines in his article Ethics of Organ Donation, the tests that are recommended before a person can be pronounced dead including: “no brain wave activity”, fully reversed sedation, anesthetics, and muscle relaxants that may imitate death, “no attempt to reathe in the presence of normal blood gases during ventilator support,” “no cranial reflexes,”and “no blood flow to the brain. ”
Howard notes that the last two tests may not always be available. These procedures can ensure that the patient cannot be saved. Doctors have their own values and morals that are sometimes tested during their duties as a medical professional, but this is the reason for the Hippocratic Oath that doctors must take before practicing. Transplanting organs from one patient to try to save the life of another has always been difficult ethically, even with the current informed consent system.