The Case for Presumed Consent
If you can remember back to when you first got your drivers’ license, you may recall being asked if you wanted to be an organ donor. You may not have thought much of it—I know that I, at 16, certainly didn’t—but with an average of 18 people dying every day waiting for an organ transplant in the United States, it is undeniable that organ shortage is a problem with far-reaching effects. To solve this problem, I believe the United States should adopt a system of presumed consent.
In its purest form, presumed consent, also called the opt-out system, means that the country assumes that you agree to having your organs donated. The “default setting,” so to speak, is that you are an organ donor, unless you have explicitly stated otherwise. By contrast, the system currently put in place in the United States is the opt-in system, meaning that one is assumed to not want to be an organ donor unless he or she has explicitly stated otherwise. Many presumed consent laws contain built-in safeguards like allowing family members to decide, after death, whether to honor the deceased’s wishes or not, and the maintenance of choice within the system preserves individuals’ autonomy and freedom.
Most importantly, the system works: countries that have adopted systems of presumed consent have seen drastic improvements in their rates of organ donation. Emily Jackson describes the effects of the system in the 2006 Medical Law, where she references an organ-transplant center in each of two Belgian cities located only 45 minutes away from each other. In the first city, Antwerp, the already-established opt-in policy was continued, accompanied by enhanced public and professional education about the importance of organ donation. In the second, Leuven, the system of presumed consent was adopted. Organ donation rates remained unchanged in Antwerp despite other efforts, but in Leuven, they rose from 15 to 40 donors per year. The effectiveness of this case study is echoed by a multitude of wide-range studies: in a 2009 systematic review of the impact of presumed consent published in the British Medical Journal, Amber Rithalia found that general organ donation rates in Austria increased from 4.6 donors per million people per year to 10.1 per million in the four years after introducing presumed consent, while rates of kidney donation in Singapore rose from 4.7 per million to 31.3 per million in three years. To summarize all this country data, a 2006 paper in the Journal of Health Economics by researchers Alberto Abadie and Sebastien Gay found that, once other factors affecting donation were accounted for, donation rates were on average 25 to 30 percent higher in presumed consent countries.
These increased organ donation rates will not only save lives by allowing for greater rates of transplantation, however. Some organs donated, which, due to concerns of age and health, may not qualify for transplantation, can go toward medical research instead. Groundbreaking treatment options for diabetes, cardiovascular disease, and hepatitis, among many other diseases, have been developed through the use of donor organs. Says Roni Lawrence of the University of Wisconsin Health Organ Procurement Organization, “When people donate organs, they’re helping both the patient who receives their live-saving transplant right away, and the next generation of recipients who will recover sooner and live longer because of the research happening today.” Presumed consent thus saves lives not only in the short term, but in the long term as well.
Beyond saving lives, the increase in donation rates caused by the system of presumed consent can lead to even further benefits by allowing for the elimination of the organ black market. Commercial organ donation negatively impacts the poorest and most vulnerable populations of society; paid kidney donation is often driven by poverty, but economic benefits from donation are limited at best. In fact, many patients who sell their kidneys are perceived to have deteriorated health and, thus, are seen as less employable, leading to negative economic impacts. Ultimately, by adopting a system of presumed consent, the United States will eliminate the need for transplant tourism, saving lives and decreasing inequality in the long run.