Over 60’000 people are on waiting lists for donor organs in the European Union. However, only a tiny fraction of Europeans register as organ donors, and a chronic shortage of donors across the EU means that thousands of people die each year waiting for a suitable transplant.
When a person leaves no instructions about organ donation during their lifetime, then doctors often seek consent from next of kin after they have died. Unsure what their relatives would have wanted, the vast majority reject donation, and healthy organs are buried or cremated. It’s a difficult ethical issue and it seems ghoulish to talk of organs being ‘wasted’, but thousands of lives could be saved if more people donated.
There are various different systems for determining consent across Europe, and it is entirely up to each EU Member State to decide for themselves which they choose. Generally speaking, ‘opt-in’ donation strategies means that nobody’s organs are used without their consent, whereas ‘opt-out’ strategies mean that everyone is treated as a potential donor unless they specifically refuse.
Should more countries use an ‘opt-out’ system for organ donation? To get a reaction, we spoke to Professor Anthony Warrens, Dean for education at Barts and the London School of Medicine and a consultant renal physician at the Royal London Hospital. What did he think?
My own view is probably not. I prefer it to be an active decision to opt-in, and what we want to do is to make people as aware as possible of the opportunity… I think it goes against the grain to make assumptions about something as important as that, so I’m not in favour of it.
To get another reaction, we also spoke to Willem Weimar, Professor of Internal Medicine at the Erasmus University Rotterdam and a council member of the European Society for Organ Transplantation (ESOT). What did he think about ‘opt-out’ systems?
Well, an ‘opt-out’ system might be a good solution for the shortage of organ donors, but it raises ethical questions about the autonomy of people. When you think that individual autonomy is one of the quintessential components of ethical behaviour, then people should always indicate themselves whether they want to become an organ donor or not…
Finally, we spoke to Bernadette Haase, Director of the Dutch Transplant Foundation. Did she think that people should be automatically registered as organ donors, with the option to ‘opt-out’ if they wanted?
That is [a] difficult question. My personal opinion is that this could be a good solution. For example, in the Netherlands our biggest problem is that a large number of next of kin refuse organ donation when they are confronted with the donation request. Many people have never thought about donation until the moment the question is actually asked. So often they refuse because they do not know what the deceased would have wanted.
When you have a presumed consent system, the automatic assumption is that people consent to donation unless they explicitly opt out. And that could make a big difference. Currently, in the Netherlands, it’s the other way around. The Dutch refusal rate is high: over 60 percent.
It is important to realize that it’s not just about the consent of the next of kin or the potential donor, but also about ensuring that the environment in hospitals is well developed. For example, ensuring that, when you die, you are recognised as a potential donor. That’s the first step. The next step is that hospitals create an environment where next of kin feel safe; that they can trust the doctors so they know that a loved one who has just died is in good hands. That also helps to improve the chance of consent.. So, introducing automatic donorship is not the only solution. We need a combination of legislation, informing the public, and educating medical professionals in hospitals.
Should everyone be considered organ donors unless they ‘opt-out’? How can more people be encouraged to register as organ donors? Let us know your thoughts and comments in the form below, and we’ll take them to policymakers and experts for their reactions!