Today, roughly 20 Americans will die waiting for an organ transplant. We already have the cure — medical technologies associated with organ transplantation have evolved to promote long-term survival and support enhanced quality of life among patients. Five-year survival rates among those who receive transplanted organs are auspicious; according to figures from the Scientific Registry of Transplant Recipients, over 80 percent of those who receive a kidney from a deceased donor remain alive after five years. This figure is almost 75 percent for those who receive a liver from a deceased donor.
The problem lies in our nation’s dearth of donated organs: kidneys, hearts, livers and lungs. As medical technologies improve, the demand for organ donation continues to outpace the rate of individuals who opt in to donate their organs. Certain nations such as Spain, Belgium and Norway have established themselves as world leaders when it comes to organ donation through their “presumed consent” laws. Under these laws, individuals are automatically considered to consent to donating their organs upon death unless they opt out. Contrast this system with the United States’, one under which individuals are considered not to consent to organ donations unless they opt in. Spain boasts the highest rate of organ donation with 35.3 donors per million people, whereas the United States has just 26 donors per million people. In order to make organ donations more accessible and shrink waiting lists, the United States should adopt an opt-out system modeled after Spain’s through presumed consent legislation.
There currently exists a disjuncture between the proportion of Americans who are willing to donate their organs and those who actively register to become organ donors. Many polls and surveys demonstrate that the majority of Americans would be willing to donate their organs upon death, yet only about 45 percent of American adults are registered donors. With above 90 percent of American adults supporting organ donation and far fewer registering to be donors, we must consider alternatives to our system of donor cards and driver’s license check-offs.
Transitioning to an opt-out system in the United States would not be a radical proposal. Domestic support for presumed consent laws is growing strong; per a 2012 study performed by the Health Resources and Services Administration, half of the American adult population (51.1 percent) would support or strongly support an opt-out system that presumes consent in the United States. This figure was significantly greater than the 41.9 percent of American adults who expressed support for such a system in 2005.
Arthur Caplan, head of the Division of Medical Ethics at New York University and supporter of presumed consent laws, writes, “changing the law will not in itself suffice. As the experience with presumed consent in Western Europe shows, education of the public and constant training of hospital personnel are essential.” Much of Spain’s success with organ donations has been attributed to the work of Rafael Matensaz, director of Spain’s National Transplant Organization, which has received plaudits for its outreach efforts and its superior organizational structure.An opt-out system is not a panacea for America’s dismal donation rates, but, when coupled with strong coordination and education initiatives, our donation rates can be higher and our waiting lists can be shorter.
Moreover, adoption of presumed consent legislation would present lawmakers with several questions and challenges. Some argue presumed consent for the deceased will result in fewer live organ donations. Others worry the opt-out system will hurt minorities and the poor, who are significantly less likely to support organ donation and may have greater difficulties with obtaining information about opting out. In order to address both issues, we must ensure there is adequate public education regarding the opt-out system and the importance of live organ donors. Additional concerns with presumed consent include the family veto for pediatric and adult donors. In Spain, parents are able to overrule the presumed consent of a dead relative. Even with the family veto Spain’s opt-out system produces the highest organ donation rate in the world. An opt-out system that maintains the family veto in the United States would increase our organ donation rate while still allowing family members of the deceased to have a say in whether or not an individual’s organs will be donated.
Right now, too many people are dying while waiting to receive the organs they need. We should place the onus on those who do not want to participate in organ donation by establishing an opt-out system supported by strong public education initiatives so no more Americans die waiting to receive an operation our surgeons already know how to perform.
Nazar Aljassar is an Opinion columnist for The Cavalier Daily. He can be reached at n.aljassar@cavalierdaily.com.
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