An Excerpt from Organ Gold

When you die, should your healthy organs be automatically available for transplant? Is this an ideal way to increase the number of organs available for transplantation? It seems so.

Explicit opt-out laws (where you need to fill a form or explicitly state that you would not like your organs to be donated upon death) are in force in countries such as Austria, Belgium, the Czech Republic, Finland, France, Greece, Hungary, Israel, Italy, Luxembourg, Norway, Poland, Singapore, Slovenia, Spain, Sweden, and Turkey.

“There is evidence that supports the association between presumed consent and increased donation rates,” noted Alejandra Zúñiga-Fajuri of the University of Chile. “Countries with opt-out laws have rates 25-30% higher than those in countries requiring explicit consent.”

Writing in the Bulletin of the WHO on December 16, 2014, the author cautioned that presumed consent was only one of several influential factors. Others included potential donor availability, transplantation infrastructure, healthcare spending, public attitudes, familial consent, and availability of donor registries.

He cited Singapore’s HOTA (Human Organ Transplant Act), which combines a priority rule with an opt-out system: “If a person objects to donating their organs upon death, they give up priority for receiving an organ should they need one in future. The opt-out with priority system provides a dual-incentive for donation: avoiding the cost of opting out, and receiving priority on the waiting list. Singapore’s combination of presumed consent and priority status appears to have been somewhat successful in increasing organ donations.”

With an opt-in system, Germany has an organ donation consent rate of 12%. On the other hand, Austria (a country with a similar culture and level of economic development) uses an opt-out system – and has a consent rate of almost 100%. Spain and Belgium also have opt-out systems, and high organ donation rates consequently.

Australia requires family members to give or refuse consent even if the donor has consented. On January 1, 2017, the opt-in scheme became law in France. In Britain, 457 people died in 2016 while waiting for an organ transplant.

BBC News reported on September 10, 2017: “The British Medical Association (BMA) and politicians alike have called for an opt-out system to be adopted in England, where people’s consent to donate their organs after their death is presumed unless they have explicitly said otherwise. This system is currently in force in Wales, and in a number of other countries throughout Europe.”

Opt-out schemes, however, don’t always translate to increased organ donor rates. “In Sweden, for example, such a scheme has been in force since 1996, and it remains one of the lowest-ranked countries for organ donation in Europe,” BBC News noted. “Luxembourg and Bulgaria also have opt-out systems, and low rates of organ donation.”

In the US, someone is added to the national transplant wait-list every 10 minutes. More than 100,000 patients were on it as at end-2017 – and, on average, 20 die every day while waiting for an organ. Between 1988 and 2006, the number of organ transplants in the US rose to 60,000 – while the number of patients waiting for an organ jumped to 600,000.