The System And Issues With Presumed Consent


The United Network for Organ Sharing(UNOS), a non-profit corporation, operates the Organ Procurement and Transplantation Network(OPTN) under contract to the Department of Health and Human Services. OPTN coordinates the work of Organ Procurement Organizations(OPO’s). The OPO’s are responsible for public and professional education about organ donation, and work with hospitals and transplant centers in their service area to identify potential donors, secure consent, and efficiently distribute donated organs. OPTN maintains the national waiting list of organ transplant candidates which determines how donated organs are allocated. UNOS/OPTN and the OPO’s have done a wonderful job under the rules now in effect, but they have only been able to provide organs for about a third of those waiting for transplantation.
The Shortage Of Donor’s
Over 100,000 people are now on the waiting list for a transplant.
On average, 22 people die every day because no organ became available for them.
For every person who is removed from the waiting list, two are added.
The Problem
Although 85% of Americans support organ donation, actual donation rates continue to be too low. One reason for this is that too often, family members do not know the wishes of their loved ones. Faced with the decision at the time of a tragic event, they do not consent to donation. In many jurisdictions, even when it is known what the individual’s wishes are, the family is still allowed to override that decision. And, despite regulations that require hospitals to report all deaths to an OPO, as many as 15% are never referred.
The Solutions
Enforce all “Required Referral” laws and regulations
Make it illegal for anyone to override an individual’s wish to be a donor (as evidenced by a Donor Card or by not opting out of a presumed consent system)
Change the system to what much of the rest of world uses: Presumed Consent

Here’s How The System Works Now
An individual who wants to be an Organ Donor must “opt-in” – by signing a Donor Card, checking the box on their Driver’s License, or by signing up with a State Donor Registry. When a person dies in circumstances that might permit Organ Donation, someone from the local Organ Procurement Organization(OPO) approaches the family about Organ Donation. If their loved one had not discussed Organ Donation with them, they all too often decline to give consent. Sometimes they decline even when they know their loved one’s wish was to be a donor. Often, even in states that have “first person consent” laws, the family is allowed to override the individual’s wishes.

The System Under Presumed Consent
An individual who does not want to be an Organ Donor would have to “opt-out” by entering their name on a National Registry maintained by OPTN – the same organization that now keeps the National Waiting List of transplant candidates. When a person died under circumstances that would permit Organ Donation, a search would be made of the Registry. If their name did not appear in the Registry, it would be presumed they had consented to be a Donor. While the family would be advised of this information, their consent would not be required, and no one would be allowed to override the donation.

Why Presumed Consent is Better
Presumed Consent enhances the right of an individual to decide what will happen after they die.
Presumed Consent works well in other countries where it has been instituted – Austria, Spain, Portugal, Italy, Belgium, Bulgaria, France, Luxembourg, Norway, Denmark, Finland, Sweden, Switzerland, Latvia, Czech Republic, Slovak Republic, Hungary, Slovenia, Poland, Greece, and Singapore – where the opt-out rate has been around 2%.
Tracking the 2% who don’t wish to be Donors would be easier than tracking the 98% who do wish to be Donors or don’t care.
Presumed Consent preserves the American spirit of unselfishness and altruism.
Presumed Consent would remove the burden of making a decision about Organ Donation from families already dealing with the traumatic death of a loved one.
Presumed Consent could be implemented quickly, easily, and relatively inexpensively by working within the framework of the existing Organ Donation system.
Presumed Consent could have a dramatic impact on the number of organs available for transplant, significantly reducing the Waiting List and the number of deaths on the waiting list, as well as relieving the pain and suffering of thousands.