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At least 19 recordsLinked to original sources
PubMed2000

Presuming consent, presuming refusal: organ donation and communal structure.

Donating, distributing and ultimately transplanting organs each has distinct ethical problems. In this paper I suggest that the first ethical question is not what should be done but what is a fair way in which each of these problems can be addressed. Experts--whether these be transplant surgeons, policy analysts, political scientists or ethicists--can help guide but cannot by themselves make such decisions. In making these decisions the difference between identified and non-identified lives is crucial. I suggest that an approach in which reason is tempered by compassion ("compassionate rationality") when dealing with unidentified lives and in which compassion is controlled by reason ("rational compassion") in dealing with identified lives must serve us well. Ultimately decisions of this sort are prone to sturdy democratic process which is possible only when the preconditions of person, economic and educational democracy are met.

Canada↗
PubMed2006

Attitudes toward financial incentives, donor authorization, and presumed consent among next-of-kin who consented vs. refused organ donation.

BACKGROUND: Financial incentives, donor authorization, and presumed consent are strategies designed to increase organ donation rates. Surveys designed to assess attitudes toward these initiatives have been conducted with the general public, transplant patients, and transplant professionals. METHODS: To assess attitudes toward financial incentives, donor authorization, and presumed consent and to identify multivariate predictors of such attitudes, we conducted telephone interviews with 561 family members who had recently been asked for consent to donate the organs of a deceased family member (348 donors, 213 nondonors). RESULTS: Financial incentives would have made a difference in the donation decision for 54% of nondonors (vs. 46% of donors, P=0.02), and a higher percentage of nondonors would themselves become donors if financial incentives were available (P=0.03). Donors had significantly more favorable attitudes toward donor authorization (P<0.0001) and presumed consent (P<0.0001) policies. Overall, 54% of participants thought that family permission for donation was unnecessary when the deceased documented their donation intention, and 24% favored a presumed consent law with an opting out provision. CONCLUSIONS: Of the three initiatives, donor authorization is likely supported by more donor and nondonor families than either financial incentives or presumed consent. Public education efforts should aim to better inform the public regarding existing and proposed donor authorization legislation and its benefits for registered organ donors and their families.

Adult↗
PubMed2006

The impact of presumed consent legislation on cadaveric organ donation: a cross-country study.

In the U.S., Great Britain and in many other countries, the gap between the demand and the supply of human organs for transplantation is on the rise, despite the efforts of governments and health agencies to promote donor registration. In some countries of continental Europe, however, cadaveric organ procurement is based on the principle of presumed consent. Under presumed consent legislation, a deceased individual is classified as a potential donor in absence of explicit opposition to donation before death. This article analyzes the impact of presumed consent laws on donation rates. For this purpose, we construct a dataset on organ donation rates and potential factors affecting organ donation for 22 countries over a 10-year period. We find that while differences in other determinants of organ donation explain much of the variation in donation rates, after controlling for those determinants presumed consent legislation has a positive and sizeable effect on organ donation rates. We use the panel structure of our dataset to test and reject the hypothesis that unmeasured determinants of organ donation rates confound our empirical results.

Cadaver↗
PubMed2004

Presumed consent, autonomy, and organ donation.

I argue that a policy of presumed consent for cadaveric organ procurement, which assumes that people do want to donate their organs for transplantation after their death, would be a moral improvement over the current American system, which assumes that people do not want to donate their organs. I address what I take to be the most important objection to presumed consent. The objection is that if we implement presumed consent we will end up removing organs from the bodies of people who did not want their organs removed, and that this situation is morally unacceptable because it violates the principle of respect for autonomy that underlies our concept of informed consent. I argue that while removing organs from the bodies of people who did not want them removed is unfortunate, it is morally no worse that not removing organs from the bodies of people who did want them removed, and that a policy of presumed consent will produce fewer of these unfortunate results than the current system.

Humans↗
PubMed1996

How presumed is presumed consent?

All things considered, one is tempted to answer the question in the title: How presumed is presumed consent? Not very, or not at all. It is evident that, regardless of the law, be it opting in or opting out, presumed consent or presumed nonconsent, the family is almost always consulted. The family has the preferential right of interpretation. Their interpretation of the attitude toward organ donation by the deceased is usually not contested, whether it is in agreement with or contrary to the stated (verbal or written) view of the deceased. This is understandable and proper; the sudden and unexpected death of a close relative is the start of the grieving process and, besides, relatives might take legal action if their opinion is not respected. Taken together, it can be argued that well-designed presumed consent legislation is the best system for many of the reasons stated. Foremost among these is that it offers a very good way to initiate consultations with the family. With due respect for any legal system, one does not discuss the legal aspects with the relatives. Since they are expected to honor the opinion of the deceased, there is reason for each of us to make our wishes regarding organ donation known to our relatives. It might relieve them of a difficult decision.

Cadaver↗
PubMed1999

Forced organ donation: the presumed consent to organ donation laws of the various states and the United States Constitution.

The issues presented in this Comment pertain to whether there are substantive limits imposed by the Fourteenth Amendment upon the state legislatures which would defeat the recent, tentative steps of many states to pass laws authorizing presumed consent to organ donation. The final and perhaps least effective presumed consent law creates a presumption of consent to organ donation. The potential organ donor makes the choice whether to donate or not during his lifetime. This form of the presumed consent law would probably have the least impact on increasing the number of available donor organs. It permitted the coroner to harvest the eyes and corneas of deceased individuals if the coroner was unaware of objections from either the decedent or the family of the decedent. Presumed consent statutes should be found unconstitutional because they infringe upon a family's property interest in a deceased relative's corpse. However, due to the family's property interest in a relative's deceased body, as set forth in the next section, the result is that presumed consent statutes are unconstitutional. In order to find the presumed consent law unconstitutional, the Court would have to find that either: (a) the Fourteenth Amendment's liberty component included the family's right to determine what happens to a relative's body after death, or (b) that the property component included a vested state law property interest in the dead body.

Humans↗
PubMed1998

Issues in organ procurement: presumed consent, bioethical type II errors, and organ registries.

In an effort to alleviate the current imbalance between the many in need of an organ transplant and the limited number of organs procured, a policy of presumed consent has been recently debated. Presumed consent assumes that potential organ donors agree to donate their organs in the absence of known objections to the contrary. The authors examine the bioethical principles and consequences involved in such a policy and apply hypothesis testing, borrowed from clinical epidemiology, to a "bioethical test" of presumed consent in a hypothetical clinical scenario. A possible bioethical alternative to presumed consent, an organ donor registry of advanced directives as has been established in British Columbia, is also discussed.

Advance Directives↗
PubMed2003

Presumed consent and other predictors of cadaveric organ donation in Europe.

CONTEXT: Few studies on presumed consent and environmental predictors of cadaveric organ donation in Europe have been published. OBJECTIVE: To determine if a presumed consent policy and other variables can be used to predict the cadaveric organ donation rate per million population. DESIGN: Secondary analysis of published data. SETTING: Europe. PARTICIPANTS: The unit of analysis for this study is the individual country. MAIN OUTCOME MEASURE: Cadaveric organ donation rate per million population. RESULTS: Original and transformed data were subjected to ordinary least-squares regression. All 4 independent variables were significant predictors of cadaveric donation rate, including (1) having a presumed consent (opting-out) policy in practice, (2) number of transplant centers per million population, (3) percentage of the population enrolled in third-tier education, and (4) percentage of population that is Roman Catholic. CONCLUSION: Findings may be useful to academics and professionals responsible for organ procurement. Additional research is necessary for practical application of findings. Generalizing these findings beyond Europe may be problematic because of external validity constraints.

Cadaver↗
PubMed2003

Presumed consent for transplantation: a dead issue after Alder Hey?

In the wake of scandals about the unauthorised retention of organs following postmortem examination, the issue of valid consent (or the lack of it) has returned to the forefront. Emphasis is put on obtaining explicit authorisation from the patient or family prior to any medical intervention, including those involving the dead. Although the controversies in the UK arose from the retention of human material for education or research rather than therapy, concern has been expressed that public mistrust could also adversely affect organ donation for transplantation. At the same time, however, the British Medical Association (BMA) continues to call for a shift to a system of presumed consent for organ transplantation. This apparent inconsistency can be justified because valid distinctions exist between the reasons requiring explicit consent for retention and the acceptability of presumed consent for transplantation. This paper argues for introducing a system of presumed consent for organ donation, given the overwhelming expressions of public support for transplantation. Ongoing legislative review in the UK provides an ideal chance to alter the default position to one where potential donors can simply acquiesce or opt out of donation. Combined with consultation with their relatives, this could be a much better method of realising individuals' wishes. It would also achieve a better balance between the duties owed to the deceased and those owed to people awaiting a transplant.

Attitude to Health↗
PubMed2003

Presumed consent for organ procurement--does it have a future in the U.S.?

Policies of presumed consent to procure organs for transplantation have stimulated discussion of success/failure in increasing organ availability, technical pitfalls, and ethical dilemmas. The presumption of consent has made inroads in public policy internationally and influenced some state policies. A policy of presumed consent remains unlikely in the face of American attitudes of freedom of choice and respect for individual autonomy, but healthcare providers need to be aware of potential policy changes and how these changes may affect their practices.

Health Policy↗
PubMed2005

Explicit or presumed consent and organ donation post-mortem: does it matter?

In the last 25 years almost every West European country has enacted a transplantation law. During the preparation of these laws an important issue was whether to base the transplantation law on explicit or presumed consent regarding organ donation post-mortem. A common view of supporters of the presumed consent system is that it will result in more organ donors than the rule of explicit consent. In this article the difference between the different systems is further explored. For that purpose, the systems for post mortem donation in 10 West European countries will be discussed. Focus will be on the legal role of relatives within the consent process and finally on the role of relatives in practice. It will be argued that the difference between the two types of systems is less important than it seems to be at first sight.

Death↗
PubMed1996

The relative impact of presumed-consent legislation on thoracic organ donation in the Eurotransplant area.

A country's organ donation rate and hence the availability of thoracic organs can be increased by organizational measures, by legislative incentives, and by increasing awareness among the public and healthcare professionals. We analyzed the relative impact of organ procurement legislation or policy on heart and lung donation rates per million population per year in the four countries participating in the Eurotransplant organization (population, 112.7 million) between January 1992 and December 1994. Within this organization, Austria and Belgium have presumed-consent legislation, whereas Germany and the Netherlands have an opting-in (explicit-consent) policy. Although practices vary even among countries with similar policies (eg. in Belgium, relatives of the donor retain the right to object to procurement of organs in the absence of an explicit consent from the deceased before death), rates of heart and lung donation were at least twice as high in the two countries with presumed-consent legislation as in the two countries that rely on a policy of explicit consent from the donor's next of kin.

Europe↗
PubMed2000

Presumed consent in emergency neonatal research.

Current methods of obtaining consent for emergency neonatal research are flawed. They risk aggravating the distress of parents of preterm and other sick neonates. This distress, and the inevitable time constraints, compromise understanding and voluntariness, essential components of adequately informed consent. Current practice may be unjust in over-representing babies of more vulnerable and deprived parents. The research findings may thus not be generalisable. Informing parents antenatally about the possible need for emergency neonatal research, with presumed consent and scope for opting out, would address these problems. It would spare parents of sick neonates, already terrified by their baby's illness, further distress. Experience with opting out suggests that recruitment might increase, thus generating earlier results, without compromising parental understanding of the nature and purpose of the research.

Clinical Trials as Topic↗
PubMed1998

Organ procurement: let's presume consent.

IN WINNING FIRST PRIZE in the Logie Medical Ethics Essay Contest in 1997, Dr. Fady Moustarah made a strong and compelling argument in favour of presumed consent in the procurement of donor organs. He stressed that a major education campaign will be needed when such a policy is adopted lest some people begin to regard physicians as "organ vultures."

Attitude to Health↗
PubMed1995

Presumed consent: the solution to the critical organ donor shortage?

Extraordinary advances in science and medicine such as transplantation of human tissues not only bring about previously unimaginable societal benefits but also create profound implications that involve autonomy and belonging, opposing moral considerations, and legal concerns. Today, technology is changing faster than our values. The issue of salvaging organs from the dead to meet the escalating need for human organs for lifesaving organ transplantation has evolved into an intricate web of interdisciplinary concerns and value conflicts; right and wrong are opinions and consensus does not seem to exist. This organ supply-demand mismatch, as well as suggestions for its resolution, has become a major challenge to the transplant community and to those in political and bioethical arenas. A methodical transition to presumed consent, or opting-out legislation, which removes the burden of decision from the family and the burden of request from the healthcare professional, may be the only solution to correct the imbalance between human organ need and availability.

Ethics, Medical↗