By: Michael DiBello
In bioethics today, there is a wide array of fiercely contested topics such as abortion, euthanasia and novel fertility treatments, which have made the front pages of newspapers around the globe. While these undoubtedly important issues demand a thorough dialogue, some equally important policy issues seem to slip under the radar.
One of these issues is our policy for organ transplantation.
On average, approximately 18 U.S. residents die per day awaiting a transplant, totaling over 6,500 per year. Only about 45% of the adult U.S. population are registered as donors. Many lives could be saved and significantly enhanced if more people were registered as organ donors. The question becomes: how do we increase the donor pool in a fair, ethically responsible manner?
In the United States, individuals must opt-in to become a donor by checking a box on a driver’s license application or by signing up online. This “opt-in” system of organ donation is inadequate not only from an efficiency perspective, but from a moral perspective as well. Many countries have adopted an alternative system to the opt-in policy, where the default position for adults is set to being a donor, with an option to opt-out. This system is generally referred to as an opt-out policy. Countries with an opt-out style policy like France, Austria, Poland, Hungary and Portugal display donor consent rates of over 99%. Countries with an opt-in style policy like the United Kingdom, Germany, Netherlands and Denmark display rates drastically lower donor consent rates under 30%.
Why is it exactly that people do not give consent to become an organ donor? One possible reason may be the immediate and intimidating nature of the decision for an individual. Organ transplantation may evoke images of dismemberment, drastic surgery and death, instilling apprehension and anxiety in the individual, resulting in a decision to not actively volunteer to become a donor. While the emotional responses regarding organ transplantation are understandable, they do not make the decision to decline becoming an organ donor morally correct.
It intuitively seems fair that if one is willing to receive a transplant (I assume the vast majority of people are), then one should also be willing to donate their own organs, especially in the situation of scarcity involved in organ availability. This is exactly why it is the state’s responsibility to provide the guidance of an opt-out system. Part of the reason for the existence of the state is to encourage individual decisions which are beneficial to the overall public, especially when those decisions involve little to no significant sacrifice for the individual. The opt-out system donor pool would include all donors that currently actively choose to be donors under the opt-in system, those who would become donors with a little more consideration and/or state guidance and also those who are simply indifferent to what happens to their organs. This could likely mean a very significant increase in the donor pool with no coercion, injustice or unfairness done.
What if an individual really does have strong feeling against being a donor? In the opt-out system one can imagine, they are entirely free opt-out without consequence. A possible mechanism for the action of opting out could involve checking a box on an application for a government ID. A whole separate debate may be necessary for the issue of automatically registering children as donors, as they may not possess a sufficient degree of autonomy to make a fully informed decision about organ donation. Should the default donor position apply to children, with the decision to opt-out left up to the parents? Should the default donor position simply not apply to children at all? These are difficult but important questions, especially considering the clear physical constraints of other children in need of organs.
One possible objection to the opt-out policy is that is a coercive state policy, since it defaults to an individual giving up something they may consider valuable (the right to an intact body after death). As mentioned previously, the opt-out policy still affords the individual this right. All that is required is simply more conscious consideration about exactly what they are doing.
Mike graduated from Northeastern University in January 2014 with a major in biology and a minor in ethics. He is interested in a wide range of issues in bioethics and how they are applied in today's world.