System Of Presumed Consent Research Articles

Interlinking Organ Scarcity to Human Rights

Organ failure is a medical emergency that causes immense suffering and a life-threatening situation. Organ transplant is the only treatment for organ failures other than renal failure. Even in cases of kidney failure, transplant is the most cost effective treatment for organ failure to prolong the lives of sufferers. The advancement of medical science in the field of transplants has improved human longevity and on an average life could be prolonged by ten- eleven years. Organ procurement from a donor is the first stage in a transplant. As in the case of blood, the organ is required to be healthy and must match. However, there is an inadequacy of organs across the world and patients who could be given a new life, die during the wait. The connection with human rights has been least explicit in the context of organ scarcity. Globally, two consent systems for organ donation can be found. The opt- in system also known as the explicit consent system requisites an express consent of either the person when alive for organ donation or their relatives after death. By contrast, opt-out systems presume everyone to be a donor and people are required to express their objection. It is generally seen that countries with presumed consent system have higher rates of organ donation in comparison to countries with opt- in system. India has opted- in system and despite having the highest population is donor rate is among the lowest in the world. This essay has two distinct objectives: First, it seeks to interlink organ scarcity to human rights. For this purpose it draws upon International Human Rights Framework. Second, it looks into the Indian law and analyses the lessons India needs to learn to improve its organ donation rate. Technological developments in the field have opened up the possibility of transplanting an increasing number of human organs, including the non vital ones like uterus, to those in need. However, the focus of the present research is limited to vital organs and does not extend to tissues and non- vital organs. Though there are human rights issues involved with allocation of organs and organ trafficking, those fall beyond the scope of the Article.

A default nudge in waste management: assessing the impact of explicit consent for unaddressed mail

ABSTRACT On 1 January 2018, the municipality of Amsterdam changed the system for the reception of unaddressed mail from presumed consent to explicit consent to reduce paper waste. This policy can be defined as a default nudge. The no-choice population received unaddressed mail in the presumed consent system but not in the new explicit consent system. Residents receive unaddressed mail only when they actively decide to put an opt-in sticker on their mailbox. This study assesses the effectiveness and social benefits of this nudge. The effect on paper waste is estimated using a difference-in-differences approach in which several other Dutch municipalities function as the control group. Our main finding is that the default nudge results in a reduction of paper waste between 5.3% and 11%. Social benefits of this reduction include, for example, lower carbon emissions for collection and transport for paper waste, which are equivalent to yearly benefits between approximately €135,000 and €285,000 in Amsterdam. If all Dutch municipalities implement the system of explicit consent for unaddressed mail, the yearly benefits are approximately between €14 million and €30 million. The default nudge is a low-cost policy to implement and, therefore, offers municipal policymakers a cost-effective way to reduce waste.

Public Perception of Organ Donation and Transplantation Policies in Southern Spain

This research explores how public awareness and attitudes toward donation and transplantation policies may contribute to Spain's success in cadaveric organ donation. A representative sample of 813 people residing in Andalusia (Southern Spain) were surveyed by telephone or via Internet between October and December 2018. Most participants trust Spain's donation and transplantation system (93%) and wish to donate their organs after death (76%). Among donors, a majority have expressed their consent (59%), and few nondonors have expressed their refusal (14%). Only a minority are aware of the presumed consent system in force (28%) and feel sufficiently informed regarding the requirements needed to be an organ donor (16%). Participants mainly consider that relatives should represent the deceased's preferences and be consulted when the deceased's wishes are unknown, as is the case in Spain. Public trust in the transplant system may contribute to Spain's high performance in organ donation. High levels of societal support toward organ donation and transplantation do not correspond with similar levels of public awareness of donation and transplantation policies in Spain.

Ethical reflection support for potential organ donors' relatives: A narrative review.

Even in countries with an opt-out or presumed consent system, relatives have a considerable influence on the post-mortem organ harvesting decision. However, their reflection capacity may be compromised by grief, and they are, therefore, often prone to choose refusal as default option. Quite often, it results in late remorse and dissatisfaction. So, a high-quality reflection support seems critical to enable them to gain a stable position and a long-term peace of mind, and also avoid undue loss of potential grafts. In practice, recent studies have shown that the ethical aspects of reflection are rarely and often poorly discussed with relatives and that no or incomplete guidance is offered. No review of the literature is available to date, although it could be of value to improve the quality of the daily practice. The objective was to review and synthesize the main concepts and approaches, theories and practices of ethical reflection support of the relatives or surrogates of potential post-mortem organ donors. A narrative review was performed in the medical, psychological and ethical fields using PubMed, PsycArticles and Web of Science databases (1980-2020). Out of 150 papers, 25 were finally retained. Four themes were drawn: the moral status of the potential post-mortem organ donor, the principlistic approach with its limits and critics, the narrative approach and the transcendental approach. This review suggests an extension of psychological support towards ethical reflection support. The process of helping relatives in their ethical exploration of post-mortem organ donation is psychologically and morally characterized. The need for specialized professionals educated and experienced both in clinical psychology and in health ethics to carry out this task is discussed. This review could contribute to optimize the quality of the ethical reflection support by initiating an evolution from an empirical, partial and individual-dependent support to a more systematized, professionalized and exhaustive support.

General public's view on opt-in, opt-out, and mandated choice organ donation policies: a qualitative study involving Swiss French-speaking citizens favourably disposed towards organ donation.

All over the world, patients die while waiting for a transplant. Facing this difficulty, countries struggle to find efficient procedures and policies. One policy that has recently been enforced in many countries is the presumed consent (opt-out) system for organ donation. In such a system, every individual is considered as a potential organ donor except in cases of expressed refusal during her or his lifetime. Based on the input of a citizen's initiative, the Swiss parliament has made a proposal for a soft presumed consent policy.It was accepted by both chambers at the national level, but will possibly be challenged by a referendum, and give rise to a public vote. Ahead of the democratic debate, our aim was to sound out what issues are perceived as relevant by ordinary citizens when they evaluate different policies regulating organ donation. What are their main worries and decision criteria? We conducted semi-structured taped interviews with ordinary citizens during which we asked their views on three different systems: the current opt-in system, the opt-out presumed consent system described in a soft and in a hard version, and the mandatory decision system. We analysed transcripts by coding, and grouping code families up to four levels. We achieved saturation with fifteenth interviews. All our participants happened to be favourably disposed towards organ donation. Participants considered it important to choose a policy that contributes to overcoming the current shortage of organs, but not by any means. They were mostly concerned about individual rights and liberties, and more specifically about the importance of respecting the deceased's will and to promote lifetime advanced directives on organ donation. The role and rights of relatives were recurrent topics on which participants expressed divergent opinions. Participants often concluded that no legal system is perfect and spent much time discussing elements that were relevant to organ donation in general but not specifically linked to a given legal system. This study provides useful information about citizens' concerns regarding organ donation. In preparation of public debates on an opt-out policy, our results reveal what issues are likely to tilt the public opinion.

Applying utilitarianism to the presumed consent system for organ donation to consider the moral pros and cons.

In May 2020, England adopted an opt-out approach for organ donation, also referred to as the deemed consent system, with the aim of alleviating the demand for organs in the UK. This system dictates that those who have not opted out will have their organs donated following their death, with the exception of those meeting certain criteria. This article applies the philosophical theory of utilitarianism to the deemed consent system for organ donation, focusing particularly on topics such as that of informed consent and family refusal. Utilitarianism is a consequentialist theory that attempts to determine whether an action is morally right or wrong based on whether or not it maximises the preferences of the greatest number of people, with each person's satisfaction being considered as equal to another's.

Does Changing Defaults save Lives? Effects of Presumed Consent Organ Donation Policies

In this review, we examine whether presumed consent organ donation policies save lives. We compare presumed consent defaults (where people are considered organ donors by default but can opt out of donation) with explicit consent defaults (where people are considered nondonors by default but can opt in to be considered donors). Experimental, cross-sectional, and longitudinal evidence indicates that rates of consent, donation, and transplantation are higher under presumed consent policies than under explicit consent policies. The evidence also suggests, however, that presumed consent is one factor among many that determine the number of organs donated and lives saved; policymakers must balance a number of other considerations to ensure that shifting to a presumed consent system will boost donation and transplantation rates. We underscore the importance of investing in health care infrastructure to support organ procurement and transplantation and offer empirically informed recommendations to enable consent policies to save the most lives.

Confucianism and organ donation: moral duties from xiao (filial piety) to ren (humaneness).

There exists a serious shortage of organs for transplantation in China, more so than in most Western countries. Confucianism has been commonly used as the cultural and ethical reason to explain the reluctance of Chinese and other East-Asian people to donate organs for medical purposes. It is asserted that the Confucian emphasis on xiao (filial piety) requires individuals to ensure body intactness at death. However, based on the original texts of classical Confucianism and other primary materials, we refute this popular view. We base our position on the related Confucian norms of filial piety and ren (humaneness, humanity or benevolence), the tension between differentiated love and universal love, and belief in the goodness of human nature. In light of this, we argue that the Confucian ethical outlook actually calls for organ donation at an individual level, and supports an opt-out (presumed consent) system at the level of social policy. Furthermore, because the popular view is based on a number of dominant but misleading modes of thinking about cultural differences, our revisionist account of Confucian moral duties regarding organ donation has implications for developing a more adequate transcultural and global bioethics. These will be discussed and expanded upon.

Does changing defaults save lives? Effects of presumed consent organ donation policies

In this review, we examine whether presumed consent organ donation policies save lives. We compare presumed consent defaults (where people are considered organ donors by default but can opt out of donation) with explicit consent defaults (where people are considered nondonors by default but can opt in to be considered donors). Experimental, cross-sectional, and longitudinal evidence indicates that rates of consent, donation, and transplantation are higher under presumed consent policies than under explicit consent policies. The evidence also suggests, however, that presumed consent is one factor among many that determine the number of organs donated and lives saved; policymakers must balance a number of other considerations to ensure that shifting to a presumed consent system will boost donation and transplantation rates. We underscore the importance of investing in health care infrastructure to support organ procurement and transplantation and offer empirically informed recommendations to enable consent policies to save the most lives.

Factors Associated with Health Care Professionals' Attitude Toward the Presumed Consent System.

This paper explores health care professionals' potential attitude toward organ donation if the presumed consent system were to be implemented in Malaysia, as well as factors associated with this attitude. We used self-administered questionnaires to investigate the attitude of 382 health care professionals from the University of Malaya Medical Center between January and February 2014. The responses were analyzed using logistic regression. Of the 382 respondents, 175 (45.8%) stated that they would officially object to organ donation if the presumed consent system were to be implemented, whereas the remaining 207 (54.2%) stated that they would not object. The logistic regression showed that health care professionals from the Malay ethnic group were more likely to object than those from Chinese (adjusted odds ratio of 0.342; P = .001) and Indian and other (adjusted odds ratio of 0.341; P = .003) ethnic groups. Health care professionals earning 3000 Malaysian Ringgit or below were more likely to object than those earning above 3000 Malaysian Ringgit (adjusted odds ratio of 1.919; P = .006). Moreover, respondents who were initially unwilling to donate organs, regardless of the donation system, were more likely to object under the presumed consent system than those who were initially willing to donate (adjusted odds ratio of 2.765; P < .001). Health care professionals in Malaysia have a relatively negative attitude toward the presumed consent system, which does not encourage the implementation of this system in the country at present. To pave the way for a successful implementation of the presumed consent system, efforts should be initiated to enhance the attitude of health care professionals toward this system. In particular, these efforts should at most target the health care professionals who are Malay, earn a low income, and have a negative default attitude toward deceased donation.

Success Factors for Social Systems to Increase the Number of Organ Donations—From the Perspectives of Mechanisms and Organizational Behaviors

Deceased organ donation is much less prominent in Japan than it is in Western and other Asian countries. Because a shortage of organ donation is a serious social issue in Japan, various solutions to the issue have been considered. Although it was believed that the most critical factor in the organ shortage was the absence of a well-established social system, no prior studies attempted to analyze the issue from the perspective of the mechanisms and organizational behaviors. To identify common success factors of increasing organ donation, we conducted a qualitative survey in 5 countries promoting organ donations on a national level and increasing the number of organ donations. We found several important common factors: 1) to change from an explicit consent system to a presumed consent system with establishment of an appropriate in-hospital system, 2) to increase the level of job satisfaction of healthcare professionals and help them generating better results, 3) to demonstrate managements’ leadership for all staff to realize the importance of organ donations, 4) to establish an environment where medical professionals engaged in organ donations can appreciate autonomous working styles, the recognition of the importance of the work. It is suggested that these successful factors are introduced into Japan with long-, mid-term strategy to enhance organ donation.

Exploring the views of Muslim community on presumed consent system: A study conducted in Malaysia

BackgroundCurrently, Malaysia follows the informed consent (IC) system of organ donation; however, the rate of organ donation in the country appears very low, and implementing a presumed consent (PC) system could help in enhancing the rate of donation. In determining the success of PC system, exploring the Muslim's perception toward the system is crucial. MethodWe conducted a questionnaire-based survey between October and December 2013. Self-administrated questionnaires were distributed among 829 Muslims in Kuala Lumpur. ResultsThe results show that 42.8% people of the Muslim community are unwilling to donate, while 17% of them are willing to sign objection form if the PC system were implemented. The PC system may violate the autonomy of about 25.8% of the Muslim community. ConclusionImplementing the PC system would have helped Malaysia to overcome the issue of organ shortage considering the fact that the majority of the people from Muslim community are willing donors. However, it is also important to consider the unwilling donors’ autonomy while designing the PC legislation, and further studies require understanding the reasons behind their reluctance to donate. We propose that a priority scheme for organ allocation should be included in organ donation legislation.

Presumed consent for organ donation: illusion of a choice

India has been following informed consent (opt- in) system of organ donation but soft pressures to shift to presumed consent (opt- out) system are simultaneously palpable. This paper describes presumed consent briefly and explains why the need to shift to this system is felt. The paper challenges the morality of presumed consent system and describes its use as absolutely unethical in view of socio cultural diversity, educational disparity and profound class stratification of our country. The paper throws some light on our own system which, unlike other countries, is not ready for this change. It focuses on thought-provoking issues that are deterrents to achieving increase in organ donation even if presumed consent system is adopted in India. It reflects the outcome of this coercive legal option in some countries. In some countries there was no change in organ donation rates. A few countries witnessed negative repercussions of presumed consent system. Some of these countries had no option except to revert back to opt- in system. The paper tries to give a message to the public and professionals by comparing Spain to India that has high donation rates in the world not because of presumed consent but because of other contributory factors. Spain initiated organ donation and transplant activities much ahead of India and their healthcare services are rated the best in the world. Socio-cultural, religious and political milieu unlike India is conducive to organ donation in Spain. Adequate investments in public health, adequate budget for organ donation and transplantation, excellent infrastructure, availability of public health assistance to 99% population, adequate availability of ICU beds, extending end of life care to all, positive approach to organ donation by majority of people, thorough professionalism and public trust is what makes Spain the best country in organ donation. The same is lacking in India. The paper warns us of this coercive option by drawing a parallel to the coercions that took place when India acted coercively to control population through compulsory sterilization and led to the wrath of masses in 1976. India as on date needs to focus on other issues to increase organ donation rates like development of infrastructure, developing well-functioning national, regional and state level organizations, building in trust of people, identifying potential donors, managing donors, caring for donor families, training manpower, increasing awareness on organ donation and transplantation, reimbursing fees to organ retrieval hospitals, merging efforts of various stakeholders, developing transparent and workable organ sharing policies and regular auditing of brain stem deaths.

Do Family Members of Dialysis Patients Have a Positive Attitude Toward Organ Donation?

Malaysia, which currently uses the informed consent system (ICS), is suffering from a severe shortage of organs for transplantation. Family members of dialysis patients (FMDPs) are expected to have a positive attitude toward deceased organ donation (DOD) because they have a close relative in need of a kidney donation. This study explores FMDPs' attitude toward DOD under the ICS and the presumed consent system (PCS). The attitude of 350 FMDPs toward DOD under the ICS and PCS were sought between June and October 2013 in 3 dialysis institutions in Kuala Lumpur, Malaysia. Under the ICS, 6.6% of respondents were registered donors, 6.6% were ready to register at the time of the survey, 38.6% were willing to donate but not ready to register at the time of the survey, and 48.2% were unwilling to donate organs upon death. If the PCS were implemented, 57.7% of respondents (28.7% of the willing donors and 88.7% of the unwilling respondents) stated that they would officially object to organ donation. FMDPs' attitude toward DOD is not more positive or significantly better than that of the general public (based on earlier studies). The PCS may increase the number of donors, but it may also worsen the attitude of FMDPs toward DOD. Strategies aiming to promote DOD in Malaysia should be revised, and should perhaps be focused on enhancing trust of the medical system.

Demographic and Socioeconomic Factors Influencing Public Attitudes Toward a Presumed Consent System for Organ Donation Without and With a Priority Allocation Scheme

The influence of demographic and socioeconomic factors on the public's attitude towards a presumed consent system (PCS) of organ donation was estimated in 2 scenarios: without and with a priority allocation scheme (PAS). Self-administered questionnaires were completed by 775 respondents. Using multiple logistic regressions, respondents’ objections to donating organs in both scenarios were estimated. In total, 63.9% of respondents would object to donating under a PCS, whereas 54.6% would object under a PCS with a PAS. Respondents with pretertiary education were more likely to object than were respondents with tertiary education, in both the first (adjusted odds ratio [AOR] = 1.615) and second (AOR = 1.728) scenarios. Young respondents were less likely to object than were middle-aged respondents, in both the first (AOR = 0.648) and second (AOR = 0.572) scenarios. Respondents with mid-ranged personal monthly income were more likely to object than were respondents with low income, in both the first (AOR = 1.994) and second (AOR = 1.519) scenarios. It does not seem that Malaysia is ready to implement a PCS. The educational level, age, and income of the broader public should be considered if a PCS, without or with a PAS, is planned for implementation in Malaysia.

Could the organ shortage ever be met?

The organ shortage is commonly presented as having a clear solution, increase the number of organs donated and the problem will be solved. In the light of the Northern Ireland Assembly’s consultation on moving to an opt-out organ donor register this article focusses on the social factors and complexities which impact strongly on both the supply of, and demand for, transplantable organs. Judging by the experience of other countries presumed consent systems may or may not increase donations but have not met demand. Donation rates have risen considerably in all parts of the UK recently but there is also an increasing demand for organs. Looking at international donation rates and attitudes, future demand for organs and education on donation, the question is whether the organ shortage could ever be met. The increase in longevity, in rates of diabetes and obesity and in alcohol related liver disease all contribute both to increased demand for transplants, and re-transplants, and a reduction in the number of usable organs. It is unlikely that demand could ever be met, since, if supply was unlimited, the focus would move to financial resources and competing demands on the health care budget in a publicly funded health system. These factors point to the need to focus on ways of reducing, or at least stabilizing, demand where lifestyle factors contribute to the underlying disease.

Non-therapeutic intensive care for organ donation: A healthcare professionals' opinion survey.

Providing non-therapeutic intensive care for some patients in hopeless condition after cerebrovascular stroke in order to protect their organs for possible post-mortem organ donation after brain death is an effective but ethically tricky strategy to increase organ grafting. Finding out the feelings and opinion of the involved healthcare professionals and assessing the training needs before implementing such a strategy is critical to avoid backlash even in a presumed consent system. A single-centre opinion survey of healthcare professionals was conducted in 2013 in the potentially involved wards of a French University Hospital: the Neurosurgical, Surgical and Medical Intensive Care Units, the Stroke Unit and the Emergency Department. A questionnaire with multiple-choice questions and one open-ended question was made available in the different wards between February and May 2013. The project was approved by the board of the Lorraine University Diploma in Medical Ethics. Of a total of 340 healthcare professionals, 51% filled the form. Only 21.8% received a specific education on brain death, and only 18% on potential donor's family approach and support. Most healthcare professionals (93%) think that non-therapeutic intensive care is the continuity of patient's care. But more than 75% of respondents think that the advance patient's consent and the consent of the family must be obtained despite the presumed consent rule regarding post-mortem organ donation in France. The acceptance by healthcare professionals of non-therapeutic intensive care for brain death organ donation seems fairly good, despite a suboptimal education regarding brain death, non-therapeutic intensive care and families' support. But they ask to require previously expressed patient's consent and family's approval. So, it seems that non-therapeutic intensive care should only remain an ethically sound mean of empowerment of organ donors and their families to make post-mortem donation happen as a full respect of individual autonomy.

A principlist approach to presumed consent for organ donation

The demand for donor organs for transplantation in the UK far exceeds the supply. A number of improvements in the infrastructure surrounding organ donation, as well as attempts to increase public awareness, have been made over recent years, but there remains a massive shortfall. It has been proposed that a system of presumed consent for organ donation, in which all individuals are considered to be potential organ donors after death unless they have previously opted out, may serve to increase the supply of organs. Recently the Welsh Assembly passed a Bill introducing presumed consent by 2015, but the debates regarding legislative changes are still on-going in England, Scotland and Northern Ireland. The ethical implications of presumed consent legislation are at the centre of these discussions. When examined by a principlist approach, presumed consent may be deemed to be an ethically beneficial measure to increase organ donation rates. It is argued here that the system of presumed consent may actually be more respectful of the principle of autonomy than a system of explicit consent, on the basis that it goes against the wishes of the fewest number of people, and it has clear benefits in terms of beneficence and justice whilst also being compatible with the principle of nonmaleficence. Although there is some debate about the precise impact that presumed consent would have on donation rates, there is evidence to suggest that it would result in an increase in the donor organ supply, when combined with improvements in education and infrastructure.

The default option: Why a system of presumed consent may be effective at increasing rates of organ donation

In Australia, general sentiment towards organ donation is somewhat positive, but actual donation rates languish amongst the poorest in the western world. Even for registered organ donors, the Australian system mandates obtaining family consent for posthumous donation; making non-donation the default option. A telephone survey in Central Queensland, Australia (n = 1289), investigated people’s confidence regarding their decision on whether to donate organs of a deceased family member; whether or not they had discussed donation with their family; and their support for an opt-out (presumed consent) system of donation. In accord with our expectations, each of these factors independently predicted the wishes of respondents to donate their own organs. The results suggest that promoting organ donation as the default option may improve rates of public acceptance for organ donations and consequently save lives.

Consenting options for posthumous organ donation: presumed consent and incentives are not favored.

BackgroundPosthumous organ procurement is hindered by the consenting process. Several consenting systems have been proposed. There is limited information on public relative attitudes towards various consenting systems, especially in Middle Eastern/Islamic countries.MethodsWe surveyed 698 Saudi Adults attending outpatient clinics at a tertiary care hospital. Preference and perception of norm regarding consenting options for posthumous organ donation were explored. Participants ranked (1, most agreeable) the following, randomly-presented, options from 1 to 11: no-organ-donation, presumed consent, informed consent by donor-only, informed consent by donor-or-surrogate, and mandatory choice; the last three options ± medical or financial incentive.ResultsMean(SD) age was 32(9) year, 27% were males, 50% were patients’ companions, 60% had ≥ college education, and 20% and 32%, respectively, knew an organ donor or recipient. Mandated choice was among the top three choices for preference of 54% of respondents, with an overall median[25%,75%] ranking score of 3[2,6], and was preferred over donor-or-surrogate informed consent (4[2,7], p < 0.001), donor-only informed consent (5[3,7], p < 0.001), and presumed consent (7[3,10], p < 0.001). The addition of a financial or medical incentive, respectively, reduced ranking of mandated choice to 7[4,9], p < 0.001, and 5[3,8], p < 0.001; for donor-or-surrogate informed consent to 7[5,9], p < 0.001, and 5[3,7], p = 0.004; and for donor-only informed consent to 8[6,10], p < 0.001, and 5[3,7], p = 0.56. Distribution of ranking score of perception of norm and preference were similar except for no-organ donation (11[7,11] vs. 11[6,11], respectively, p = 0.002). Compared to females, males more perceived donor-or-surrogate informed consent as the norm (3[1,6] vs. 5[3,7], p < 0.001), more preferred mandated choice with financial incentive option (6[3,8] vs. 8[4,9], p < 0.001), and less preferred mandated choice with medical incentive option (7[4,9] vs. 5[2,7], p < 0.001). There was no association between consenting options ranking scores and age, health status, education level, or knowing an organ donor or recipient.ConclusionsWe conclude that: 1) most respondents were in favor of posthumous organ donation, 2) mandated choice system was the most preferred and presumed consent system was the least preferred, 3) there was no difference between preference and perception of norm in consenting systems ranking, and 4) financial (especially in females) and medical (especially in males) incentives reduced preference.