Sunday, January 19, 2014

Is An Opt-Out Organ Donation System A Solution To Organ Shortages?

I am personally repulsed by how the government creates a shortage in organ donations simply because it does not want people donating organs for cash. I honestly believe that allowing consenting adults to voluntarily donate their organs for monetary compensation is good policy because if nothing else, money talks. The American Enterprise Institute reminded me of this by citing a Wall Street Journal article, in which one of the authors was Nobel Prize-winning economist Gary Becker. In spite of the argument that Becker made, a colleague of mine astutely brought an intriguing alternative policy to my attention: opt-out organ donation.

The opt-out system, also known as presumed consent, is the idea that anyone who has not explicitly refused to be an organ donor is automatically enrolled as an organ donor. This is in contrast with America's status quo of the opt-in system, in which one has to explicitly give consent in order to be considered a donor. The reason why opt-out is supposed to be so successful is because the donors drastically increase the supply of human organs. For instance, take a look at Germany and Austria. The former has an opt-in system, and the latter an opt-out system. In spite of having similar cultures, Austria's donation rate is eight times higher than that of Germany! While a higher donation does not automatically translate into eliminating the organ shortfall, those in the Eurotransplant system seem to have success with the opt-out system. 

From the start, I have an issue with how much this infringes on individual liberty. First, there is arguably no consent in the process. The government takes away one's organs unless one can navigate the government's system for objecting. Opting out might sound like a simple procedure, but there is the issue of clerical errors, improperly filling out a form, losing paperwork, or not being fully aware of the implications or able to fill out the paperwork (e.g., those with a low IQ, the mentally or physically disabled, children). Conversely, based on successful implementation in other countries, these concerns are minimal. Furthermore, if the government can seize your body parts upon death for the "greater good," couldn't the government also seize your assets to collect government revenue for the "greater good," as well? Don't get me wrong. I'm all for saving people's lives, which is why I'm all for the market providing monetary incentives to get individuals to donate. I get annoyed by the presumption that the default effect dictates that the government knows best about what to do with one's body. One's body belongs to the individual, not society

I don't want to dismiss the deontological argument because it certainly has merit. However, strictly for argument's sake, let's assume we shouldn't care at all about our freedom and the right to do what we want with our bodies, even postmortem. Does the opt-out system provide a viable solution? 
According to the British Medical Journal (BMJ), presumed consent can close the gap by 20-30 percent (also see the Hastings Center; Neto et al, 2007). However, since the American donation rate is already higher than other countries, such as the one in the BMJ, the odds are that this gap would be closed by a smaller amount than 20-30 percent.

According to a Mayo Clinic poll, most people would donate their organs, even to a stranger. Assuming that most people do not have a problem donating postmortem because "what am I going to do with the organs when I am dead?," then defaulting to a "yes" response would streamline the process. I can also worry about factors such as government funding, the government's ability to harvest organs in a timely fashion since organs need to be harvested and transplanted quickly, and a scenario in which the shortfall gets bad enough where doctors hasten the patient's death in order to keep up with the supply (if policy alternatives mitigate the shortfall, I can see how this concern would be minimal, at best). In spite of these problems, proponents make a good argument in which our inaction causes the deaths of a sizable amount of citizens (there still is the question I have about the percent of organs harvested from cadavers are actually healthy and viable enough for donor recipients). In a situation that does not inherently remove one's choice, as would be the case in mandatory organ donation, I have to acquiesce that at least from a consequentialist standpoint, this is a good policy, under the conditions that a) the government makes a concerted effort to inform the people about organ donation so they have an informed choice [in the event that they choose to opt out], and b) create a weak presumed consent process in which one's partner or next of kin has veto power (although I can see issues with posthumously denying the donor autonomy). 

Even if you want to justify proposed consent based on a decrease in the organ shortage, there is a matter of political feasibility. Countries like Brazil had to withdraw their opt-out system because the citizens had trust issues with the government's health care system. With all of the contention behind Obamacare and the decrease of freedom of health care choices in this country, how do you think Americans would react if they were stripped of yet another freedom? Although I have reservations about the infringements of freedom, I don't think the opt-out system is necessarily a bad idea, and I think it is better than the status quo. In light of other policies, the opt-out system should be weighed against its alternatives, which is why I still prefer permitting monetary compensation for organ donations.

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