Consent and Organ Donation

One of the most well-known types of informed consent is organ donation. When issued a driver’s license for the first time, we are all given the option to sign a form and then the back of license indicating we will donate our organs upon death if possible. Recently, New York State there has been a proposal to change this type of consent from given to presumed. This means that if you do not sign to be a donor and your organs are healthy enough to be used, they will be transplanted. This would create a system where you would sign a document to opt out of being donor. This New York Times round table debate article poses the question about what this means for donating and informed consent and solicits answers from five different authorities, all with different points of view. The authorities include Arthur Caplan (professor of bioethics), Kieran Healy (sociologist), Sally Satel from the American Enterprise Institute, Elaine Berg from the New York Organ Donor Network and Mary Ann Baily from the Hastings Center (see the article for more detailed qualifications).

A reoccurring issue the new measure’s dissolution of the “veto power” of the next of kin. Currently, as more than one respondent points out, next of kin veto power is a large deterrent in the current system. However, as Kieran Healy explains, “veto power” is an important component of European systems that use “presumed consent,” like in Spain which has an efficient and successful transplant system. Healy says that the European countries that have dissolved the next of kin veto power and have a presumed consent system (he cites Austria) do not have a much higher transplant number than the US. Most of the respondents refer to Europe in their examples because many of the countries in the EU already have presumed consent systems and it works well.

However, Healy points out that many EU countries have success because of the investment into their system in general, just not the change to a presumed consent system. Mary Ann Baily backs up this argument, independently, by explaining that the government needs to build trust with the public on issues of informed consent, whether for organs, blood or DNA. Consequently, the relationship between doctor and patient and doctor and patient’s family is complex, but a doctor is more likely to get support from the family if the family feels involved in the consent and/or the decision. Informed consent is quickly moving out the realm of signing a legal document into a new frontier of trust and comfort.