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Should our organ-donor policy change so that people are presumed donors unless they opt out? (The moderator's message)

Posted at 8:00 AM on July 11, 2011 by Michael Caputo

The Assertion: Change U.S. organ-donor policy so that people are presumed to be donors unless they opt out

What's at issue?

Last month a Chinese teenager made international news for selling a kidney on the black market for money to buy an iPad.

Black markets for organs exists around the world for a simple reason: Demand far outstrips supply. In America about 110,000 people are on a waiting list for organ donation but in the first quarter of 2011, only about 4,500 donations were made.

Every 52 minutes someone on the waiting list dies due to the shortage of organs, according to FAIR (the Fair Allocations in Research Foundation)

FAIR calls this "America's organ-donor crisis".

So what to do? Some propose financial incentives for donation. A Florida State University law professor advocates giving a scholarship to a young person who donates a kidney.

Then there is an idea that New York Times David Brooks called last week a "tiny and costless change in procedure" that could make a large change in organ donation behavior.

It's called presumed consent. But the bioethical arguments around this simple change provoke big debate.

Why is this debate important?

Currently people "opt in" to the donor program, primarily done when you apply for, or renew, a driver's license. A presumed consent policy would assume you agree to be an organ donor unless you "opt out" of the program.

A number of European countries have adopted "presumed consent," including Spain, France and Norway. But it hasn't happen in the United States. Supporters of presumed consent want state and federal leaders to create pilot projects in various states.

But attempts at creating this on the state level have been rebuffed. Colorado, New York, Delaware and Illinois have been the latest places where the legislation was proposed and failed.

Why the rejection? People fear that medical institutions might not do what they can for a critical patients in order to harvest their organs. Some opponents say countries where presumed consent is the policy don't see more donations because of that policy but because the change prompts health officials to better manage donation programs (read the conclusion of this study written by Kieran Healy, sociology professor at Duke University).

Those backing presumed consent say changes must be made in the system not only because there aren't enough organs for those who need them, but because transplant centers are often having to engage in medical rationing.

This is not only a health care debate for those in need of an organ transplant, but also on how public policy should direct us to make organ donations.

Who are the primary debators?

Pro - David Courtney, interim president, The Presumed Consent Foundation, Plainview, TXCourtney was diagnosed with Chronic Obstructive Pulmonary Disease (COPD) at the age of 40 and received a bi-lateral lung transplant in 2008. Courtney is the interim president for the Presumed Consent Foundation, Inc. and also its current vice president and director of public relations. He served on the Fair Allocations in Research Foundation (or FAIR) Board of Directors. He is past chapter president of the Texas Panhandle Chapter, Transplant Recipients International Organization (TRIO). He has presented the Presumed Consent Foundation's proposed policy to many state and federal legislative committees and staff. David is a member of, serves as a Deacon and leads the Men's Ministry at Western Heritage Fellowship.

Con - Mary Faith Marshall, professor, Center for Bioethics, University of Minnesota. Marshall is also professor of Family Medicine and Community Health at the University of Minnesota Medical School, and she serves as co-chairman of the University of Minnesota Medical Center Ethics Committee. Marshall is a past president of the American Society for Bioethics and Humanities and the American Association for Bioethics. She is a former member of the Board of Directors of the National Marrow Donor Program. She has served on multiple special emphasis panels, review panels and study sections at National Institutes of Health and in the public and private sectors. Marshall once served on the faculty of the Center for Biomedical Ethics at the University of Virginia Health Sciences Center.

The home for this debate can be found by clicking here

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