Bioethics in Faith and Practice, Volume 3, Number 1

Bioethics in Faith and Practice ⦁ 2017 ⦁ Volume 3 ⦁ Number 1 11 Bioethics in Faith and Practice vol. 3, no. 1, pp. 11-22. ISSN 2374-1597 © 2017, Ryan Marquardt, licensed under CC BY-NC-ND ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ) Presumed Consent for Organ Donation: Principlism Opts Out Ryan Marquardt Cedarville University Introduction The State of the Organ Shortage Most people know transplantable organ shortage is a monumental problem in the United States and around the world. Ever since the first successful kidney transplant at Boston’s Brigham & Women's Hospital in 1954, the need for donors has been apparent. 1 Once effective anti-rejection drugs became readily available in the late 1970s and transplants became routine, the organ shortage became as much a social issue as a medical issue . 2 Even though new research and technology has only made transplants safer and more successful, a transplant’s chances of success are irrelevant without an available donor. According to Organ Procurement and Transplantation Network data as of March 23, 2017, 118,049 candidates are waiting for a transplant in the United States. From 2012-2016, 267,177 new candidates were added to waiting lists, but only 151,132 transplants from 73,702 donors took place, which is possible because a single deceased donor can supply several organs for transplant. That means that each year, the theoretical gap between those in need of organs and organs available increased by over 20,000 on average . 3 Now, we do not actually see this kind of an expanding shortage over time in reality because many candidates (21,237 in 2016) are removed from waiting lists for reasons other than the receipt of a transplant, such as death or improved condition, but that fact is hardly any comfort. More than any other statistic, the fact that in those five years 31, 853 Americans died waiting for a transplant speaks to the tragedy of the current situation. 4 Understanding the need for more organs is only the first step to remedying the problem, and it is a small one. While the possibility remains that science could provide the solution in the form of so-called ‘organs in a dish’ or mechanical substitutes, thousands die waiting for science to fix a problem that need not exist. While it is difficult to fault healthy people for not becoming living donors, these only account for about 37% of total donors and 18% of transplants, due to the fact that a deceased donor can provide up to eight vital organs . 5 Far more organs are lost due to a lack of willingness to donate after death. A 2003 study estimated that in the U.S. from 1997-1999, potentially life-saving organs from 58% of possible donors were buried. 6 There is little reason to believe the situation has changed, as 95% of American adults support organ donation, but only 51% were registered donors in 2016. 7 Even with all this data, the overall shortage can only be estimated and is difficult to quantify, but the problem is obvious nonetheless. The argument can be made that the supply will never meet the demand due to the rapidly rising need for organs, but that in no way reduces the value of endeavoring to close the gap. 8 A life saved is a life saved. The Proposal of Presumed Consent With the state of the organ donor shortage clearly laid out, we can begin to consider the effectiveness and ethicality of possible solutions. A common proposal to close the gap between organ donation approval and registration that has been implemented in several European countries and heavily discussed in the United States and the UK is an ‘opt out’ or presumed consent system. This type of arrangement would provide all adults with a mechanism to join a non-donor registry and take failure to join as consent to donate . 9 While some believe that changing from explicit consent to presumed consent would not significantly increase the donor rate, most objections to presumed consent are made on ethical grounds.