Presumed Consent or Mandated Choice to Overcome Organ Shortage

Correspondence Address:
Dr.Sunil Shroff
Prof & Head of the Department of Urology & Renal Transplantation
Sri Ramachandra Medical College & Research Institute,
Porur, Chennai 600 116, India
Email : srmcurology@gmail.com
Telephone: 91 44 24761546
Fax: 91 44 2476 1540

"Presumed consent" (PC) manycountries have followed this method of consent for organ donation to overcomeorgan shortage problem. PC means thatunless someone has opted out, the state presumes that  their citizen have said yes to organdonation. This means official consent is not required for organ donation in thevent of death and organs can be retrieved without delay. This type of consentis also called Implied consent. 

Countries following presumed consent law andincludes Belgium, Austria,  Finland, France, Norway,  Spain and  Singapore.  The Success with Presumed consent law in these countries has been quited ramatic and to a large extent overcome the shortage of organs.     

Spain- The Organizacã­on Nacional de Trasplantes (ONT)was  established in 1989 to help withshortage of organs in the country. Spain had one of the lowest donation ratesin the world at that time but within a few years with the help of presumedconsent and hospital based teams and transplant coordinators its organ donationrate rose steadily to make it the best procurement programme in the world . Ittoday has 34 per million person donation rates. This has been achieved despitethe fact that Spain also has one of the lowest road traffic accidents rate inthe European Union.

France-  France  passed the law in1976. Since it was passed the PC law produced increases in organ donationapproaching 5,000%.

 Austria  itaccepted PC law in 1982. By the end of 1990 and it helped to overcome shortageof kidneys.

Belgium the law was passed in 1986. Its organ donation ratemoved up by 183%.

Singapore-the law passed in 1986 changed the organ donationrate by almost 120%

The world shortage of organs is compellingmany countries to look at PC as the answer. UK has been seriously debating thisissue and may accept the law.  In India,it is still too early to look at this legislation.

"Mandatedchoice" law is another way of increasing thedonation rate and can be implemented in different ways. This law requires citizens to declare their choice aboutorgan donation. This can be done by registering with a national body orexpressing their wishes during the issue of important documents like DrivingLicence or National Identity cards or Passport.  Sweden and Denmark are two counties that have implemented thelegislation quite effectively.   In 1996, when  Sweden instituted the law the potential  national donor registry swelled by 600,000. Similarly in Denmarkit increased by 150,000. In India too we can use this soft approach and use mandated choice especially when issuing the Driving licences  or Passport and make our choices regardingorgan donation.