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 : [email protected]
Telephone: 91 44 24761546
Fax: 91 44 2476 1540

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

Countries following presumed consent law and includes 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 Organizacă­on Nacional de Trasplantes (ONT)was  established in 1989 to help with shortage of organs in the country. Spain had one of the lowest donation rates in the world at that time but within a few years with the help of presumedconsent and hospital based teams and transplant coordinators its organ donation rate rose steadily to make it the best procurement programme in the world. Today it has 34 per million person donation rates. This has been achieved despite the fact that Spain also has one of the lowest road traffic accidents rate in the European Union.

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

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

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

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

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

"Mandatedchoice" law is another way of increasing the donation rate and can be implemented in different ways. This law requires citizens to declare their choice about organ donation. This can be done by registering with a national body or expressing their wishes during the issue of important documents like driving licence or National Identity cards or Passport.  Sweden and Denmark are two countries that have implemented the legislation 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 regarding organ donation.