How to Reverse the Organ Shortage

Abstract

Thousands of lives are lost each year because of a lack of organs available for transplant, but currently, in the UK and many other countries, organs cannot be taken from a deceased donor without explicit consent from the donor or his or her relatives. Switching to an 'opt-out' (or 'presumed consent') system for organ donation could substantially increase the supply of organs, and save many lives. However, it has been argued in some quarters that there are serious ethical objections to an opt-out policy, and that it would be better to adopt a different policy known as the 'presumptive approach', that requires explicit consent while also attempting to sway the choices of potential donors and family in the direction of donating, using various persuasive techniques.This article shows how reflection on the impact of a well-known cognitive bias known as 'status quo bias' can explain (i) why moving from the status quo to an opt-out policy might be effective in increasing organ availability, even without impinging on anyone's autonomous choices, (ii) why we might have overestimated the strength of the objections to an opt-out policy, and (iii) why the presumptive approach is morally objectionable, while an opt-out policy is not.

Ethical Challenges of Organ Transplantation

“…Some reject it on the grounds that people have a right to determine what happens to their organs after they die and therefore their preferences should take priority over benefits to recipients (Sharif/Moorlock 2018). Others argue that the presumptive approach is potentially manipulative and so may lead family members to make decisions that are not fully autonomous or in the best interests of family members and patients (Rippon 2012;Troug 2012). Nevertheless, if nudging family members is expected to significantly increase the supply of donated organs, one might argue that societal benefits outweigh the pro tanto wrongness of nudging family members (MacKay/Robinson 2016).…”

Can financial rewards complement altruism to raise deceased organ donation rates?

“…58 Critics are quick to note that the presumed consent regulations deny large numbers of people freedom to make decisions as many are unaware of such laws. 59 Moreover, under the opt-out system, donation becomes a norm rather than a special act to do. 60 Hence, the argument against the opt-out system is persuasive enough to suggest that there is a need for ethical alternatives to raise organ donation rates.…”

“…Counselors are to promote donation using ethical methods while promoting the benefits of organ donation to dying patients or their next of kin. 59 As Beauchamp and Childress 62 have argued, an outright opt-out policy would not be adopted in some countries. It is claimed that for the countries with explicit consent, contemplating conversion to presumed consent in the effort to boost organ donation rate is an important political issue.…”

The reversal test, status quo bias, and opposition to human cognitive enhancement

“…This is the reversal test. The reversal test has been appealed to by many, including Wilkinson (2009, 236), Sandberg (2011, 83), Rippon (2012, 350–354), and Kahane and Savulescu (2015, 138) 2…”