Increasing organ donation by presumed consent and allocation priority: Chile

Abstract

Chile, a middle-income country, recently joined Israel and Singapore as the world’s only countries to require reciprocity as a precondition for organ transplantation. The Chilean reform includes opt-out provisions designed to foster donation and priority for organ transplantation for registered people. Although the reform has had serious difficulties in achieving its mission, it can be reviewed by other countries that seek to address the serious shortage of organs. As increased organ donation can substantially enhance or save more lives, the effect on organ availability due to incentives arising from rules of preference should not be underestimated.

A Case for an Opt-Out Organ Donation System in Canada

“…The sudden pressure of this change spurred public unease and millions of opt-outs. However, surveys showed that 70% of people did not fully understand the new law [5]. We can be reasonably sure that this will not be the case in Canada.…”

“…In general, this idea is thought to promote organ donation. Many studies have been dedicated to confirming this hypothesis [5,6]. However, one must be careful when com-paring donor and transplant rates in different countries.…”

“…Furthermore, one must consider global trends while comparing donor rate increases. Yet, even while controlling for determining factors, studies show that 'opt-out' legislation increases donor rates [5,6,8,9]. For example, the donor rate in Austria quadrupled after instituting 'opt-out' legislation.…”

“…These trends continue today [3]. Along with new legislation, better transplantation infrastructure, public opinion, and family education also help increase the donor rate [5].…”

“…Conversely, the second system is called 'opt-out'. This system operates under the assumption that the majority of the population wishes to donate and therefore a person must express a refusal or remove their name from a list if they choose not to become a donor [5]. Currently, Canada is operating under an 'opt-in'-like system [1,6].…”