Normative consent and opt-out organ donation

Saunders, Ben

doi:10.1136/jme.2009.033423

Cited by 35 publications

(33 citation statements)

References 25 publications

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“…Critics have argued that ‘presumed consent’ de facto takes away the potential donor's autonomy because many people may not be aware of the ‘opt out’ clause and have their organs removed in opposition to their wishes 4 5. Ben Saunders6 has recently responded to this objection by claiming that actual consent is not necessary for organ donation. We offer arguments to refute this claim.…”

mentioning

confidence: 99%

“…The idea is that if the patient had been previously opposed to organ donation and would not have given consent, such lack of consent would have been morally wrong, and there is no moral obligation to go along with an immoral lack of consent. ‘Implicit or explicit’ consent to donate one's organs ‘is not needed’ 6. Saunders claims that his view ‘supports an opt-out system which provides protection for those who have genuine reasons to refuse donation and spares the worries as to what the deceased would actually have wanted’ 6…”

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confidence: 99%

“…Saunders' version of the principle in the context of organ procurement is ‘when we can prevent something bad, such as a death, without sacrificing anything of comparable moral importance, we ought to do so’ 6 8. If Singer is correct, the application of Estlund's position to the issue of consent for organ donation seems to follow.…”

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confidence: 99%

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Normative consent and presumed consent for organ donation: a critique

et al. 2010

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Ben Saunders claims that actual consent is not necessary for organ donation due to 'normative consent', a concept he borrows from David Estlund. Combining normative consent with Peter Singer's 'greater moral evil principle', Saunders argues that it is immoral for an individual to refuse consent to donate his or her organs. If a presumed consent policy were thus adopted, it would be morally legitimate to remove organs from individuals whose wishes concerning donation are not known. This paper disputes Saunders' arguments. First, if death caused by the absence of organ transplant is the operational premise, then, there is nothing of comparable moral precedence under which a person is not obligated to donate. Saunders' use of Singer's principle produces a duty to donate in almost all circumstances. However, this premise is based on a flawed interpretation of cause and effect between organ availability and death. Second, given growing moral and scientific agreement that the organ donors in heart-beating and non-heart-beating procurement protocols are not dead when their organs are surgically removed, it is not at all clear that people have a duty to consent to their lives being taken for their organs. Third, Saunders' claim that there can be good reasons for refusing consent clashes with his claim that there is a moral obligation for everyone to donate their organs. Saunders' argument is more consistent with a conclusion of 'mandatory consent'. Finally, it is argued that Saunders' policy, if put into place, would be totalitarian in scope and would therefore be inconsistent with the freedom required for a democratic society.

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confidence: 99%

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Normative consent and presumed consent for organ donation: a critique

et al. 2010

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“…Debate regarding the appropriateness of a presumed consent policy derives from ethical, legal and religious arguments surrounding the implications on human rights and individual autonomy. 13,14 Rendhawa et al interviewed faith leaders from different religious organizations in the UK and found that most supported transplantation as an opt-in, but not as an opt-out, paradigm. 15 Debate also exists among the ethics community as to whether tacit agreement to become a donor is justified or alternatively whether a system of opting out of donation sufficiently protects the rights of individuals who are not willing to consent.…”

Section: Presumed Consent and Opt-out Policiesmentioning

confidence: 98%

“…15 Debate also exists among the ethics community as to whether tacit agreement to become a donor is justified or alternatively whether a system of opting out of donation sufficiently protects the rights of individuals who are not willing to consent. 14,16,17 More broadly, the transplant community has a vested interest for maintaining positive engagement with the general public and different community leaders, and recognizes that alienating certain groups with any intervention could have an adverse impact on public perception of transplantation.…”

Section: Presumed Consent and Opt-out Policiesmentioning

confidence: 99%

Increasing the pool of deceased donor organs for kidney transplantation

Schold

Segev

2012

Nat Rev Nephrol

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Expanding the pool of available deceased donor kidneys is critical for improving the outcomes of prospective and current renal transplant candidates. A number of interventions have been proposed that may increase the pool of donors in the US. However, these interventions have variable levels of empirical evidence supporting their potential beneficial impact. Proposed interventions include the instigation of policies for presumed donor consent, the expansion of donor registration, increased quality oversight of transplant providers, financial incentives for donors, increased reimbursement for higher risk donors, alterations in organ allocation policies and distribution, and the selective use of donors with potential or known risk for disease transmission. Many of these interventions have contentious elements that may have delayed or impeded their implementation; however, these options should be considered in the context of the diminishing prognoses for prospective transplant patients, given the increasing scarcity of donor organs relative to the population need. In this Review, we outline the proposed interventions and briefly discuss salient issues that characterize the debates concerning their implementation and effectiveness. Ultimately, any intervention must be based on the best evidence available, with consideration of numerous stakeholders and in conjunction with a careful evaluation of long-term and potential unintended consequences.

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Organ Donation: Opt In and Opt Out Strategies

Saunders

2012

Encyclopedia of Life Sciences

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Opt‐in strategies only take organs from those who have specifically consented to donation, whereas opt‐out strategies treat everyone as a willing donor unless they exempt themselves. Both strategies allow individuals (or their next of kin) power to determine what happens to their cadaveric organs; the difference between them is the ‘default’ treatment of someone who has expressed no wish either way. Opt‐out strategies are likely to increase donation rates, because those who do not register a preference either way will be treated as donors. Opt‐out strategies are often called ‘presumed consent’ and critics contend that this is unjustifiable. In fact, numerous other justifications for such a policy are available, for instance it may be that those who do not opt out thereby tacitly consent to the use of their organs. Key Concepts: Opt‐in donation strategies means no one's organs are used without their consent. Opt‐out donation strategies mean that everyone is treated as a donor unless they specifically refuse. Few countries operate ‘pure’ opt‐in or opt‐out strategies, because consent is usually sought from next of kin. It is difficult to measure or predict the effects of a change in policy, but likely that an opt‐out strategy will procure more organs than an opt‐in strategy. An opt‐out strategy should not be identified with ‘presumed consent’. There are a variety of possible justifications for an opt‐out strategy, including tacit consent and normative consent. ‘Tacit consent’ means that one's consent is implied by one's silence. Tacit consent does not necessarily meet the conditions of informed consent.

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Normative consent and opt-out organ donation

Cited by 35 publications

References 25 publications

Normative consent and presumed consent for organ donation: a critique

Normative consent and presumed consent for organ donation: a critique

Increasing the pool of deceased donor organs for kidney transplantation

Organ Donation: Opt In and Opt Out Strategies

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