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Opinion 2.155 - Presumed Consent and Mandated Choice for Organs from Deceased Donors

The supply of organs for transplantation to treat end-stage organ failure is inadequate to meet the clinical need. Therefore, physicians should support the development of policies that will increase the number of organ donors. Two prominent proposals aimed at increasing organ donation would change the approach to consent for deceased donation: mandated choice and presumed consent.

Under a presumed consent model, deceased individuals are presumed to be organ donors unless they indicate their refusal to donate. Such donations would be ethically appropriate only if it could be determined that individuals were aware of the presumption and if effective and easily accessible mechanisms for documenting and honoring refusals to donate were established. Moreover, physicians could proceed with organ procurement only after verifying that there was no documented prior refusal by the decedent and that the family was unaware of any objection to donation by the decedent.

Under a mandated choice model, individuals are required to express their preferences regarding organ donation at the time of performing a state-regulated task. This contrasts with the widespread model of voluntary organ donation under which individuals are afforded an opportunity to indicate their preferences. A mandated choice model would be ethically appropriate only if an individual’s choice were made in accordance with the principles of informed consent, which would require a meaningful exchange of information. Physicians could proceed with organ procurement only after verifying that an individual’s consent to donation was documented. It is not known whether implementation of ethically appropriate models of presumed consent or mandated choice for deceased donation would positively or negatively affect the number of organs transplanted. Therefore, physicians should encourage and support properly designed pilot studies, in relatively small populations, that investigate the effects of these policies. Unless there are data that suggest a positive effect on donation, neither presumed consent nor mandated choice for deceased donation should be widely implemented.

In all models, education of individuals to facilitate informed consent is requisite. (I, III, V)

Issued November 2005 based on the report "Presumed Consent for Organ Donation," adopted June 2005.