[Series] Organ Donation Pt. 1

To open, I want to recognize that this can be a very touchy subject and that I intend to break it down a bit over the next few weeks. There are a whole battery of issues ranging from freedom of choice, to religious dogma, to concerns about quality of care. I don’t mean to prescribe my beliefs on anybody, but truly do believe that a universal application of an opt-out organ donation can only bring us a net benefit to the health of human society as a whole. With that out of the way, let’s jump into some recent developments on perspectives from around the world.

As of the time of this writing, a growing list of nations have ratified presumed consent donation policies. These include: Argentina, Austria, Belgium, Chile, Colombia, Italy (although only partly observed), Spain, and Wales, with many more countries in the process of consideration. Ireland announced in the fall of 2017 that they expect a rollout of their presumed consent program by fall of 2018.

…a growing list of nations have ratified presumed consent donation policies. These include: Argentina, Austria, Belgium, Chile, Colombia, Italy (although only partly observed), Spain, and Wales…

While the opt-out programs may vary to some degree in their implementation, the core idea revolves around the default action in the event no intention is declared by a potential donor. On the other end of the spectrum is the opt-in system which is currently the model employed by both Canada and the United States among many other countries around the world. In this system, potential donors must make informed consent of their intentions to donate their organs should a situation arise where it is feasible. In many cases, no decision is made and is ultimately left to family members. It’s understandable that many families may choose not to donate their loved one’s organ(s) since the decision often comes suddenly at a time when the family is in a poor position to make a composed and informed decision.

Finally, somewhere in between these two stances lies a handful of countries that have taken to relatively unique solutions to the donation question. Most notable are Iran, Israel and New Zealand. These countries have found variations on the opt-out or opt-in models that work for the socioeconomic conditions of their respective nations.

Iran marks an exceptional entry on this list as it is the only country in the world to have successfully implemented a legal organ marketplace. A nonprofit organization, Dialysis and Transplant Patients Association manages the process of linking would-be donors to recipients. The nonprofit ensures the legitimacy of the transaction as an impartial third party, reducing the chances of fraud and corruption in a process that sees the donor receiving approximately US$4,500 for a kidney. Though the program receives criticism from the World Health Organization and other groups for commercializing the transplant process, it has served to effectively eliminate the kidney transplant wait list in Iran since its introduction in 1988.

There’s a lot to unpack here, so I’ll be continuing this as a series over the course of the next few weeks so check in next week for the following segment where I’ll take a closer look at the countries that have implemented an opt-out policy.