Organ donation, an opt-out policy?

Such an interesting article in USA Today…

A suburban New York City assemblyman whose daughter is a two-time kidney transplant recipient wants to flip New York’s organ-donation system on its head by presuming people are donors unless they indicate otherwise.  

Assemblyman Richard Brodsky’s proposal would require that people automatically be added to the state donor registry unless they opt out of being a donor when they get a driver’s license or state identification card. Other states, including Delaware and Pennsylvania, have made similar proposals, but none passed.

“What I’ve said to anybody, whether they like it or they don’t like it, we can’t sustain the current system,” said Brodsky, a Democrat from Greenburgh in New York’s Westchester County.

He and other advocates of the “presumed consent” donor system believe it could help increase organ and tissue donations.

“People are dying in New York this week because we have failed to create a system that maximizes the opportunities to keep them alive,” said Brodsky, whose daughter, Julianne “Willie” Brodsky, received her second transplant four years ago and has become an advocate for changing the system.

An April survey by the New York Alliance for Donation found 67% of state residents strongly support organ and tissue donation, yet 13% of the state’s residents 18 and older are on the Donate Life Registry, which allows individuals to give their legal consent to be an organ or tissue donor. Nationally, 37% of adults 18 and older are designated donors, according to a report card published in April by Donate Life America based on an online survey of 5,100 adults.

Nearly 9,600 people in New York and 107,991 across the country needed organ transplants as of June 18, Organ Procurement and Transplantation Network statistics show. Last year, there were 423 deceased organ donors in New York and 8,021 nationwide, the group said.

Brodsky said his bill to implement presumed consent, which is sponsored in the Senate by Manhattan Democrat Thomas Duane, has sparked a lot of interest, but he knows both individuals and religious groups have raised concerns.

Mary Ann Baily, a fellow of the Hastings Center, a bioethics research group in Garrison, N.Y., said it’s easy to see why presumed consent would not go over well with Americans at a time when many are pushing against government control on a variety of other issues.

“The problem is it’s quite easy not to even notice that box that says, ‘I don’t want to donate my organs,’ ” Baily said, referring to a driver’s license form. “You should only presume consent when it really is clear that everybody would consent if they thought about it.”

To get traction in this country, “it’s going to take one state to sort of jump out there and show that it works,” said Arthur Caplan, a bioethics professor at the University of Pennsylvania School of Medicine, who has been working on the issue since 1983.

Efforts elsewhere:

• Legislation proposed in the Illinois Senate this year is still in committee, but there is a chance it could be acted on before the session ends in January, said Lisa Sims, a spokeswoman for Republican Sen. Dale Risinger of Peoria, who proposed the bill.

• Legislation died in committee in the Pennsylvania General Assembly in 1993, said Christie Herrera, director of the American Legislative Exchange Council’s Health and Human Services Task Force. The council, a group of conservative state lawmakers, opposes presumed consent, she said.

• A presumed-consent bill didn’t get out of committee in the Texas Legislature in 2003, Herrera said. The same thing happened in the Delaware Legislature two years ago, she said.

Among the objections to presumed consent are a belief that physicians may not work as hard to save a potential organ or tissue donor and the government and health care systems would have too much power in a life or death situation.

“This legislation opens up the door to abuse via hastened death of vulnerable people and overriding of family concerns,” Jerome Higgins, chairman of the the Long Island Coalition for Life Inc., wrote in a memo to New York lawmakers. “The sick and disabled need to be protected, not exploited for their body parts.”

Physicians who conduct transplants “don’t hope for somebody to die to be a donor,” said Luca Cicalese, chairman and director of the Texas Transplant Center and surgery professor at the University of Texas Medical Branch.

“There is a system that is very careful in keeping things separate and avoiding conflicts of interest,” he said.

Other states with low donor-registration rates are Texas (an estimated 2%), South Carolina (9%) and New Hampshire (10%), the Donate Life America report found.

A number of European nations, including France, Austria and Spain, have a presumed-consent system in place, and they have seen an increase in organ availability, said Caplan, the bioethics professor.

Organ donation: an opt-out policy, USA Today, June 30, 2010, 3A by Cara Matthews

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