Written by Mita Majumdar, M.Sc. | 
Medically Reviewed by Dr. Sunil Shroff, MBBS, MS, FRCS (UK), D. Urol (Lond) on Feb 12, 2019

Consent for Organ Donation

Deciding to donate an organ requires a a consent, and deciding against donating an organ requires an objection. Once you decide to consent or object to organ donation, it is important that you discuss this with your family, partner, or with people close to you. This constitutes an important part of the donation process as they will be asked about your decision to be a donor to confirm that you had not changed your mind since you gave your consent (or objection).

In case you want to donate your body or organs for research purposes, you need to seek separate and specific permission for the same. This is because donated tissues and organs cannot be used for medical research unless explicit written permission is granted.

Organ donation requires one of the three types of consent, viz., informed consent, presumed consent, and mandated choice.

Informed consent is when an individual specifically expresses desire to donate his/her organs. It is basically an ‘opt-in’ model where they have to sign up to donate organs. Informed consent has four components:

  • The donor should have the necessary decision-making capacity regarding organ donation.
  • The decision should be voluntary, that is, free from pressure and coercion.
  • The donor must have adequate information on which to base the decision.
  • The donor must understand and reflect on the information that has been given.

Informed consent is required in countries like India, United States, Latin America, United Kingdom, Ireland, Denmark, Netherlands and Germany.

Presumed consent means if an individual has not expressly rejected donation of organ, that individual is considered to have consented to organ donation. In other words, default option is ‘consent to donation.’ Presumed consent is required in countries Finland, Portugal, Austria, Sweden, Czech Republic, Slovakia, Hungary Singapore and Poland.

Although these are the two main types of consent, another way of consent is the theoretically presumed consent, but practically informed. In countries without legal limitation with presumed consent system, merely for ethical issues, coordinators approach the family to get consent for organ donation. For example, The British Medical Association recommends what is called the ‘soft approach’ where relatives are approached and have the opportunity to request that organs are not used if the deceased has not specifically ‘opted-out.’ This type of consent is being followed in Spain, Italy, Greece, Belgium, Luxembourg, and France.

Mandated choice is a consent approach, where all adults are required by law to state in advance whether or not they are willing to donate an organ and to document their decision as part of tax returns, driver’s license or benefit claims. However, many feel that mandated choice is coercive and intrusion on privacy where people are forced to make choices.

Chouhan and Draper proposed a modified scheme of mandated choice, in which though all patients are given a choice whether to donate or not, they are actively encouraged to do so.

References:

  1. Transplant rejection - (http://www.nlm.nih.gov/medlineplus/ency/article/000815.htm)
  2. An Update on Immunosuppressive Medications in Transplantation - (http://www.fmshk.org/database/articles/897.pdf)
  3. Immunosuppressive drugs - Snell GI, et al. Everolimus versus azathioprine in maintenance lung transplant recipients: an international, randomized, double-blind clinical trial. Am J Transplant 2006; 6:169.
  4. Immunosuppressive drugs - Kawai, Tatsuo et al. HLA-Mismatched Renal Transplantation without Maintenance Immunosuppression. N Engl J Med 2008 358: 362-368. Volume 358:362-368, January 24, 2008, Number 4.
  5. Immunosuppressive drugs - E K Geissler and H J Schlitt. Immunosuppression for liver transplantation. Gut 2009; 58; 452-463; originally published online 3 Dec 2008;
  6. Informed Consent in Living Organ Donors - (http://www.biology-online.org/articles/informed_consent_living_organ.html)
  7. Recovery of transplantable organs after cardiac or circulatory death: Transforming the paradigm for the ethics of organ donation - (http://www.peh-med.com/content/2/1/8)
  8. Presumed Consent or Mandated Choice to Overcome Organ Shortage - (http://www.mohanfoundation.org/organ-donation-transplant-resources/presumed-consent-mandated-choice-overcome-organ-shortage.asp)
  9. Chouhan P and H Draper. Modified Mandated Choice for Organ Procurement J Med Ethics. 2003;29(3):157-162, at p. 158.

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