Under a new law that took effect on January 1, every citizen of France is now presumed to be an organ donor. Under the “presumed consent” law, citizens not wishing to have their organs or tissues harvested upon their death must enter their names on a National Rejection Register.
As of January 2, about 150,000 people had already “opted out” by joining the rejection list.
France is only the latest European country to adopt an “opt-out” system for organ donation, as part of ongoing efforts to stem major shortages in organs for lifesaving transplants. When France’s new law was passed in April 2016, the country had 19,000 people on organ donation waiting lists.
The French law also allows people to opt out by signing and dating a refusal document and leaving it with a relative, or by making an oral testimony to someone who can convey their wishes to a medical team. (RELATED: See more news about modern medicine at Medicine.news.)
Supporters of presumed consent laws say that opt-out systems dramatically increase the pool of available organ donors. According to at least one study for the World Health organizations, countries with opt-out laws have organ donor rates an average of 25 to 30 percent higher than countries with opt-in systems.
Under opt-in systems like those used in the United States, the United Kingdom and Canada, only people who have explicitly signed up to donate organs or whose next of kin give permission will have their organs or tissues harvested.
Supporters of opt-out systems often point to discrepancies between the rates at which people opt-in to organ donation and the proportions who say they support it. For example, 90 percent of UK residents say they support organ donation, but less than 33 percent are registered as donors
Critics of presumed consent tend to question the ethics and fairness of a system that requires explicit action to opt out of a major decision such as the disposition of one’s bodily remains. Concerns about opt-out systems include uneven access to information about the need to opt-out or how to do so, as well as to the opt-out system itself. Other concerns include the ability of children and the mentally incompetent to understand the issues and make an informed decision.
Another major concern is that the primary goal of opt-out systems is to remove the next of kin’s ability to make organ donation decisions. For example, while 80 percent of French citizens tend to say in surveys that they support donating their own organs, only about 60 percent tend to allow their relatives’ organs to be harvested.
But critics warn that removing this choice from next of kin may not be ethical, or even effective.
Does it really work?
There’s no question that the United States, like France, has a dire shortage of organs available for donation. Drawing off the example of many European countries, some groups such as the American Kidney Fund have urged the United States to also adopt a presumed consent system.
But according to a 2011 paper conducted by researchers from Johns Hopkins University and published in the journal Transplantation, an opt-out system would be unlikely to significantly increase the number of available organs in the United States, and might do more harm than good.
That’s because the United States already has a larger proportion of people donating organs than many countries with opt-out systems.
In a review of practices in 13 European countries with presumed consent, the researchers found that opt-out laws notwithstanding, medical teams still largely defer to the wishes of next-of-kin.
The ethical quandaries raised by presumed consent risk pitting families and the transplant community against each other, the author warned, which would ultimately lead to lower donation rates.
“With opt-out the perception becomes, We will take your organs unless you take the time to fill out a form,” lead researcher Dorry L. Segev said. “That’s a dangerous perception to have. We only want to use donated organs from people who intended to donate.”
A better way to increase donation rates, the study suggested, is to follow the example of Spain and have dedicated medical teams at hospitals that screen for potential donors and talk honestly with families about their options.