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In 1954, the first successful transplant in a human was performed (Prabhu, 2019). It was a kidney that was given from one twin to another (Prabhu, 2019). Since then, technology has branched to include lots of different procedures. With the advancement of technology comes the question of what is ethical and what is unethical. One of those debates is centered around whether organ donation should be an opt in system or an opt out system. In an opt out system, there is a presumed consent, meaning that everyone is assumed to be an organ donor unless they decide to opt out. In an opt in system, everyone is assumed to not be an organ donor and they must opt in to be one. America is currently running on an opt in system. This raises the ethical dilemma: should organ donation be an opt out system?
This problem affects a few different people. If affects the patient, the patient’s family, and those on the waiting list for an organ. It affects the patient because it’s their organs that are in question. It affects the patient’s family because if the patient is unable to speak for themselves, the family must be responsible for making a decision. It affects those on the waiting list because they could miss out on an organ if the patient or family chooses not to donate. In addition to those people, it affects all the healthcare workers taking care of that patient. It affects them because the system that we operate on depends on how we approach patients about organ donation. Ultimately, the decision should be left up to the patient on what they want to do with their organs. Leaving the decision up the family could cause distress, especially if the family members disagree. The people most affected by the patient’s decision are those that are on the organ transplant waiting list, but the decision could affect the patient’s family too.
Dewey and Holecek mentioned six types of ethical principles: nonmaleficence, beneficence, autonomy, fidelity, justice, and paternalism (2018). Nonmaleficence means that no matter what we do for the patient, we must do it with the intent of making their health improve (Dewey & Holecek, 2018). This relates to the topic because we must make sure we take every effort to save the patient and run multiple tests to make sure the patient is brain dead before we presenting organ donation. Beneficence means that healthcare workers should be doing what is best for the patient (Dewey, et al., 2018). This relates to the topic because if a patient is brain dead and an organ donor, taking them off of life support and donating their organs might be the best option for them. Autonomy means that patients should be able to make their own healthcare choices (Dewey, et al., 2018). This relates to the topic because the patient chooses whether they’d like to opt out of organ donation or be an organ donor. If they’re unable to choose for whatever reason, a family member appointed by the patient may make the decision. Fidelity means that all interactions between the patient and healthcare worker must be truthful and genuine (Dewey, et al., 2018). This plays a role in the topic because without information on organ donation, the patient or the family might not fully understand what happens, therefore making them choose against organ donation. Another way this plays a role is the healthcare worker talking to the family about the patient’s condition. If they downplay the patient’s condition, like a brain-dead patient, the family may think the patient has a chance of coming back and may not consider organ donation. Justice means that all patients have equal rights to resources and is treated fairly and equally (Dewey, et al., 2018). This is super important in organ donation because we should not treat patients who are organ donors differently, such as thinking they are brain dead before they are, therefore prematurely taking them off of life support to donate their organs. Paternalism means that healthcare worker-patient relationships should be equal (Dewey, et al., 2018). The healthcare worker should not put themselves above the patient. This is important for the topic because organ donation should be taught about in a non biased way. The doctor should not talk to the family or patient in a way that makes it sound like they’re smarter than them, because ultimately it is not the doctor’s decision.
There are two types of opt out systems. One is called the hard system (Rudge, 2018). This means that if an individual did not opt out of organ donation, the organs will be removed no matter what (Rudge, 2018). The family does not have any say in what happens with the body. Of course, this is an ethical concern because the consent is implied because the person did not opt out of the donation (Rudge, 2018). It is also an ethical concern because the family has no say at all over the body, which makes it seem like the body is viewed as their organs rather than an actual human that has a life (Rudge, 2018). The other opt out system is a soft system (Rudge, 2018). In a soft system, donation is assumed if the individual did not opt out, but the family has the final say (Rudge, 2018). This can be ethical too because if a patient would like to donate their organs, their wishes should be granted (Rudge, 2018). All the power should not be in the hands of the family (Rudge, 2018).
One way we could approach the lack of donors is to educate. As nurses, a huge role in our career is to educate patients. If the general public was more educated on the topic of organ donation, it could potentially cause more people to register as an organ donor. Also, educating the family on organ donation could potentially help make their decision about their loved one easier. People tend to think that they’ll never be in a situation where they would be able to donate organs, so they just don’t sign up. Another thing we could do to increase the amount of donors is to bring more awareness to the topic. There are ads all over the place for tobacco and alcohol, but there aren’t many, if any, promoting organ donation. One last thing that could bring awareness to organ donation is end the stigma. Have organ donor recipients talk to students in school so the topic is brought up early and is seen as less taboo. Education could play a huge role in helping increase the amount of organ donors globally and there are multiple different options to educate the general public.
In an argument against opt out organ donation, critics tend to say it would not actually increase the number of transplants taking place (Rudge, 2018). Another argument against an opt out system is that the family would ultimately have no choice in the matter, leading to a huge ethical concern (Rudge, 2018). The opposing side also thinks that autonomy would not be upheld because it would see potential donors as organs that could be used to save someone else rather than a human (Rudge, 2018). They also cite that Spain, which does not use the opt out system, has the best rates of organ donation, proving that you don’t need the opt out system to have good rates of donation (Fabre, 2014).
In cases advocating for opt out organ donation, people argue that the opt out system does increase the amount of organ donations, mostly in countries where rates of donation are low (Ezaz & Lai, 2019). They studied six countries for twenty three years and found that the rate of liver donation went up in every country and the rate of kidney donation went up in four of those countries (Ezaz, et. al., 2019). Adding onto that, in the UK, 62% of people said they would want to be an organ donor, however, only 31% are actually registered (Willis, 2014).
In my opinion, I believe that organ donation should run on an opt out system. More specifically, I think it should run on a soft opt out system. I think the hard opt out system could run into too many legal and ethical problems, whereas the soft opt out system is similar to the process we have now. I came to this conclusion because I feel like we would increase the number of potential donors. I had thought about being a donor since I was 16, however I did not sign up to be one until I was nearly 21. When I signed up, I asked a lot of my friends if they considered being an organ donor. The majority of them said yes, but they hadn’t signed up to be one yet. I think that is the case in a lot of people. They think about doing it, but the thought slips their mind before they’re able to go online and sign up. My decision doesn’t conflict with any value system I currently have. I’m all for letting people choose what to do with their own bodies. In my opinion, the opt out system is nearly the same as the opt in system, the only difference is that instead of saying you’d like to donate our organs, you’re saying you would rather not donate your organs.
Organ donation is a complicated topic no matter what the debate is about. In this situation, the debate is about how people should become registered to be an organ donor, whether we should run on an opt in or opt out system. Currently, many countries run on an opt in system, but are trying to change to an opt out system, which comes with some ethical dilemmas. A hard system comes with the most ethical dilemmas. A soft system seems to be more ethical and seems close to the system we currently run on. Medicine is always evolving to improve the lives of the patients we take care of every day, and there’s no doubt that we will keep updating our organ donation process to make it even better for everyone involved in the process.
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