Korean J Transplant.  2020 Mar;34(1):2-7. 10.4285/kjt.2020.34.1.2.

The effect of a mandatory choice system for organ donation after brain death on ethical legitimacy and potential efficacy in a mathematical model

• Cho IS
• Lee HY
• Park UJ
• Kim HT
• Roh YN

• KMID: 2503776
• DOI: http://doi.org/10.4285/kjt.2020.34.1.2

Abstract

Background
The “mandatory choice” system is an organ donation system that forces individuals to clearly express their choice about organ donation. Although this system is widely practiced in western countries, it has not yet been implemented in many Asian countries. This study aimed to compare the possible outcomes of a mandatory choice system and the current system in Korea.
Methods
A mathematical model was used to predict outcomes under each system. A structured questionnaire assuming two systems (current opt-in and mandatory choice) was developed to investigate participants’ decisions on organ donation and the family’s consent after brain death in each system. Participants who enrolled in this survey were 100 couples (200 people).
Results
The total number of donors decreased slightly from 102 (51.0%) in the current opt-in system to 93 (46.5%) in the mandatory choice system. The rate of achieving autonomy was increased from 62.5% (125/200) in the current system to 68.0% (136/200) in the mandatory choice system. The achievement of negative autonomy was relatively higher in the mandatory choice system (73.6% [67/91] vs. 63.2% [55/87]).
Conclusions
The mandatory choice system can supplement the weak ethical point of the current system by increasing the achievement of autonomy.

Keyword

Organ donation; Mandatory choice system; Autonomy

Figure

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  Fig. 1 A mathematical model to predict the outcomes of the two organ donation systems. (A) Current system. (B) Mandatory choice system.

Reference

BMA Medical Ethics Committee. 2012. Building on progress: where next for organ donation policy in the UK? British Medical Association;London:

Howard DH. 2007. Producing organ donors. J Econ Perspect. 21:25–36. DOI: 10.1257/jep.21.3.25. PMID: 19728420.

Johnson EJ., Goldstein D. 2003. Medicine: do defaults save lives? Science. 302:1338–9. DOI: 10.1126/science.1091721. PMID: 14631022.

Shanmugarajah K., Villani V., Madariaga ML., Shalhoub J., Michel SG. 2014. Current progress in public health models addressing the critical organ shortage. Int J Surg. 12:1363–8. DOI: 10.1016/j.ijsu.2014.11.011. PMID: 25463765.

Siminoff LA., Mercer MB. 2001. Public policy, public opinion, and consent for organ donation. Camb Q Healthc Ethics. 10:377–86. DOI: 10.1017/S0963180101004042. PMID: 14533404.

van Dalen HP., Henkens K. 2014. Comparing the effects of defaults in organ donation systems. Soc Sci Med. 106:137–42. DOI: 10.1016/j.socscimed.2014.01.052. PMID: 24561775.

Whyte KP., Selinger E., Caplan AL., Sadowski J. 2012. Nudge, nudge or shove, shove-the right way for nudges to increase the supply of donated cadaver organs. Am J Bioeth. 12:32–9. DOI: 10.1080/15265161.2011.634484. PMID: 22304518.

Spital A. 1992. Mandated choice: the preferred solution to the organ shortage? Arch Intern Med. 152:2421–4. DOI: 10.1001/archinte.152.12.2421. PMID: 1456852.

Spital A. 1995. Mandated choice: a plan to increase public commitment to organ donation. JAMA. 273:504–6. DOI: 10.1001/jama.1995.03520300078045. PMID: 7837372.

Spital A. 1996. Mandated choice for organ donation: time to give it a try. Ann Intern Med. 125:66–9. DOI: 10.7326/0003-4819-125-1-199607010-00010. PMID: 8644990.

Rieu R. 2010. The potential impact of an opt-out system for organ donation in the UK. J Med Ethics. 36:534–8. DOI: 10.1136/jme.2009.031757. PMID: 20817820.

Abouna GM. 2003. Ethical issues in organ transplantation. Med Princ Pract. 12:54–69. DOI: 10.1159/000068158. PMID: 12566971.

Exley M., White N., Martin JH. 2002. Why families say no to organ donation. Crit Care Nurse. 22:44–51. DOI: 10.4037/ccn2002.22.6.44. PMID: 12518567.

Hulme W., Allen J., Manara AR., Murphy PG., Gardiner D., Poppitt E. 2016. Factors influencing the family consent rate for organ donation in the UK. Anaesthesia. 71:1053–63. DOI: 10.1111/anae.13535. PMID: 27440055.

Jacoby L., Jaccard J. 2010. Perceived support among families deciding about organ donation for their loved ones: donor vs nondonor next of kin. Am J Crit Care. 19:e52–61. DOI: 10.4037/ajcc2010396. PMID: 20810408.

Siminoff L., Mercer MB., Graham G., Burant C. 2007. The reasons families donate organs for transplantation: implications for policy and practice. J Trauma. 62:969–78. DOI: 10.1097/01.ta.0000205220.24003.51. PMID: 17426556.

Siminoff LA., Gordon N., Hewlett J., Arnold RM. 2001. Factors influencing families' consent for donation of solid organs for transplantation. JAMA. 286:71–7. DOI: 10.1001/jama.286.1.71. PMID: 11434829.

Simpkin AL., Robertson LC., Barber VS., Young JD. 2009. Modifiable factors influencing relatives' decision to offer organ donation: systematic review. BMJ. 338:b991. DOI: 10.1136/bmj.b991. PMID: 19383730. PMCID: PMC2671586.

Sque M., Long T., Payne S. 2005. Organ donation: key factors influencing families' decision-making. Transplant Proc. 37:543–6. DOI: 10.1016/j.transproceed.2004.11.038. PMID: 15848450.

Jarvis R. 1995. Join the club: a modest proposal to increase availability of donor organs. J Med Ethics. 21:199–204. DOI: 10.1136/jme.21.4.199. PMID: 7473637. PMCID: PMC1376712.

Park UJ., Han SY., Han KH., Oh SW., Jang HY., Kim HT, et al. 2019. Effects of phased education on attitudes toward organ donation and willingness to donate after brain death in an Asian country. Asian J Surg. 42:256–66. DOI: 10.1016/j.asjsur.2018.04.007. PMID: 29803596.