Editing Organ donation (section)

===Consent process===
The term consent is typically defined as a subject adhering to an agreement of principles and regulations; however, the definition becomes difficult to execute concerning the topic of organ donation, mainly because the subject is incapable of consent due to death or mental impairment.<ref name=":02"/> There are two types of consent being reviewed; explicit consent and presumed consent. Explicit consent consists of the donor giving direct consent through proper registration depending on the country.<ref name="Peltier">{{cite journal |last1=D'Alessandro |first1=Anthony M. |last2=Peltier |first2=James W. |last3=Dahl |first3=Andrew J. |title=Use of Social Media and College Student Organizations to Increase Support for Organ Donation and Advocacy: A Case Report |journal=Progress in Transplantation |date=December 2012 |volume=22 |issue=4 |pages=436–441 |doi=10.7182/pit2012920 |pmid=23187063 |s2cid=22015905 }}</ref> The second consent process is presumed consent, which does not need direct consent from the donor or the next of kin.<ref name="Peltier"/> Presumed consent assumes that donation would have been permitted by the potential donor if permission was pursued.<ref name="Peltier"/> Of possible donors an estimated twenty-five percent of families refuse to donate a loved one's organs.<ref>{{cite journal |last1=Siminoff |first1=Laura A. |last2=Agyemang |first2=Amma A. |last3=Traino |first3=Heather M. |title=Consent to Organ Donation: A Review |journal=Progress in Transplantation |date=March 2013 |volume=23 |issue=1 |pages=99–104 |doi=10.7182/pit2013801 |pmid=23448829 |pmc=6776471 }}</ref>

====Opt-in versus opt-out====
{{see also|Mandated choice}}

As medical science advances, the number of people who could be helped by organ donors increases continuously. As opportunities to save lives increase with new technologies and procedures, the demand for organ donors rises faster than the actual number of donors.<ref name="The Week (4)">{{cite web|title=Automatic organ donation: the pros and cons|url=http://www.theweek.co.uk/35635/automatic-organ-donation-the-pros-and-cons|archive-url=https://web.archive.org/web/20160124030032/http://www.theweek.co.uk/35635/automatic-organ-donation-the-pros-and-cons|url-status=dead|archive-date=January 24, 2016|website=The Week: Science and Health|access-date=September 1, 2016}}</ref> To respect individual autonomy, voluntary [[consent]] must be determined for the individual's disposition of their remains following death.<ref name="Cohen">{{cite journal |last1=Cohen |first1=Carl |title=The case for presumed consent to transplant human organs after death |journal=Transplantation Proceedings |date=October 1992 |volume=24 |issue=5 |pages=2168–2172 |pmid=1413020 }}</ref> There are two main methods for determining voluntary consent: "opt in" (only those who have given explicit consent are donors) and "opt out" (anyone who has not refused consent to donate is a donor). In terms of an opt-out or presumed consent system, it is assumed that individuals do intend to donate their organs to medical use when they expire.<ref name="Cohen"/> Opt-out legislative systems dramatically increase effective rates of consent for donation as a consequence of the [[default effect]].<ref name="do defaults save lives">{{cite journal |last1=Johnson |first1=Eric J. |last2=Goldstein |first2=Daniel |title=Do Defaults Save Lives? |journal=Science |date=November 21, 2003 |volume=302 |issue=5649 |pages=1338–1339 |doi=10.1126/science.1091721 |pmid=14631022 }}</ref> For example, Germany, which uses an opt-in system, has an organ donation consent rate of 12% among its population, while [[Austria]], a country with a very similar culture and economic development, but which uses an opt-out system, has a consent rate of 99.98%.<ref name="do defaults save lives"/><ref name="nytimes2009"/>

Opt-out consent, otherwise known as "deemed" consent, support refers to the notion that the majority of people support organ donation, but only a small percentage of the population are actually registered, because they fail to go through the actual step of registration, even if they want to donate their organs at the time of death. This could be resolved with an opt-out system, where many more people would be registered as donors when only those who object consent to donation have to register to be on the non-donation list.<ref name="Cohen"/>

For these reasons, countries, such as [[Wales]], have adopted a "soft opt-out" consent, meaning if a citizen has not clearly made a decision to register, then they will be treated as a registered citizen and participate in the organ donation process. Likewise, opt-in consent refers to the consent process of only those who are registered to participate in organ donation. Currently, the United States has an opt-in system, but studies show that countries with an opt-out system save more lives due to more availability of donated organs. The current opt-in consent policy assumes that individuals are not willing to become organ donors at the time of their death, unless they have documented otherwise through organ donation registration.<ref name="Cohen"/>

Registering to become an organ donor heavily depends on the attitude of the individual; those with a positive outlook might feel a sense of altruism towards organ donation, while others may have a more negative perspective, such as not trusting doctors to work as hard to save the lives of registered organ donors. Some common concerns regarding a presumed consent ("opt-out") system are sociologic fears of a new system, moral objection, sentimentality, and worries of the management of the objection registry for those who do decide to opt-out of donation.<ref name="Cohen"/> Additional concerns exist with views of compromising the freedom of choice to donate,<ref name="2012 National Survey of Organ Donation">{{cite journal |title=2012 National Survey of Organ Donation Attitudes and Behaviors|journal=U.S. Department of Health and Human Services: Health Research and Services Administration|date=September 2013|page=47<!--|pages=51-->}}</ref> conflicts with extant religious beliefs<ref name=Leins2016>{{cite news |last1=Leins |first1=Casey |title=Should the Government Decide if You're an Organ Donor? |url=https://www.usnews.com/news/articles/2016-02-12/presumed-consent-and-americas-organ-donor-shortage |work=U.S. News & World Report |date=February 12, 2016 }}</ref> and the possibility of posthumous violations of [[bodily integrity]].<ref>{{cite journal |last1=Qurashi |first1=G M |title=Opt-out paradigms for deceased organ donation are ethically incoherent |journal=Journal of Medical Ethics |date=December 2023 |volume=49 |issue=12 |pages=854–859 |doi=10.1136/medethics-2021-107630 |pmid=34509985 |s2cid=237490506 }}</ref> Even though concerns exist, the United States still has a 95 percent organ donation approval rate. This level of nationwide acceptance may foster an environment where moving to a policy of presumed consent may help solve some of the organ shortage problem, where individuals are assumed to be willing organ donors unless they document a desire to "opt-out", which must be respected.<ref name=Leins2016/>

Because of public policies, cultural, infrastructural and other factors, presumed consent or opt-out models do not always translate directly into increased effective rates of donation. The United Kingdom has several different laws and policies for the organ donation process, such as consent of a witness or guardian must be provided to participate in organ donation. This policy was consulted on by Department of Health and Social Care in 2018,<ref>{{cite web |url=https://engage.dh.gov.uk/organdonation/ |title=Archived copy |website=engage.dh.gov.uk |access-date=January 11, 2022 |archive-url=https://web.archive.org/web/20180123112022/https://engage.dh.gov.uk/organdonation/ |archive-date=January 23, 2018 |url-status=dead}}</ref> and was implemented starting May 20, 2020.<ref>{{Cite journal |last=Mahenthran |first=Thakshayene |date=January 2021 |title=The new 'opt-out' organ donation English law: Is the NHS ready for this? |journal=Clinical Medicine |volume=21 |issue=1 |pages=e92–e93 |doi=10.7861/clinmed.2020-0675 |issn=1470-2118 |pmc=7850211 |pmid=33479084}}</ref>

In terms of effective organ donations, in some systems like Australia (14.9 donors per million, 337 donors in 2011), family members are required to give consent or refusal, or may veto a potential recovery even if the donor has consented.<ref name=mythbusting/> Some countries with an opt-out system like Spain (40.2 donors per million inhabitants),<ref name= infographic2017>{{cite web|url=https://www.edqm.eu/sites/default/files/infographic-eodd-2017-web.pdf|date=December 30, 2018|publisher=European Directorate for the Quality of Medicines & HealthCare|title=Bring back hope to patients on waiting lists all over Europe!|type=infographic|access-date=December 30, 2018|archive-url=https://web.archive.org/web/20170907022202/http://www.edqm.eu/sites/default/files/infographic-eodd-2017-web.pdf|archive-date=September 7, 2017|url-status=dead}}</ref> [[Croatia]] (40.2 donors/million)<ref name= infographic2017/> or [[Belgium]] (31.6 donors/million)<ref name= infographic2017/> have high donor rates, however some countries such as [[Greece]] (6 donors/million) maintain low donor rates even with this system.<ref>{{cite journal |last1=Sotiropoulos |first1=Georgios C |last2=Machairas |first2=Nikolaos |title=Organ donation during the financial crisis in Greece |journal=The Lancet |date=September 2016 |volume=388 |issue=10048 |pages=957–958 |doi=10.1016/s0140-6736(16)31488-x |pmid=27598669 |s2cid=46419956 |doi-access=free }}</ref> The president of the Spanish [[National Transplant Organisation]] has acknowledged Spain's legislative approach is likely not the primary reason for the country's success in increasing the donor rates, starting in the 1990s.<ref name="ReferenceA">{{cite web|url=http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_090303.pdf|title=The potential impact of an opt out system for organ donation in the UK.|author=Organ Donation Taskforce|year=2008|publisher=[[Department of Health (United Kingdom)|Department of Health]]|location=United Kingdom|page=22|archive-url=http://webarchive.nationalarchives.gov.uk/20130107105354/http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_090303.pdf|archive-date=January 7, 2013|url-status=dead|access-date=March 8, 2014|author-link=Organ Donation Taskforce}}</ref>

Looking to the example of Spain, which has successfully adopted the presumed consent donation system, [[intensive care units]] (ICUs) must be equipped with enough doctors to maximize the recognition of potential donors and maintain organs while families are consulted for donation. The characteristic that enables the Spanish presumed consent model to be successful is the resource of [[Organ transplantation|transplant]] coordinators; it is recommended to have at least one at each hospital where opt-out donation is practiced to authorize organ procurement efficiently.<ref>{{cite journal |last1=Rodríguez-Arias |first1=David |last2=Wright |first2=Linda |last3=Paredes |first3=David |title=Success factors and ethical challenges of the Spanish Model of organ donation |journal=The Lancet |date=September 2010 |volume=376 |issue=9746 |pages=1109–1112 |doi=10.1016/S0140-6736(10)61342-6 |pmid=20870101 |s2cid=46708934 }}</ref>

Public views are crucial to the success of opt-out or presumed consent donation systems. In a study done to determine if [[health policy]] change to a presumed consent or [[opt-out]] system would help to increase donors, an increase of 20 to 30 percent was seen among countries who changed their policies from some type of opt-in system to an opt-out system. Of course, this increase must have a great deal to do with the [[health policy]] change, but also may be influenced by other factors that could have impacted donor increases.<ref name="Rithalia (6)">{{cite journal |last1=Rithalia |first1=A |last2=McDaid |first2=C |last3=Suekarran |first3=S |last4=Norman |first4=G |last5=Myers |first5=L |last6=Sowden |first6=A |title=A systematic review of presumed consent systems for deceased organ donation |journal=Health Technol |date=2009 |volume=13 |issue=26 |pages=iii, ix–xi, 1–95 |doi=10.3310/hta13260|pmid=19422754 |doi-access=free }}</ref>

Transplant Priority for Willing Donors, also known as the "donor-priority rule", is a newer method and the first to incorporate a "non-medical" criterion into the priority system to encourage higher donation rates in the opt-in system.<ref name="Dai 2020 622–641">{{cite journal |last1=Dai |first1=Tinglong |last2=Zheng |first2=Ronghuo |last3=Sycara |first3=Katia |title=Jumping the Line, Charitably: Analysis and Remedy of Donor-Priority Rule |journal=Management Science |date=February 2020 |volume=66 |issue=2 |pages=622–641 |doi=10.1287/mnsc.2018.3266 |s2cid=54028044 }}</ref><ref>{{cite news |last1=Ofri |first1=Danielle |title=In Israel, a New Approach to Organ Donation |url=https://archive.nytimes.com/well.blogs.nytimes.com/2012/02/16/in-israel-a-new-approach-to-organ-donation/ |work=Well |publisher=The New York Times |date=February 16, 2012 }}</ref> Initially implemented in Israel, it allows an individual in need of an organ to move up the recipient list. Moving up the list is contingent on the individual opting-in prior to their need for an organ donation. The policy applies nonmedical criteria when allowing individuals who have previously registered as an organ donor, or whose family has previously donated an organ, priority over other possible recipients. It must be determined that both recipients have identical medical needs prior to moving a recipient up the list. While incentives like this in the opt-in system do help raise donation rates, they are not as successful in doing so as the opt-out, presumed consent default policies for donation.<ref name=mythbusting>{{cite web |title = Myth busting|url = http://www.donatelife.gov.au/discover/mythbusting|at = My family can overrule my decision to be a donor|access-date = May 15, 2013|archive-date = May 22, 2013 |archive-url = https://web.archive.org/web/20130522024547/http://www.donatelife.gov.au/discover/mythbusting|website = DonateLife|publisher = Australian Government Organ and Tissue Authority}}</ref>
{| class="wikitable"
|+
! colspan="2" |Country
!Policy
!Year implemented
|-
| colspan="2" |Argentina
|opt-out
|2005
|-
| colspan="2" |Austria
|opt-out
|
|-
| colspan="2" |Belarus
|opt-out
|2007<ref>{{cite web | url=http://center.gov.by/publikatsii-rabotnikov-tsentra/kommentarii-zakonodatel-stva/kommentarij-k-zakonu-respubliki-bela-7/ | title=Комментарий к Закону Республики Беларусь "О внесении изменений и дополнений в Закон Республики Беларусь "О трансплантации органов и тканей человека" | access-date=January 4, 2023 | archive-date=January 4, 2023 | archive-url=https://web.archive.org/web/20230104091918/http://center.gov.by/publikatsii-rabotnikov-tsentra/kommentarii-zakonodatel-stva/kommentarij-k-zakonu-respubliki-bela-7/ | url-status=dead }}</ref>
|-
| colspan="2" |Belgium
|opt-out
|
|-
| colspan="2" |Brazil
|opt-in
|
|-
| colspan="2" |Czech Republic
|opt-out
|September 2002<ref>{{cite news |title=Enabling foreigners to become organ donors |url=https://english.radio.cz/enabling-foreigners-become-organ-donors-8561095 |work=Radio Prague International |date=August 22, 2011 }}</ref>
|-
| colspan="2" |Chile
|opt-out
|2010
|-
| colspan="2" |Colombia
|opt-out
|2017
|-
| colspan="2" |Guatemala
|opt-in
|February 2024<ref>{{Cite web |date=February 28, 2024 |title=¿Qué órganos se pueden donar y quiénes pueden ser donantes? |url=https://www.prensalibre.com/guatemala/politica/que-organos-se-pueden-donar-y-quienes-pueden-ser-donantes/ |access-date=2024-03-26 |language=es-GT}}</ref>
|-
| colspan="2" |Israel
|opt-in
|
|-
| colspan="2" |Netherlands
|opt-out
|2020<ref>[https://dutchreview.com/news/organ-donation-on-the-rise-in-the-netherlands/ The Netherlands is seeing more permissions for organ donation]</ref>
|-
| colspan="2" |Spain
|opt-out
|1979
|-
| colspan="2" |Ukraine
|opt-in
|<ref>{{cite news |last1=Panasytska |first1=Oleksandra |title=Donate An Organ And Save Your Neighbor's Life. What Is Happening With The Transplant System In Ukraine? |url=https://voxukraine.org/en/donate-an-organ-and-save-your-neighbor-s-life-what-is-happening-with-the-transplant-system-in-ukraine/ |work=Vox Ukraine |date=July 5, 2021 }}</ref>
|-
| rowspan="4" |United Kingdom
|Wales 
| rowspan="4" |opt-out
|December 1, 2015<ref>{{cite web |title=Organ donation law in Wales |url=https://www.organdonation.nhs.uk/uk-laws/organ-donation-law-in-wales/ |access-date=2024-10-10 |website=NHS Organ Donation |publisher=NHS Blood and Transplant}}</ref>
|-
|England 
|May 20, 2020<ref>{{cite web |title=Organ donation law in England |url=https://www.organdonation.nhs.uk/uk-laws/organ-donation-law-in-england/ |access-date=2024-10-10 |website=NHS Organ Donation |publisher=NHS Blood and Transplant}}</ref>
|-
|Scotland
|March 25, 2021<ref name=":6">{{cite web |title=Organ and tissue donation law in Scotland |url=https://www.organdonation.nhs.uk/uk-laws/organ-donation-law-in-scotland/ |access-date=2024-10-10 |website=NHS Organ Donation |publisher=NHS Blood and Transplant}}</ref>
|-
|Northern  Ireland
|June 1, 2023<ref name=":7">{{cite web |title=Organ donation law in Northern Ireland |url=https://www.organdonation.nhs.uk/uk-laws/organ-donation-law-in-northern-ireland/ |access-date=2024-10-10 |website=NHS Organ Donation |publisher=NHS Blood and Transplant}}</ref>
|-
| colspan="2" |United States
|opt-in
|
|}