In search of a system which acquires the maximum number of organs and is consistent with a society's values.

Abstract

In 2008, the Organ Donation Taskforce was asked to consider the impact of introducing an opt-out system for organ donation in the United Kingdom. The Taskforce conducted a thorough investigation, which included information gathering from both the public and experts in the field of healthcare, ethics and law and a thorough appraisal of the countries currently operating an opt-out system. Having reviewed this evidence the ODT conceded that whilst the numbers of organs generated may increase under an opt-out system, conversely, because of the way the system actually works, they felt there was a risk that its introduction may cause a backlash amongst the general public resulting in a decrease in organ donations. They based their concerns around fears that such a system would remove the potential for spontaneous acts of goodwill, denying people the opportunity to give a gift, and may deny the opportunity for individuals to determine whether their organs should be donated, thereby precluding choice and the right to self-determination. This might ultimately compromise public trust in the system.
This thesis challenges the assumptions made by the Organ Donation Taskforce in respect of introducing an opt-out system. It casts doubt on their claims about compromising privacy interests and then looks to reconcile the potential issues which may arise under an opt-out system; these are preventing the choice to act altruistically and acting in such a way as to undermine public trust. Both of these may result in policy failure. It will advocate a system which addresses the issues raised by the ODT and acts to provide respect for self-determination; this is a soft opt-out system with a combined registry. Such a system would increase the supply of organs for those in need of a transplant, and remain consistent with a society's values in terms of demonstrating respect for individual choice regarding donation.