Beginning in 2017, France has converted its organ donor registry to an opt-out system. But you are still permitted to refuse donation (according to The Guardian there are currently 150,000 people signed up for the “refusal register”).
The implications of this policy change are huge! Surgeons almost always cite the organ shortage crisis as the principal barrier to transplantation for the majority of patients in need. As of today, there are nearly 120,000 Americans in need of a lifesaving organ transplant (U.S. DHHS). Only slightly more than half are active candidates (on the waiting list). Only 25% of those in need receive a transplant, based on the annual statistic from 2016. And there are only 13,000 Americans signed up as donors. What?! This is so discouraging.
I say this in a position of tremendous health blessings and can’t imagine the strength required of patients and families for which receiving an organ (or multiple) is their only hope. Despite the numerous second chances for French patients that are bound to arise from the policy, I can’t fight the moral reservations I have about this new opt-out system.
The Guardian writes that “the new law presumes consent for organs to be removed, even if it goes against the wishes of the family.” Individual autonomy over one’s body, and who has “ownership” after death if an individual’s wishes are unclear, seemingly contradicts France’s policy stance. Yet strategies such as presumptive communication are used in other medical specialties. I’ve most recently seen them employed by pediatricians to emphasize the routineness of childhood vaccination. Technically, everyone still has a choice in making their health decisions.
There are many reasons for the organ shortage crisis. Maybe cultural or religious differences make people unwilling to donate. Or perhaps people are willing to donate, but the inconvenience of having to sign up prevents potential donors from initiating the process. But perhaps the hardest reason to explain: a combination of fear, discomfort, and/or ambivalence about giving up your organs. Even if you could save eight lives after you yourself pass away? Is this a selfish perspective?
Surgery is gratifying in its immediate, results-oriented, and personalized nature. But transplant surgeons are intimately involved in this very complicated political, cultural, and social dilemma. This is why health policy captures my fascination. There is so much potential to help people beyond our own medical practices. Even if we don’t enact a perfect policy (it’s impossible anyway).