Obtaining consent for organ donation: what are our options?

A severe shortage of organs limits the number of patients with end-stage organ disease who can be transplanted. Many of these people will die before a suitable organ can be found. Aggravating this tragedy is the fact that many valuable cadaveric organs are not recovered. One of the major barriers to organ procurement is the failure to obtain consent. In this article, I review the two systems currently used for obtaining permission to remove organs: opting in and opting out. I argue that both of these approaches have major problems and consider two alternatives: mandated choice and conscription. I conclude that, if respect for individual autonomy is the greatest concern, then mandated choice is preferred. If ensuring an adequate supply of organs is considered to be most important, and mandated choice is unable to achieve this goal, then conscription is the best approach. These are difficult questions that each society must answer for itself.