Presumed Consent for Organ Donation: Principlism Opts Out

The number of available organs for transplant each year falls woefully short of the number of patients in need of donated organs in the United States. While approval numbers are very high for organ donation, the number of registered donors is much smaller. A commonly proposed solution to increase the pool of organ donors is to replace the current explicit consent policy with a presumed consent system, where everyone is considered to have consented as a donor unless they have opted out by joining a non-donor registry or by some other method. This proposal raises many ethical questions that must be examined in light of standard medical ethics principles before implementation of such a policy should be supported. On a practical level, the evidence for the results of putting presumed consent policy in place should first be analyzed. Careful consideration of such evidence reveals that implementation of presumed consent in the United States may raise donor rates, but this result is not at all as guaranteed as many proponents claim. Under principlism, a common ground bioethics approach, presumed consent is morally questionable at best. Examination with regards to the four pillars of principlism, beneficence, non-maleficence, justice, and autonomy, reveals considerable ethical difficulties that all but disqualify presumed consent from consideration. While it is possible that such a system would increase organ donation rates, it increases the potential for discrimination in the donation process, is likely to subvert doctor-patient trust in some cases, and undermines the concept of true informed consent in medicine.