New Delhi: When it comes to an organ donation policy, the world is generally split between two approaches— the ‘opt-in’ and the ‘opt-out’ system.
India has adopted the opt-in system where the emphasis is on ‘encouraged voluntarism’ or individuals (or their families) making their intention to donate their organs known in an act of exceptional altruism.
On the other hand, the opt-out approach works on the premise that every individual is a potential organ donor (their consent is presumed) unless they explicitly say no.
Spain, Austria, France, Singapore and Denmark are some of the countries that run their organ donation programmes based on presumed consent.
A Case for Presumed Consent
Presumed consent has many proponents based on the fact that countries that follow this system largely have larger organ donation/transplantation rates. The best example of this is Spain, which has seen the world’s leading organ donation rates for 2 decades.
A study that was conducted by the University of Nottingham, University of Stirling and Northumbria University in the UK, analyzed the organ donation systems of 48 countries for a period of 13 years. 23 of these countries used an opt-in system while 25 were using the opt-out system. The study found that the countries with an opt-out system had a higher overall number of organ transplants.
While India has always followed the opt-in system, there are voices within the medical fraternity that believe it is time for a change.
“The system of opt-out will improve the scenario (in India). Heart and other organs go unutilised after accidental fatalities, even though patients are in need of various transplants. So, we must have a presumed consent for the harvesting of the organs, but it has to be made legal to address the shortage,” AIIMS Director M.C. Misra had told PTI in November.
Should India Switch?
However, despite there being a global argument in favour of presumed consent, it is difficult to say with certainty that a switch to this approach could automatically fix India’s organ shortage.
The implementation of a presumed consent model has not always been successful. For instance, Brazil, which tried to switch to this system in 1997, was forced to repeal the law just 8 years later. The initiative had faced heavy criticism and was widely distrusted by the general public who feared that their organs would be removed before they were declared clinically dead.
Moreover, a look at Spain, which is considered the gold standard for organ donation, reveals that the success of its model cannot be purely attributed to presumed consent. The country is very well equipped in terms of infrastructure, awareness and trained personnel, as well as its general organ sharing network. Additionally, what Spain actually follows is a soft approach to presumed consent, which means that, like India, the final authority of deciding whether to donate or not to donate lies with the potential donor’s next of kin.
“I don’t think implementing presumed consent would make too much of a difference to the organ donation rate in our country. What will really help is— educating the public and doctors, training transplant coordinators and encouraging more hospitals to register as organ retrieval centres,” says Priyanka Shylendra, CEO, Gift Your Organ Foundation, an NGO that works to raise awareness about organ donation.
This is something that the National Organ Tissue and Transplant Organisation (NOTTO), India’s apex body mandated to coordinate and raise awareness around organs donation, has reiterated, claiming that their one of their top priorities is training ICU doctors and transplant coordinators.
“Our biggest challenge right now is in the medical setup. Our hospitals are not equipped, our hospitals are not declaring brain death, you know?” says Pallavi Kumar from the MOHAN Foundation, a non-profit organisation that also works to create awareness about the cause.
“Organ donation is very personal, influenced by our society and culture, and cannot be encouraged by replicating a model that has succeeded in another country,” Kumar adds.