Why we should have an ‘Opt Out’ organ donation policy

Updated
In this May 30, 2013 photo provided by the Murnaghan family, Sarah Murnaghan, left, lies in her hospital bed next to adopted sister Ella on the 100th day of...
In this May 30, 2013 photo provided by the Murnaghan family, Sarah Murnaghan, left, lies in her hospital bed next to adopted sister Ella on the 100th day of...
AP Photo/Murnaghan family

Let me finish tonight with this.

In a week of NSA and DNA and MLB, a 10-year-old girl has captured national and world attention.

Sarah Murnaghan is dying of end-stage cystic fibrosis in the Children’s Hospital of Philadelphia.  She has been waiting for lung transplant for a year and a half.

Now, she has weeks to live–if that.

The issue?

To be eligible for an adult lung you have to be 12 years old and Sarah is only 10, so she’s been waiting for a transplant from a pediatric donor–of which there are few.

Her parents appealed, requesting Sarah be placed on the adult lung transplant list. That appeal was denied, and an online petition was launched calling for that policy to change and for federal officials to make an “exceptional ruling” on behalf of the child.

Sadly, this story has become political with Kathleen Sebelius at center of storm.  Secretary Sebelius called the case “agonizing” but said she could not interfere with the donor rules.

Midweek, a federal judge in Philadelphia ruled that Sarah is eligible to receive a lung from the adult donor list.  The judge ordered Sebelius to suspend the donor rules for at least 10 days and a hearing is set for June 14.

With that door open, the family of 11-year-old Javier Acosta has subsequently been granted a temporary injunction to waive the rule.

My thoughts and prayers are with Sarah and Javier and their families but I think this raises a bigger question about organ donation in the United States.

If the issue is not enough lungs and kidneys and hearts and corneas,  how do we get more?

Two words: Opt Out.

Opt IN is the current national US policy. It requires explicit consent from the donor (given through a donor card administered by the DMV) or from relatives if the donor failed to indicate desire during his or her lifetime.

Let’s reverse that.

A national Opt OUT system would presume consent of the deceased to have their organs harvested unless they had opted out.

No one is taking your organs without consent.  But if you say nothing, you’ll be presumed to have opted in.

The system has been tested in Europe.

As of 2010, 24 European countries have some form of the Opt OUT  system–which some call “presumed consent”–with Spain, Austria, and Belgium yielding high donor rates.

Art Caplan, head of the Division of Medical Ethics at NYU Langone, agrees:

“Your organs aren’t going to do you much good when you’re dead…I think we’d get more donors if we just shifted the responsibility to say what you want to do about donation from saying “I want to do it” to having to say “I don’t want to do it.”  Most people say they do want to donate, so why don’t we make that the default?”


Opt Out.  Why not indeed?

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Why we should have an 'Opt Out' organ donation policy

Updated