Increasing Consent for Organ Donation: Mandated Choice, Individual Autonomy, And Informed Consent‪.‬

INTRODUCTION As of April 13,2011, there were 110,758 individuals on the waiting list for an organ transplant in the United States. (1) The number of waiting list candidates greatly exceeds the number of available organs, and the gap between needed and available organs grows wider every year. (2) While the need for organs is growing five times faster than the number of available organs, rates of organ donation have remained stable. (3) In fact, individuals whose organs are suitable for donation at their time of death may outnumber actual donors by more than three to one. (4) As a result, many individuals on the waiting list die before they receive an organ; indeed, as many as sixty percent of candidates die while on the waitlist. (5) While multiple studies indicate overwhelming public support for organ donation, only ten to twenty percent of individuals who die with organs suitable for donation ultimately become actual donors. (6) Most states in the U.S. currently utilize an "opt-in" system for organ donation, by which an individual or an individual's family must explicitly consent before donation. (7) Some countries utilize a presumed consent system by which individuals are assumed to be donors unless they have expressly stated otherwise. (8) Although the current opt-in system has resulted in an organ shortage and extended waiting lists in the United States, a presumed consent system raises concerns about individual autonomy and informed consent and is politically unfeasible in the United States at present.