posted 2011-11-18 15:13:15

Opting In to an Opt-Out System of Organ Donation

A call for change in New York State

Salim Westvind—Opinion Editor

 In New York State, it’s a little box near the top of the Department of Motor Vehicles’ driver license application form MV-44. "Sign below," the box reads, to “[consent] to donate all of your organs and tissues for transplantation, research or both.”

According to United Network for Organ Sharing (UNOS) statistics, there are currently more than 70,000 active candidates waiting for organ transplants in the United States. "Active" in this sense means that a person who is in need of a transplant is simply waiting for a donation—someone is eligible, has completed all the necessary paperwork and qualifies medically, but there aren't any organs available.

The relative lack of available organs for transplant when compared to demand is not solely an American problem. Many nations from both sides of the economic spectrum have a severe shortage in available solid organs for donation. These shortages result in tens of thousands of annual deaths that could have otherwise been prevented, and they have other adverse social effects as well. The World Health Organization reports that between five and ten percent of all kidney transplants globally are the result of trafficked organs. As is often the case with the buying and selling of human “goods,” the organ market is fraught with ethical issues, including the risk of exploitation and questions about the value of human life—both monetarily and existentially.

Following the lead of several countries, including France, Spain, Australia, Belgium and Portugal, New York and other states have debated shifting the organ donation drive from an “opt-in” to an “opt-out” format. Proponents of the switch argue that it will lead to increased donation rates, which in turn will help fix many of the problems caused by the current organ shortage, particularly as it relates to kidney donation. While it may seem like a no-brainer to take action to improve donation rates, there are concerns that need to be addressed. But ultimately, the potential gains of an opt-out system outweigh the risks.

I count myself among the 67% of New Yorkers cited by Cara Matthews in USA Today who “strongly” support organ donation. Even ignoring any altruistic motivations, I have few hang-ups about what happens to my body after I die—after all, I won’t be around to care, so why shouldn’t I donate my organs? Unfortunately, I cannot also count myself among the 13% of New Yorkers that are currently registered organ donors. It is not that I haven’t had the chance (I have filled out and submitted form MV-44 six times so far), but rather that I chose inaction over making a decision regarding what seemed at the time to be a scary question. Perhaps this was especially true most recently, as I prepared to receive my motorcycle license—a hobby with a reputation for “creating” donors.

I can recall a conversation with my mother some time ago which echoed the fears of many. She urged me not to enter the registry, fearing I would be given inadequate care by doctors more interested in preserving my organs for transplantation than saving my life at any cost. It is a reasonable concern. At some point, given the time-sensitive nature of many organ donations, a doctor has to switch gears from the preservation of life to the preservation of organs. But doctors already face a mountain of judgment calls with every patient they see, and the doctor–patient bond is rooted in giving control to an expert—one who knows your health better than you do. Why suddenly question that trust when it comes to this particular judgment call? But rather than follow my rational instincts, I deferred to my mother, and when I filled out that form I again left that section blank.

Since the form allowed me to simply ignore the question, I was able to shirk some of the responsibility for choosing not to be an organ donor. In a sense, the feeling is that I had done no wrong, but rather had simply not gone out of my way to do something right. One can simply walk away and do nothing, and claim inaction rather than self-interested (and arguably misguided) behavior. By highlighting the passivity of my position, I could reasonably deny that I had made any choice at all. I didn’t directly hurt anyone by not joining the donation registry because I was never involved in the first place.

In a sense, an opt-out system removes the third option. By forcing me to take concrete steps to remove myself from the donation registry, it forces me to justify my decision, if only to myself. While it was easy to quasi-justify not specifically signing up, it would seem a far harder task to justify removing myself in the first place. Perhaps it has to do with the way we make decisions as humans, and our tendency towards a sort of mental inertia. Like an object in motion, it takes far more effort to change direction than it does to continue on.

My penchant for riding bicycles in New York City traffic without a helmet, for motorcycles and for extreme sports may make me more likely to require emergency care at some point, and I accept that. But perhaps the risk of my lifestyle makes it all the more important that I become an organ donor, so as not to waste the help I could give other New Yorkers in need. Today, after reflecting on the issues, I may now join the registry. But I am also certain that had an opt-out system been in place when I last filled out DMV form MV-44, I probably never would have left.

Addendum: On October 30th, 2011, the author signed the back of his driver’s license and officially became an organ donor.