Department of Global Health & Social Medicine, School of Global Affairs, Faculty of Social Science & Public Policy, King's College London, UK.
Transplant Rev (Orlando). 2021 Jan;35(1):100589. doi: 10.1016/j.trre.2020.100589. Epub 2020 Nov 22.
The legal shift to an opt-out system of consent for deceased organ donation is now official in England, Wales and Scotland. While it is commendable that national governments across the United Kingdom have publicly signalled their serious engagement with organ donation, it remains questionable that opt-out policy can in and of itself solve the public health issue of organ shortage. Opt-out policy risks becoming a futile solution if it fails to attend to key factors in clinical practice. Thus, this article provides critical insights and practical considerations in order to work towards increasing the availability of organs for transplantation: 1) organ donation specialists on their own are not enough, a collaborative hospital culture of donation is also needed; 2) investment in innovative perfusion technologies is fundamental to increase both the quantity and quality of organs utilised for transplants; and 3) opt-out does not solve the enduring problem of consent or authorization for donation, rather than hoping that opt-out will shift the societal culture of donation and make donation the default choice, it is necessary to acknowledge that families' authorization remains essential and their emotional experience can neither be minimized nor excluded altogether. Importantly, consent rates are not the only factor to account for overall deceased donation rates. The organ shortage cannot be solely attributed to a matter of negative public attitudes reversible by law. Doing that does a disservice to the public and diverts strategic attention and resources from fostering the organizational and technological enablers of organ donation in clinical practice.
英国、威尔士和苏格兰已正式将默认同意的法律制度适用于死者器官捐献。虽然联合王国的各国政府公开表示将认真对待器官捐献问题，值得称赞，但默认同意政策本身能否解决器官短缺这一公共卫生问题仍值得怀疑。如果默认同意政策未能解决临床实践中的关键因素，那么它可能成为徒劳无益的解决方案。因此，本文提供了一些批判性的见解和实际考虑因素，以努力增加可用于移植的器官供应：1. 仅器官捐献专家是不够的，还需要建立一种协作的医院捐献文化；2. 对创新灌流技术的投资对于增加用于移植的器官数量和质量至关重要；3. 选择默认同意并不能解决同意或授权捐献的持久问题，与其寄希望于默认同意能够改变社会的捐献文化，使捐献成为默认选择，不如承认家庭的授权仍然是必不可少的，而且不能忽视或完全排除他们的情感体验。重要的是，同意率并不是衡量整体死者捐赠率的唯一因素。器官短缺不能仅仅归因于公众态度消极，通过法律可以改变这种态度。这样做对公众不利，也分散了在临床实践中培养器官捐献的组织和技术支持的战略注意力和资源。
