Cho In Soo, Lee Hyun Yong, Park Ui Jun, Kim Hyoung Tae, Roh Young-Nam
Department of Surgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea.
Division of Transplantation and Vascular Surgery, Department of Surgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea.
Korean J Transplant. 2020 Mar 31;34(1):2-7. doi: 10.4285/kjt.2020.34.1.2.
The "mandatory choice" system is an organ donation system that forces individuals to clearly express their choice about organ donation. Although this system is widely practiced in western countries, it has not yet been implemented in many Asian countries. This study aimed to compare the possible outcomes of a mandatory choice system and the current system in Korea.
A mathematical model was used to predict outcomes under each system. A structured questionnaire assuming two systems (current opt-in and mandatory choice) was developed to investigate participants' decisions on organ donation and the family's consent after brain death in each system. Participants who enrolled in this survey were 100 couples (200 people).
The total number of donors decreased slightly from 102 (51.0%) in the current opt-in system to 93 (46.5%) in the mandatory choice system. The rate of achieving autonomy was increased from 62.5% (125/200) in the current system to 68.0% (136/200) in the mandatory choice system. The achievement of negative autonomy was relatively higher in the mandatory choice system (73.6% [67/91] vs. 63.2% [55/87]).
The mandatory choice system can supplement the weak ethical point of the current system by increasing the achievement of autonomy.
“强制选择”系统是一种迫使个人明确表达其器官捐赠选择的器官捐赠系统。尽管该系统在西方国家广泛实行，但在许多亚洲国家尚未实施。本研究旨在比较韩国强制选择系统和现行系统可能产生的结果。
使用数学模型预测每个系统下的结果。设计了一份假设两种系统（现行选择加入和强制选择）的结构化问卷，以调查参与者在每个系统中关于器官捐赠的决定以及脑死亡后家属的同意情况。参与本次调查的是100对夫妇（200人）。
捐赠者总数略有下降，从现行选择加入系统中的102人（51.0%）降至强制选择系统中的93人（46.5%）。自主达成率从现行系统中的62.5%（125/200）提高到强制选择系统中的68.0%（136/200）。在强制选择系统中，消极自主的达成相对较高（73.6% [67/91] 对63.2% [55/87]）。
强制选择系统可以通过提高自主达成率来补充现行系统薄弱的伦理要点。
