Spital A
University of Rochester School of Medicine, NY.
JAMA. 1995 Feb 8;273(6):504-6. doi: 10.1001/jama.273.6.504.
To estimate the impact of mandated choice--a system that requires competent adults to decide prospectively whether or not they wish to be organ donors when they die--on public commitment to organ donation; and to explore who is best suited to provide consent--the family or the individual?
A national, random-digit telephone survey conducted by the Gallup Organization in July 1993.
A representative sample (n = 1002) of adults (aged 18 years and older) living in homes with telephones in the continental United States.
Although the majority of respondents had given at least some thought to organ donation, only 25% had carefully considered this issue. Overall, 30% had decided to donate, but 58% were undecided and only 38% had made their wishes known to a family member. Yet the vast majority (82%) believes that the best way to obtain consent is for each adult to decide for himself or herself, rather than leaving this decision for the family. Under mandated choice, which is designed to encourage such self-determination, 63% would sign up to donate, 24% would not, and 13% were unsure.
Only a small fraction of the US public is currently committed to organ donation and relatively few people have carefully considered and communicated their wishes regarding this important issue. Therefore, the difficult question of consent is often left for the family. Yet most people believe that ideally all adults should answer this question for themselves, in contrast to our present family-oriented approach, but consistent with the design of mandated choice. If mandated choice became law, it appears that most adults would sign up to donate, thereby increasing the pool of desperately needed committed donors.
评估强制选择（一种要求有行为能力的成年人预先决定自己死后是否愿意成为器官捐献者的制度）对公众器官捐献意愿的影响；并探讨由谁来提供同意更为合适——是家属还是个人？
1993年7月由盖洛普组织进行的一项全国性随机数字电话调查。
居住在美国本土有电话家庭中的18岁及以上成年人的代表性样本（n = 1002）。
尽管大多数受访者至少对器官捐献有所考虑，但只有25%的人仔细考虑过这个问题。总体而言，30%的人已决定捐献，但58%的人尚未决定，只有38%的人已将自己的意愿告知家人。然而，绝大多数人（82%）认为获得同意的最佳方式是让每个成年人自己做决定，而不是由家人来做这个决定。在旨在鼓励这种自我决定的强制选择制度下，63%的人会登记成为捐献者，24%的人不会，13%的人不确定。
目前美国公众中只有一小部分人致力于器官捐献，相对较少的人仔细考虑并表达了他们在这个重要问题上的意愿。因此，同意这个难题往往留给了家属。然而，大多数人认为理想情况下所有成年人都应该自己回答这个问题，这与我们目前以家庭为导向的方式不同，但与强制选择的设计一致。如果强制选择成为法律，似乎大多数成年人会登记成为捐献者，从而增加急需的志愿捐献者群体。
