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European regulations on organ donation: consent models, family involvement, and national registries
Our research
We have systematically analyzed and compared the laws of each European state on organ procurement for transplantation purposes, taking into account three fundamental aspects: 1. the models of consent, 2. the level of family authority in the organ procurement decision-making (as legally stated), and 3. the availability of donation and/or refusal registries to express organ donation preferences. Our results constitute the first comprehensive map of organ transplantation laws in Europe. We hope this study can be useful for both researchers and policy makers.
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Autores/as:
Marina Morla-González Clara Moya-Guillem Janet Delgado-Rodríguez Alberto Molina-Pérez David Rodríguez-Arias Gonzalo Díaz-Cobacho |
Consent models in Europe
Several European countries are introducing legislative reforms regarding consent for postmortem organ donation. The relative capacity of consent policies (opt-in; opt-out) for increasing organ procurement rates is being discussed.
Opt-in (or explicit consent): Under an opt-in system, organs may be obtained from a deceased person if the person had expressly consented to such removal during his or her lifetime, either verbally or, depending on domestic laws, through a donor card, a donor registry, their driver’s license or identity card or their medical record.
Opt-out (or presumed consent): Under an opt-out system, organs may be obtained from a deceased person for transplantation unless the person had expressed his or her opposition before death.
Opt-in (or explicit consent): Under an opt-in system, organs may be obtained from a deceased person if the person had expressly consented to such removal during his or her lifetime, either verbally or, depending on domestic laws, through a donor card, a donor registry, their driver’s license or identity card or their medical record.
Opt-out (or presumed consent): Under an opt-out system, organs may be obtained from a deceased person for transplantation unless the person had expressed his or her opposition before death.
Adapted from:
- MORLA M, MOYA GUILLEM C, DELGADO J and MOLINA-PEREZ A., European and comparative law study regarding family's legal role in deceased organ procurement. Revista General de Derecho Público Comparado (accepted)
- MOLINA-PÉREZ A, DELGADO J, RODRÍGUEZ-ARIAS D (2021), “Defining Consent: Autonomy, and the Role of the Family” Ethical Challenges of Organ Transplantation: Current Debates and International Perspectives", Transcript
Role of the Family in deceased organ donation
Families may be decisive as well, depending on their degree of involvement along the decision–making process. Most states, both those with an opt-in system and those with an opt-out system, allow family members to make decisions when the deceased have not expressed any preference in life. However, while some countries only allow family members to communicate or update the preferences of the deceased (i.e., to act as witness), other jurisdictions also allow them to act on their behalf (i.e., to act as surrogates) or even to overrule or "veto" their consent (i.e., to have full decisional authority). Within each country, the role play by families as stated by law (de iure) and the role they actually play (de facto) may differ.
Adapted from:
- DELGADO J, MOLINA-PEREZ A, SHAW D, RODRÍGUEZ-ARIAS D (2019), The role of the family in deceased organ procurement. A guide for clinicians and policy makers. Transplantation, Vol. 103, No. 5, May 2019
- MORLA M, MOYA GUILLEM C, RODRIGUEZ-ARIAS D, de MIGUEL BERIAIN I, MOLINA-PEREZ A, ORTEGA-DEBALLON I, European and comparative law study regarding family's legal role in deceased organ procurement. Revista General de Derecho Público Comparado (accepted)
Registries for organ donation
Adapted from:
- MORLA M, MOYA GUILLEM C, DELGADO J and MOLINA-PEREZ A. European and comparative law study regarding family's legal role in deceased organ procurement. Revista General de Derecho Público Comparado (accepted)
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