Mandated choice. A plan to increase public commitment to organ donation
A. Spital
University of Rochester School of Medicine, NY.
OBJECTIVES--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? DESIGN--A national, random-digit telephone survey conducted by
the Gallup Organization in July 1993. PARTICIPANTS--A representative sample
(n = 1002) of adults (aged 18 years and older) living in homes with
telephones in the continental United States. RESULTS--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. CONCLUSIONS--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.
