Last week England decided against switching from informed consent to presumed consent for organ donations because a committee of experts felt it would not significantly raise donations.  In informed consent countries, agents are only donors when deceased if they registered to do so while alive. Conversely, in presumed consent countries, everybody is a potential donor once deceased. Therefore people need to register if they do (respectively do not) want to donate their body in informed (respectively presumed) consent countries.

While some studies found that there is a positive effect of presumed consent on organ donations, it is difficult to actually make the leap of faith that a change of legislation would increase donations.  The problem of presumed consent countries, such as France and Portugal, is that they rely on the fact that a deceased person is a donor by default.  Hence, in case people die and did not express any preference over organ donation, the next of kin that survives her has the choice between giving the organs and preventing the organs from being harvested.  Given that the family ends up making the final choice, the informed consent system might lead to more organ donations.  Spain is often regarded as an example of successful presumed consent country.  But their success is driven by the presence of organ coordinators that are trained to identify potential transplant organs and to talk to the families about the process of donation.

For England, the solution to the problem of organ donations requires a more dynamic approach involving more than new legislation, such as harnessing market forces and involving members of the community.  For starters, markets could potentially eliminate organ shortages and significantly reduce health care costs (see Becker and Elias, 2006, Introducing Incentives in the Market for Live and Cadaveric Organ Donations).  A market for buying and selling organs would result in the existence of an equilibrium price for living and cadaveric donors.  It would also decrease medical costs:  Today, the cost of kidney dialysis is about $44,000 per year.   The cost of kidney transplant and medical care for the first year is about $90,000.   After the first year, medical treatments, mostly for immunosuppressant drugs to prevent rejection are $16,000. That means after about two and a half years transplants save the medical system $27,000 per year as opposed to patients remaining on long term dialysis.

Secondly, the success of organ donation programs in England  depend primarily on people understanding what   the complete set of benefits:  England is now making the right first step by starting a $9 million public awareness campaign to raise donations.  But in order to stay on the right track, the English government should favor the creation of organ coordinators to produce a steady and permanent increase in organ donations.  Responsibility of people and the existence of a registry that collects people’s preferences on organ donations (yes or no) and not only one side of the question (for example, saying non donor if you are in a presumed consent country) would lead to a much needed donation spike.