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In the Balance |

Who Are the Donors in Organ Donation? The Family's Perspective in Mandated Choice

Ann C. Klassen, PhD; and David K. Klassen, MD
[+] Article and Author Information

From Johns Hopkins University School of Hygiene and Public Health and University of Maryland School of Medicine, Baltimore, Maryland. Requests for Reprints: Ann C. Klassen, PhD, Johns Hopkins School of Public Health, 624 North Broadway, Room 729, Baltimore, MD 21205. Current Author Addresses: Dr. Klassen: Johns Hopkins School of Public Health, 624 North Broadway, Room 729, Baltimore, MD 21205.


Copyright ©2004 by the American College of Physicians


Ann Intern Med. 1996;125(1):70-73. doi:10.7326/0003-4819-125-1-199607010-00011
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Evidence that families requested to permit organ donation refuse half the time has led to proposals for mandated choice.Under mandated choice, a person's donation wishes would be collected and retrieved at death, and requests to families would be avoided.

There are both ethical and logistic problems with mandated choice.The view of the family should be respected in organ requests, even when patient wishes are known. Public sentiment against overriding family wishes could cause low rates of pro-donation registration. Caregivers have usually refused to take organs when families oppose donation. Logistic issues with mandated choice include the cost and complexity of maintaining a national database on donors and the enforcement of registration. No such database of adults currently exists, even for tax purposes. Two states that have mandated choice programs through departments of motor vehicles report relatively low numbers of pro-donation registrants compared with nondonors or undecided persons. Public education and voluntary donor identification hold more potential to increase donation.

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