France joined the list of countries which have made organ donation mandatory after the death of a person. The new ‘presumed consent’ law assumes that the deceased person agrees to have their organs donated, even if the individual’s immediate family is against it. Those who do not wish to donate their organs can put their name on a national “refusal register” whereby their consent will not be presumed, and their organs will not be donated after their demise.
The legislation took effect on 1 January 2017. Until then, if the deceased was not enrolled for organ donation, doctors needed the consent of the deceased’s kin. In almost a third of such cases, the relatives refused to give permission. The “refusal register” will be an easily accessible portal in which citizens can enrol online or by post.
It is widely expected that France’s frequency of organ donation will steeply rise shortly. Countries like Austria, Spain, Wales and Chile which have experimented with varying degrees of the presumed consent system have all reported dramatic rises in organ donations.
Opt-in vs. opt-out
The opt-out system is the presumed consent system where the deceased person’s consent to organ donation is presumed unless their name is on the nation’s refusal registry. On the contrary, the opt-in system demands the prior consent of the deceased person for the organ donation to go forward.
The opt-out system automatically sees greater rates of organ donations and donors. For example, Germany, which uses an opt-in system has an organ donation consent rate of 12% while neighbouring Austria, which has an opt-out system, has a consent rate of 99.98%. Another study found that in countries which changed from an opt-in system to an opt-out system, the number of donors increased by 20 to 30 percent, indicating that such a system alters the dynamics of public view on health policy drastically.
The Spanish model, and why it is regarded as the best in the world
Spain is often cited as an epitome in this area. Following protests against endless waiting lists, Spain began to work on increasing organ donations. After transitioning to an opt-out system, Spain dramatically emerged as the undisputed world leader in organ donations. It is important to note that the success of opt-out systems can only be ensured when it is accompanied by high numbers of medical facilities, personnel and awareness. Spain invests a significant amount in healthcare. Despite decreasing rates of health spending in the recent years, the Spanish healthcare system is considered among the best in the world by the World Health Organisation.
Where does India stand when it comes to organ donations?
A huge gap persists between demand and supply of organs in India. India has a donation rate of 0.5 per million – one of the lowest in the world. In contrast, Spain has a donation rate of 36 per million inhabitants while numbers for Germany and the United States are 11 and 26 respectively.
According to studies, around 1.6 lakh patients are waiting for organs in India while a mere 12,000 donors are available. The Ministry of Health has estimated that the annual requirement for kidneys could range between 1-2 lakh while there are only 5,000 transplants occurring in reality.
The state and central governments have taken many steps to increase the rates of organ donation in India. For example, in 2012 the Delhi Government launched an online portal for registration of organ donors. The Indian Medical Association recently announced several campaigns to increase awareness about organ donations.
India can solve its problems regarding organ donation only by increasing health spending. India’s healthcare system remains insufficient, with private providers being the dominant force and no solid program for a universal healthcare system in sight. Expenditure on healthcare increased from about 3.5% to 5.0% in the period between 1988 and 2002. In countries like the United States and the United Kingdom, healthcare accounts for more than 18% of the GDP. Meanwhile, government spending on healthcare has hovered around 20–25% during the past two decades. Moreover, healthcare in India is severely divided along the lines of income and urbanisation.
If the government were to increase government spending on healthcare – like in the West – it would improve health conditions of millions of Indians. Without improving its healthcare scenario, India cannot hope to make meaningful strides towards ensuring that its organ donation needs are met.