Deceased Organ Donation

The field of solid organ transplantation is dependent on the availability of donor organs. The deceased donor waiting list in the United States continues to grow. The American Society of Transplantation (AST) recognizes the decision to donate organ(s) or a portion of an organ, as a truly selfless act, focused on the potential to save the life of another. Moreover, this decision may come at a particularly difficult time (impending death) for family members of a loved one.

A number of strategies have been implemented to increase the number of organs donated; AST supports these efforts, which include:

• timely referral,
• routine notification and mandated choice,
• donation after circulatory determination of death,
• computerized donor registries and first person consent donor designation,
• organ donation and the transplantation breakthrough collaborative.

However, remedying the ongoing shortage of organs will likely require additional innovative interventions. There are at least three additional approaches under consideration that the AST believes require further study and review.

Improved donor management has the potential to result in additional organs for transplantation. However, there are significant impediments (both ethical and logistic) to innovative studies to optimize deceased donor management and organ preservation that might enable advances to become reality. The AST strongly supports working to overcome these hurdles.

Presumed consent assumes assent of all individuals to become organ donors unless they specifically document otherwise (“opt-out”). A presumed consent system requires proactively defined and legally sanctioned measures to register a refusal. Several European countries have implemented similar policies. AST supports exploring potential benefits of an “opt-out” system in the United States.

The role of financial incentives (or removal of financial disincentives) for deceased organ donation has been debated. The AST reaffirms its long-held position that “families of deceased donors should not profit financially nor be financially disadvantaged from donation”. However, because many questions remain regarding the effect financial incentives might have on donation rates, the AST supports careful study and continued debate of this approach. Small pilot programs might provide needed information to assist in answering the many difficult questions.

In summary, the AST supports the following initiatives:

Continued emphasis on timely referral, routine notification and mandated choice to identify potential organ donors and to maximize donation options for self-designated donors or surviving next of kin.

• Expansion of programs to encourage first person consent and actionable donor registries.
• Partnership with other organizations working on organ donation to continuously improve and increase the number of organs available for transplant.
• Expansion of professional education programs to optimize the use of expanded criteria donors and donation after circulatory determination of death.
• Increased public recognition of organ donors and their families.
• Promotion and Federal funding of basic science and clinical research initiatives to improve the science of organ donation.
• Carefully conducted examination and focused trials of the potential of presumed consent and/or financial incentives to increase deceased donor organ donation.

Approved by the AST Board of Directors on December 6, 2012