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Korean J Transplant 2020; 34(1): 2-7

Published online March 31, 2020

https://doi.org/10.4285/kjt.2020.34.1.2

© The Korean Society for Transplantation

The effect of a mandatory choice system for organ donation after brain death on ethical legitimacy and potential efficacy in a mathematical model

In Soo Cho1 , Hyun Yong Lee2 , Ui Jun Park2 , Hyoung Tae Kim2 , Young-Nam Roh2

1Department of Surgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
2 Division of Transplantation and Vascular Surgery, Department of Surgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea

Correspondence to: Young-Nam Roh
Division of Transplantation and Vascular Surgery, Department of Surgery, Dongsan Medical Center, Keimyung University School of Medicine, 56 Dalseong-ro, Jung-gu, Daegu 41931, Korea
Tel: +82-53-250-7325
Fax: +82-53-250-7322
E-mail: nyn0913@gmail.com

Received: November 26, 2019; Revised: January 27, 2020; Accepted: January 31, 2020

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background: The “mandatory choice” system is an organ donation system that forces individuals to clearly express their choice about organ donation. Although this system is widely practiced in western countries, it has not yet been implemented in many Asian countries. This study aimed to compare the possible outcomes of a mandatory choice system and the current system in Korea.

Methods: A mathematical model was used to predict outcomes under each system. A structured questionnaire assuming two systems (current opt-in and mandatory choice) was developed to investigate participants’ decisions on organ donation and the family’s consent after brain death in each system. Participants who enrolled in this survey were 100 couples (200 people).

Results: The total number of donors decreased slightly from 102 (51.0%) in the current opt-in system to 93 (46.5%) in the mandatory choice system. The rate of achieving autonomy was increased from 62.5% (125/200) in the current system to 68.0% (136/200) in the mandatory choice system. The achievement of negative autonomy was relatively higher in the mandatory choice system (73.6% [67/91] vs. 63.2% [55/87]).

Conclusions: The mandatory choice system can supplement the weak ethical point of the current system by increasing the achievement of autonomy.

Keywords: Organ donation, Mandatory choice system, Autonomy

HIGHLIGHTS
  • A mathematical model was used to predict ethical legitimacy and potential efficacy of current opt-in system and mandatory choice system for organ donation after brain death in this study.

  • Even if the total number of donors slightly decreases in the mandatory choice system, the mandatory choice system can improve the ethical limitation of the current system by increasing achievement of autonomy in the decision for organ donation in Korea.

  • In the mandatory choice system, achieving of negative autonomy was more prominent than that of positive autonomy.

  • The mandatory choice system is needed for ethical justification rather than promoting organ donation.