Bridging the gap between organ donor registration and actualisation rates : the role of mandated choices

Abstract

The role of the presumed consent legislation on deceased organ donation has seen great success over the past decade, with a plethora of studies ascertaining an increase in donor registration rates following its implementation. However, there exists a fundamental gap between the high donor registration rates and its corresponding actualisation rates. This is often attributed to the ‘weak’ consent delineated in presumed consent legislations, which may lead to a high level of family resistance pertaining to donors’ posthumous organ extraction. Thus, through an experimental study, we seek to propose the effectiveness of a new alternative delineated by a stronger consent directive – Mandated Choice Structures (Mandated Choice and Enhanced Mandated Choice) in postmortem organ donation. Results suggest that donor registration rates under Mandated Choice Structures are equivalent to that of a presumed consent legislation. Furthermore, the latter leads to lower family resistance and consequentially higher actualisation rates, thereby making it a stronger candidate in deceased organ procurement.