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Is presumed consent the answer to organ shortages? No

BMJ 2007; 334 doi: (Published 24 May 2007) Cite this as: BMJ 2007;334:1089

This article has a correction. Please see:

  1. Linda Wright, bioethicist
  1. University Health Network and Joint Centre for Bioethics, University of Toronto, Toronto General Hospital, Toronto ON, Canada M5G 2N2
  1. Linda.wright{at}

    The supply of donor organs cannot keep up with demand. Veronica English argues that assuming people want to donate unless there is contrary evidence will increase availability, but Linda Wright believes the problem is more complex

    Presumed consent will not answer the organ shortage. It has not eliminated waiting lists despite evidence that it increased organ donation in some countries.1 Systems of opting out do not ensure higher rates of donation than opting-in systems.2 Strategies to encourage people to donate and public education seem to help and are independent of whether people have to opt in or out. The shortage of organs has multiple causes; no single strategy is likely to solve it.

    Controversy over presumed consent

    Presumed consent refers to laws that permit the procurement of organs without explicit permission.3 The term is used widely in discussion of systems of opting in or opting out of organ donation. The US Institute of Medicine is concerned that the introduction of presumed consent without …

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