Lung transplant – opting in vs. opting out
Hirman Ismail MD (UKM) MPH (Nottingham)
Transplantation Unit, Medical Development Division
There are many strategies that have been widely discussed and implemented in many countries to increase donor pool and organ transplantation rate. These include among others strengthening central and local organisational structure, establish good transplant/ donor coordinator network, raising public awareness, addressing professional awareness and competencies, incentive (to donor, staff & medical institution), establish mechanism for potential deceased donor identification, ABO incompatible transplant, paired exchange programme, domino transplant, extended donor criteria and regional organ sharing. Legislation has been implicated to be as one of the many ways to improve organ and tissue donation rate in particular through the implementation of opting out system. Opting out system or also known as presumed consent is a system by which consent to donate organ and tissue is presumed unless a person has expressly indicated otherwise during his/her lifetime. Contrary to the opting out system, in opting in system however, consent to donate has to be explicit through verbal or written consent expressed by the donor when he/she was still alive. Legal and ethical barrier in implementing opting out system arises because of the fact that such system would exclude the next of kin from the decision making process when a donor passes away. In Malaysia, the law that governs the authorisation of removal of organ and tissue from a deceased is Human Tissues Act 1974 [Act 130]. Malaysia practices an opting in system as specified in subsection 2(1) of the Act 130 but the final decision to authorise the removal of organ and tissue of the deceased donor rest on the spouse or the next of kin, as specified in subsection 2(2). At the moment, the Ministry is in the process of drafting a new more comprehensive law on transplantation in which the option for possible implementation of opting out system was discussed. Even though it is thought that opting out system may increase donor pool as demonstrated in some countries, the challenges to its implementation is much more complex and shall be tailored to consider local sensitivity, level of awareness/ acceptance and also cultural/ religious values.