{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T17:04:49Z","timestamp":1771002289368,"version":"3.50.1"},"reference-count":46,"publisher":"BMJ","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Med Ethics"],"published-print":{"date-parts":[[2003,6]]},"abstract":"<jats:p>Presumed consent to organ donation looks increasingly unlikely to be a palatable option for increasing organ procurement in the UK following the publication of the report into events at Alder Hey and elsewhere. Yet, given that the alternative to increasing the number of cadaveric organs available is either to accept a greater number of live donations, or accept that people will continue to die for the want of an organ, public policy makers remain obliged to consider other means of increasing the procurement rate.<\/jats:p><jats:p>In this paper, we meet the main objections to mandated choice (namely that it undermines autonomy and that mandated donation is preferable). We have modified the traditional approach to mandated choice to take into account the force of the objection that mandated donation is preferable, by accepting that people can and do make bad decisions about organ donation and proposing that all accompanying public education and information about cadaveric donation should be directed in favour of donation.<\/jats:p>","DOI":"10.1136\/jme.29.3.157","type":"journal-article","created":{"date-parts":[[2003,6,9]],"date-time":"2003-06-09T23:09:42Z","timestamp":1055200182000},"page":"157-162","source":"Crossref","is-referenced-by-count":44,"title":["Modified mandated choice for organ procurement"],"prefix":"10.1136","volume":"29","author":[{"given":"P","family":"Chouhan","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"H","family":"Draper","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2003,6,1]]},"reference":[{"key":"2024052910422030000_29.3.157.1","unstructured":"Figures from UK Transplant\u2019s web site, for instance, state that in 2000, although a total of 1823 (cadaveric and live) kidney donations were performed the waiting list at the close of the year had 6284 patients; 709 liver transplants were performed but 175 patients remained on the waiting list; 250 heart or heart\/lung transplants were performed but 289 patients were still waiting for a transplant, and 98 lung transplants were performed but 205 patients were still awaiting transplant."},{"key":"2024052910422030000_29.3.157.2","unstructured":"Council of Europe. Convention on Human Rights and Biomedicine. Oriedo, Spain: 1997 Apr 4. Article 21: Prohibition of financial gain states: \u201cThe human body and its parts shall not, as such, give rise to financial gain\u201d."},{"key":"2024052910422030000_29.3.157.3","unstructured":"For instance, UK Transplant reported on its web site that the number of live kidney donations had risen from 89 in 1991 to 336 in 2000."},{"key":"2024052910422030000_29.3.157.4","unstructured":"For example, for kidney donors, major complications for the donor are rare, and the mortality rate is about 0.03%. See: British Medical Association (BMA) Medical Ethics Committee (MEC). Organ donation in the 21st century: time for a consolidated approach. London: BMA, 2000: 10."},{"key":"2024052910422030000_29.3.157.5","unstructured":"For example, although liver segments may regenerate, lung segments do not, and donors may suffer from respiratory problems. See: UNOS. Living donation\u2014an overview on the UNOS website www.unos.org."},{"key":"2024052910422030000_29.3.157.6","unstructured":"For instance, the Unrelated Live Transplantation Regulatory Authority (ULTRA) is at the time of writing considering the possibility of permitting paired donation and altruistic donation by strangers, and this consideration has been incorporated into the recently announced public consultation on the review of the law governing human tissue transplantation in the UK."},{"key":"2024052910422030000_29.3.157.7","unstructured":"See reference 4: 5 where, for instance, it is pointed out that very few of those who die are actually suitable organ donors."},{"key":"2024052910422030000_29.3.157.8","unstructured":"Human Tissue Act 1961: section 1(2). London: Her Majesty\u2019s Stationery Office, 1961."},{"key":"2024052910422030000_29.3.157.9","unstructured":"British Medical Association (BMA) Medical Ethics Committee (MEC). Organ donation in the 21st century: time for a consolidated approach. London: BMA, 2000."},{"key":"2024052910422030000_29.3.157.10","unstructured":"Price D. Legal and ethical aspects of organ transplantation. Cambridge: Cambridge University Press, 2000: 86 cites a Council of Europe survey that 23 European countries operated presumed consent systems for organ procurement."},{"key":"2024052910422030000_29.3.157.11","unstructured":"See reference 10: 89."},{"key":"2024052910422030000_29.3.157.12","unstructured":"See reference 10: 90."},{"key":"2024052910422030000_29.3.157.13","unstructured":"It is likely to make a reappearance in the recently announced review of the law on human tissue transplantation in the UK"},{"key":"2024052910422030000_29.3.157.14","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1994.03520100071036"},{"key":"2024052910422030000_29.3.157.15","unstructured":"Kings Fund Institute. A question of give and take: improving the supply of donor organs for transplantation. London: Kings Fund Institute, 1994:37\u201342."},{"key":"2024052910422030000_29.3.157.16","doi-asserted-by":"publisher","DOI":"10.1136\/jme.25.5.365"},{"key":"2024052910422030000_29.3.157.17","unstructured":"Redfern M, Keeling JW, Powell E. The Royal Liverpool Children\u2019s inquiry report. Liverpool: The Royal Liverpool Children\u2019s Inquiry, 2001: 367, 369\u2013375."},{"key":"2024052910422030000_29.3.157.18","unstructured":"It is, however, expected to be one of the options explored in the public consultation of the review of the law governing the transplantation of human tissue in the UK."},{"key":"2024052910422030000_29.3.157.19","unstructured":"Kings Fund Institute. A question of give and take: improving the supply of donor organs for transplantation. London: Kings Fund Institute, 1994:39\u201340."},{"key":"2024052910422030000_29.3.157.20","unstructured":"Harris J. The value of life. London: Routledge, 1985: 118\u201319."},{"key":"2024052910422030000_29.3.157.21","first-page":"2175","volume":"24","year":"1992","journal-title":"Transplant Proc"},{"key":"2024052910422030000_29.3.157.22","first-page":"340","volume":"8","year":"1993","journal-title":"Camb Q Healthc Ethics"},{"key":"2024052910422030000_29.3.157.23","unstructured":"Veatch RM. Death, dying and the biological revolution. New Haven: Yale University Press, 1976: 272\u20133. Here Veatch did not use the term \u201cmandated choice\u201d but spoke instead of \u201croutine and organised solicitation of donation\u201d."},{"key":"2024052910422030000_29.3.157.24","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1995.03520300078045"},{"key":"2024052910422030000_29.3.157.25","unstructured":"See reference 24: Spital A: 1992 : 2421\u20134."},{"key":"2024052910422030000_29.3.157.26","unstructured":"See reference 22: Dennis J, Hanson P, Hedge E, et al: 1993."},{"key":"2024052910422030000_29.3.157.27","unstructured":"See reference 4: 20\u201321."},{"key":"2024052910422030000_29.3.157.28","unstructured":"To get around the contradiction inherent in the phrase \u201ccompulsory or mandatory donation\u201d, John Harris, in The value of life, London: Routledge, 1985: 119, used the phrase \u201ctransplant orders\u201d. We have chosen to stick with the phrase \u201cmandatory donation\u201d because this formulation made it easier for us to contrast mandatory choice and donation. We acknowledge the inherent contradiction in the choice of terms here."},{"key":"2024052910422030000_29.3.157.29","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468-5930.1993.tb00073.x"},{"key":"2024052910422030000_29.3.157.30","doi-asserted-by":"crossref","unstructured":"Dworkin G. The theory and practice of autonomy. Cambridge: Cambridge University Press, 1988:8.","DOI":"10.1017\/CBO9780511625206"},{"key":"2024052910422030000_29.3.157.31","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1111\/1468-5930.00074","volume":"15","year":"1998","journal-title":"J Appl Philos"},{"key":"2024052910422030000_29.3.157.32","first-page":"294","volume":"1","year":"1993","journal-title":"Med Law Rev"},{"key":"2024052910422030000_29.3.157.33","unstructured":"Nuffield Council on Bioethics. Human tissue\u2014ethical and legal issues. London: Nuffield Council on Bioethics, 1995: 68."},{"key":"2024052910422030000_29.3.157.34","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1177\/096853329800300404","volume":"3","year":"1998","journal-title":"Med Law Int"},{"key":"2024052910422030000_29.3.157.35","unstructured":"Steiner H. Property in the body: a philosophical perspective. In: Stern K, Walsh P, eds. Property rights in the human body. London: Centre of Medical Law and Ethics\u2014Kings College London, 1997: 1."},{"key":"2024052910422030000_29.3.157.36","unstructured":"Paradoxically, arguments against the body being seen as property have been made to protect those who might come under pressure to sell various body parts. The desire to balance the public interest in not permitting trade in organs with the interest individuals are thought to have in making decisions about the disposal of their bodies after their death, has given rise to a legal situation whereby \u201c . . . at the moment property is created the owner of it must inevitably have ceased to exist!\u201d: reference 10: 132."},{"key":"2024052910422030000_29.3.157.37","unstructured":"See for instance, Elizabeth Adams v Julian James Lewis (Administrator of the Estate of Frank Adams, Deceased) (2001) where it was held that reasonable provision had not been made by Mr Adams for his wife Elizabeth, and the amount to be paid to her from his estate was therefore considerably increased."},{"key":"2024052910422030000_29.3.157.38","unstructured":"Here we are referring to moral not legal interests. In most states the relatives do not have legal ownership as such."},{"key":"2024052910422030000_29.3.157.39","unstructured":"Mill JS. On liberty. London: Penguin Books, 1982: 68."},{"key":"2024052910422030000_29.3.157.40","unstructured":"See Feinberg J. Harm to others. The moral limits of the criminal law [vol 1]. New York: Oxford University Press, 1984: 26\u20137."},{"key":"2024052910422030000_29.3.157.41","unstructured":"See reference 21: 2175, adapted from Menzel, and Beauchamp TL, Childress JF. Principles of biomedical ethics [4th ed]. Oxford: Oxford University Press, 1994: 266."},{"key":"2024052910422030000_29.3.157.42","doi-asserted-by":"publisher","DOI":"10.1023\/A:1009402628830"},{"key":"2024052910422030000_29.3.157.43","doi-asserted-by":"crossref","unstructured":"Charlesworth M. Bioethics in a liberal society. Cambridge: Cambridge University Press, 1993: 14.","DOI":"10.1017\/CBO9780511552120"},{"key":"2024052910422030000_29.3.157.44","unstructured":"For a full account of the Spanish system see reference 4: 22, or the web site of the Organizacion Nacional de Trasplantes (ONT) on http:\/\/www.msc.es\/ont\/ing\/home.htm. We stress that there is much more to the Spanish system than the idea we have borrowed from it and modified."},{"key":"2024052910422030000_29.3.157.45","unstructured":"We accept that this runs counter to the emerging tradition of impartial information giving and counselling. Our point is that this approach is justified by appeals to the greater good."},{"key":"2024052910422030000_29.3.157.46","unstructured":"It could, of course be sheer small-mindedness but we are hoping for the best in human nature here."}],"container-title":["Journal of Medical Ethics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/jme.29.3.157","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,29]],"date-time":"2024-05-29T17:42:35Z","timestamp":1717004555000},"score":1,"resource":{"primary":{"URL":"https:\/\/jme.bmj.com\/lookup\/doi\/10.1136\/jme.29.3.157"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2003,6]]},"references-count":46,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2003,6,1]]},"published-print":{"date-parts":[[2003,6]]}},"alternative-id":["10.1136\/jme.29.3.157"],"URL":"https:\/\/doi.org\/10.1136\/jme.29.3.157","relation":{},"ISSN":["0306-6800","1473-4257"],"issn-type":[{"value":"0306-6800","type":"print"},{"value":"1473-4257","type":"electronic"}],"subject":[],"published":{"date-parts":[[2003,6]]}}}