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

대한이식학회지 2020년 34권 1호 p.2 ~ 7
 ( Cho In-Soo ) - Keimyung University Dongsan Medical Center Department of Surgery

이현용 ( Lee Hyun-Yong ) - Keimyung University Dongsan Medical Center Department of Surgery
박의준 ( Park Ui-Jun ) - Keimyung University Dongsan Medical Center Department of Surgery
김형태 ( Kim Hyoung-Tae ) - Keimyung University Dongsan Medical Center Department of Surgery
노영남 ( Roh Young-Nam ) - Keimyung University Dongsan Medical Center Department of Surgery

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.

키워드

Organ donation; Mandatory choice system; Autonomy
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