Organ donation and presumed consent. Objetions to its implementation in Mexico
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Published:
Jan 4, 2019
Keywords:
organ donation, presumed consent, autonomy
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Abstract
In April 2018, the Mexican Senate approved an initiative to modify the organ donation system. The intention of this initiative was to pass from an opt-in or explicit consent model, in which someone who wishes to donate an organ has to register in the donor registry, to an opt-out system, in which all adults would be presumed donors, unless they expressed their refusal. However, the initiative was stopped in the Chamber of Deputies by the adverse reaction of specialists and part of the public opinion. Here I analyze some of the reasons that were given, and I criticize them in order to defend the implementation of the opt-out system in Mexico.
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Ortiz Millán, G. (2019). Organ donation and presumed consent. Objetions to its implementation in Mexico. Medicina Y Ética, 30(1), 151–180. Retrieved from https://revistas.anahuac.mx/index.php/bioetica/article/view/437
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References
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324, 325, 326 y 329 of the Health General Law, approved on April 3,2018. Available
on http://www.senado.gob.mx/sgsp/gaceta/63/3/2018-04-03-1/assets/documentos/
Dict_Salud_Donacion_de_Organos.pdf. Consulted on June 2, 2018.
2 NATIONAL TRANSPLANT CENTER (Cenatra), Statistics-information Bulletin of the
BEI-Cenatra, National Transplant Center vol. 2, no. 2 (January-December 2017).
Available on https://www.gob.mx/cenatra. Consulted on May 30, 2018.
3 TORIBIO, L., “80% dies waiting for a donor”, Excélsior, September 29, 2015. Available
on http://www.excelsior.com.mx/nacional/2015/09/26/1047819. Consulted on
May 31, 2018.
4 RAMÍREZ VILLATORO, I. “The Organ Donation Law is killed”, El Heraldo de México,
May 8, 2018.
5 MARVÁN, M.L., A. ÁLVAREZ DEL RÍO, K. JASSO, P. SANTILLÁN-DOHERTY, “Psychosocial
barriers associated with organ donation in Mexico”. Clinical Transplantation 31
(2017): e13112. https://doi.org/10.1111/ctr.13112.
G. Ortiz Millán
178 Medicina y Ética 2019/1
6 NATIONAL TRANSPLANT CENTER (Cenatra), Donation and Transplants in Mexico.
2017 Annual Report. Available on https://www.gob.mx/cenatra. Consulted July 2,
2018.
7 GARCÍA, I., “Automatic donation of organs is stopped”, Índigo Report, April 18,
2018. Available on https://www.reporteindigo.com/reporte/frenan-donacion-automatica-
organos-sector-salud-preparacion-ciudadanos-numero-transplantes/. Consulted
on May 31, 2018.
8 SUNSTEIN, C., y R. THALER, Nudge. A small push, translated. B. Urrutia, Madrid:
Taurus, 2009.
9 RIVERA LÓPEZ, E., Ethics and Organ Transplant. México: FCE-UNAM, 2001.
10 KURTZ, S. y M., SAKS “The transplant paradox: Overwhelming public support for
organ donation vs. under-supply of organs: The Iowa organ procurement study”,
Journal of Corporation Law vol. 21, no. 4 (1996): 767–803.
11 Chamber of Representatives, 2018 National Survey on the Health System in
Mexico, Mexico: Center for Social Studies and Public Opinion, Chamber of Representatives.
Available on http://www5.diputados.gob.mx/index.php/camara/Centrosde-
Estudio/CESOP/Opinion-Publica/Encuestas/Sistema-de-Salud-en-Mexico-2018.
Consulted on June 1, 2018.
12 ZEPEDA-ROMERO, L.C., G. GARCÍA-GARCÍA, O. AGUIRRE-JAÚREGUI, “Results on a
Survey on Donation and Transplant of Organs in the Metropolitan area of Guadalajara,
Mexico”. Public Health Mexico 45 (2003): 54-57.
13 KLUGE, E.H., “Improving organ retrieval rates: Various proposals and their ethical
validity”, Health Care Analysis 8 (2000): 279-295.
14 SANTILLÁN-DOHERTY, P., “Ethics and Organ Transplant”. In R. PÉREZ TAMAYO, R.
LISKER and R. TAPIA (comps.), The building of Bioethics, Mexico: FCE, 2007: 85-
118.
15 ZANOLLI, B. “Mexico with forced donation, a new Paradise for organ trafficking”,
El Universal, April 6, 2018.
16 GARCÍA, I., “Organ donation, ¿forced?” Reporte Índigo, March 1, 2018. Available
on https://www.reporteindigo.com/reporte/donacion-organos-forzosa-ley-generalsalud-
hospitales-voluntad-legislacion/. Consulted on June 21, 2018.
17 PÉREZ-PEÑA, R., “U.K. moves toward making adults presumed organ donors”,
The New York Times, February 23, 2018.
18 JOHNSON, E.J., y D.G. GOLDSTEIN, “Do defaults save lives?” Science, vol. 302
no. 5649 (2003): 1338-1339. Doi: 10.1126/Science.1091721.
19 An interview to María de Jesús Medina Arellano, “Human organ donation”, Juridicans
Opina Program, broadcasted on April 23, 2018. Available on: https://
www.youtube.com/watch?v=NeGXOSep6Ak&t=17s.
20 VEATCH, R.M., y J.B. PITT, “The myth of presumed consent: Ethical problems in
organ procurement strategies”. Transplantation Proceedings, 27 (1995): 1888–
1892.
21 GILL, M.B. “Presumed consent, autonomy, and organ donation”. Journal of Medicine
and Philosophy 29, 1 (2004): 37-59.
22 PLATTS, M., on uses and abuses of morality, Mexico: UNAM-Paidós, 1999.
Organ donation and presumed consent. Objetions to its implementation
Medicina y Ética 2019/1 179
23 HERNÁNDEZ, S., “The deceased of nobody; from the morgue to the common grave”,
El Sol de México, October 31, 2017.
24 SIMINOFF, L., N. GORDON, J. HEWLETT y R. ARNOLD, “Factors influencing families’
consent for donation of solid organs for transplantation”, Journal of the American
Medical Association, vol. 286, no. 1 (2001): 71-77.
25 RIVERA LÓPEZ, E. “Organ Donation and the family role. Is it worth to rethink the
subject matter?” Bioethic Perspectives 37/38 (2015): 46–53.
26 SHAW, D. “We should not let families stop organ donation from their dead relatives”,
British Medical Journal 345 (2012): e5275.
27 HEVIA, F., “Trust and Mistrust on the Public Health System in Mexico”, Revista
Chilena de Salud Pública vol. 10, no. 2 (2006): 107-111.
28 LÓPEZ CERVANTES, M. (coord.), A critical thought about the health of the Mexicans.
National Health Survey. The Mexicans seen by themselves. The big national
issues, Mexico: UNAM, 2015.
29 PROTTAS, J., y H.L. BATTEN, “The willingness to give: The public and the supply
of transplantable organs”, Journal of Health Politics, Policy, and Law vol. 16, no. 1
(1991): 121–134.
30 O’NEILL, O. Autonomy and Trust in Bioethics, Cambridge: Cambridge University
Press, 2002.
31 DOBBELS, F., F. VAN GELDER, K. REMANS, A. VERKINDEREN, J. PEETERS, J. PIRENNE,
F. NEVENS, “Should the law on anonymity of organ donation be changed? The
perception of liver transplant recipients”, Clinical Transplantation vol. 23, no. 3
(2009): 375-381.
32 MAY, C., Transnational Crime and the Developing World, Washington: Global Financial
Integrity, 2017.
33 MATESANZ, R., “Organ Trafficking: Facts, Fiction and Rumors”, Nephrology, vol.
XIV, no. 6 (1994): 633-645.
34 Debate 3.0, “Organ Donation”, Channel eleven, a television program featuring
Josefina Alberú and Aczel Sánchez Cedillo, broadcasted on May 17, 2018. Available
on https://www.youtube.com/watch?v=u2YicQvjSPk.
35 MEJÍA, X., “Organ trafficking is a myth: specialist”, Excelsior, May 3, 2018. Available
on https://www.excelsior.com.mx/nacional/trafico-de-organos-es-un-mito-especialista/
1236534. Consulted on June 5, 2018.
36 MVS News, “In Mexico there are no denouncements of organ trafficking, neither
there exists «transplant tourism: specialist”, MVS News, May 14, 2016. Available in
http://www.mvsnoticias.com/#!/noticias/centro-nacional-de-trasplantes-aseguraque-
no-hay-denuncias-de-trafico-de-organos-en-mexico-245. Consulted on June
5, 2018.
37 KRAUS, A., “Organ donation”, El Universal, April 22, 2018. Available on http://
www.eluniversal.com.mx/articulo/arnoldo-kraus/nacion/donacion-de-organos.
Consulted on June 2, 2018.
38 PROTTAS, J., “Organ and tissue procurement”, en Stephen G. Post (ed.), Encyclopedia
of Bioethics, vol. 4, 3ª ed., Nueva York: Macmillan, 2004: 1936.1940.
G. Ortiz Millán
180 Medicina y Ética 2019/1
39 ABADIE, A., y S. GAY, “The impact of presumed consent legislation on cadaveric
organ donation: A cross-country study”, Journal of Health Economics 25 (2006):
599-620.
40 SADE, R.M., N. KAY, S. PITZER, P. DRAKE, P. BALIGA, y S. HAINES, “Increasing organ
donation: A successful new concept”. Transplantation 74 (2002): 1142-1146.
41 BURDICK, J.F., A.M. CAPRON, F.L. DELMONICO, M.D. RAVENSCRAFT, C.R. RECKARD
y M. SHAPIRO, Preferred Status for Organ Donors: A Report of the UNOS
Ethics Subcommittee, 1993. Available on https://optn.transplant.hrsa.gov/resources/
ethics/preferred-status-for-organ-donors/. Consulted on June 21, 2018.
42 OFFRI, D., “In Israel, a new approach to organ donation”, The New York Times,
February 16, 2012. Available on https://well.blogs.nytimes.com/2012/02/16/in-israel-
a-new-approach-to-organ-donation/. Consulted on June 21, 2018.
324, 325, 326 y 329 of the Health General Law, approved on April 3,2018. Available
on http://www.senado.gob.mx/sgsp/gaceta/63/3/2018-04-03-1/assets/documentos/
Dict_Salud_Donacion_de_Organos.pdf. Consulted on June 2, 2018.
2 NATIONAL TRANSPLANT CENTER (Cenatra), Statistics-information Bulletin of the
BEI-Cenatra, National Transplant Center vol. 2, no. 2 (January-December 2017).
Available on https://www.gob.mx/cenatra. Consulted on May 30, 2018.
3 TORIBIO, L., “80% dies waiting for a donor”, Excélsior, September 29, 2015. Available
on http://www.excelsior.com.mx/nacional/2015/09/26/1047819. Consulted on
May 31, 2018.
4 RAMÍREZ VILLATORO, I. “The Organ Donation Law is killed”, El Heraldo de México,
May 8, 2018.
5 MARVÁN, M.L., A. ÁLVAREZ DEL RÍO, K. JASSO, P. SANTILLÁN-DOHERTY, “Psychosocial
barriers associated with organ donation in Mexico”. Clinical Transplantation 31
(2017): e13112. https://doi.org/10.1111/ctr.13112.
G. Ortiz Millán
178 Medicina y Ética 2019/1
6 NATIONAL TRANSPLANT CENTER (Cenatra), Donation and Transplants in Mexico.
2017 Annual Report. Available on https://www.gob.mx/cenatra. Consulted July 2,
2018.
7 GARCÍA, I., “Automatic donation of organs is stopped”, Índigo Report, April 18,
2018. Available on https://www.reporteindigo.com/reporte/frenan-donacion-automatica-
organos-sector-salud-preparacion-ciudadanos-numero-transplantes/. Consulted
on May 31, 2018.
8 SUNSTEIN, C., y R. THALER, Nudge. A small push, translated. B. Urrutia, Madrid:
Taurus, 2009.
9 RIVERA LÓPEZ, E., Ethics and Organ Transplant. México: FCE-UNAM, 2001.
10 KURTZ, S. y M., SAKS “The transplant paradox: Overwhelming public support for
organ donation vs. under-supply of organs: The Iowa organ procurement study”,
Journal of Corporation Law vol. 21, no. 4 (1996): 767–803.
11 Chamber of Representatives, 2018 National Survey on the Health System in
Mexico, Mexico: Center for Social Studies and Public Opinion, Chamber of Representatives.
Available on http://www5.diputados.gob.mx/index.php/camara/Centrosde-
Estudio/CESOP/Opinion-Publica/Encuestas/Sistema-de-Salud-en-Mexico-2018.
Consulted on June 1, 2018.
12 ZEPEDA-ROMERO, L.C., G. GARCÍA-GARCÍA, O. AGUIRRE-JAÚREGUI, “Results on a
Survey on Donation and Transplant of Organs in the Metropolitan area of Guadalajara,
Mexico”. Public Health Mexico 45 (2003): 54-57.
13 KLUGE, E.H., “Improving organ retrieval rates: Various proposals and their ethical
validity”, Health Care Analysis 8 (2000): 279-295.
14 SANTILLÁN-DOHERTY, P., “Ethics and Organ Transplant”. In R. PÉREZ TAMAYO, R.
LISKER and R. TAPIA (comps.), The building of Bioethics, Mexico: FCE, 2007: 85-
118.
15 ZANOLLI, B. “Mexico with forced donation, a new Paradise for organ trafficking”,
El Universal, April 6, 2018.
16 GARCÍA, I., “Organ donation, ¿forced?” Reporte Índigo, March 1, 2018. Available
on https://www.reporteindigo.com/reporte/donacion-organos-forzosa-ley-generalsalud-
hospitales-voluntad-legislacion/. Consulted on June 21, 2018.
17 PÉREZ-PEÑA, R., “U.K. moves toward making adults presumed organ donors”,
The New York Times, February 23, 2018.
18 JOHNSON, E.J., y D.G. GOLDSTEIN, “Do defaults save lives?” Science, vol. 302
no. 5649 (2003): 1338-1339. Doi: 10.1126/Science.1091721.
19 An interview to María de Jesús Medina Arellano, “Human organ donation”, Juridicans
Opina Program, broadcasted on April 23, 2018. Available on: https://
www.youtube.com/watch?v=NeGXOSep6Ak&t=17s.
20 VEATCH, R.M., y J.B. PITT, “The myth of presumed consent: Ethical problems in
organ procurement strategies”. Transplantation Proceedings, 27 (1995): 1888–
1892.
21 GILL, M.B. “Presumed consent, autonomy, and organ donation”. Journal of Medicine
and Philosophy 29, 1 (2004): 37-59.
22 PLATTS, M., on uses and abuses of morality, Mexico: UNAM-Paidós, 1999.
Organ donation and presumed consent. Objetions to its implementation
Medicina y Ética 2019/1 179
23 HERNÁNDEZ, S., “The deceased of nobody; from the morgue to the common grave”,
El Sol de México, October 31, 2017.
24 SIMINOFF, L., N. GORDON, J. HEWLETT y R. ARNOLD, “Factors influencing families’
consent for donation of solid organs for transplantation”, Journal of the American
Medical Association, vol. 286, no. 1 (2001): 71-77.
25 RIVERA LÓPEZ, E. “Organ Donation and the family role. Is it worth to rethink the
subject matter?” Bioethic Perspectives 37/38 (2015): 46–53.
26 SHAW, D. “We should not let families stop organ donation from their dead relatives”,
British Medical Journal 345 (2012): e5275.
27 HEVIA, F., “Trust and Mistrust on the Public Health System in Mexico”, Revista
Chilena de Salud Pública vol. 10, no. 2 (2006): 107-111.
28 LÓPEZ CERVANTES, M. (coord.), A critical thought about the health of the Mexicans.
National Health Survey. The Mexicans seen by themselves. The big national
issues, Mexico: UNAM, 2015.
29 PROTTAS, J., y H.L. BATTEN, “The willingness to give: The public and the supply
of transplantable organs”, Journal of Health Politics, Policy, and Law vol. 16, no. 1
(1991): 121–134.
30 O’NEILL, O. Autonomy and Trust in Bioethics, Cambridge: Cambridge University
Press, 2002.
31 DOBBELS, F., F. VAN GELDER, K. REMANS, A. VERKINDEREN, J. PEETERS, J. PIRENNE,
F. NEVENS, “Should the law on anonymity of organ donation be changed? The
perception of liver transplant recipients”, Clinical Transplantation vol. 23, no. 3
(2009): 375-381.
32 MAY, C., Transnational Crime and the Developing World, Washington: Global Financial
Integrity, 2017.
33 MATESANZ, R., “Organ Trafficking: Facts, Fiction and Rumors”, Nephrology, vol.
XIV, no. 6 (1994): 633-645.
34 Debate 3.0, “Organ Donation”, Channel eleven, a television program featuring
Josefina Alberú and Aczel Sánchez Cedillo, broadcasted on May 17, 2018. Available
on https://www.youtube.com/watch?v=u2YicQvjSPk.
35 MEJÍA, X., “Organ trafficking is a myth: specialist”, Excelsior, May 3, 2018. Available
on https://www.excelsior.com.mx/nacional/trafico-de-organos-es-un-mito-especialista/
1236534. Consulted on June 5, 2018.
36 MVS News, “In Mexico there are no denouncements of organ trafficking, neither
there exists «transplant tourism: specialist”, MVS News, May 14, 2016. Available in
http://www.mvsnoticias.com/#!/noticias/centro-nacional-de-trasplantes-aseguraque-
no-hay-denuncias-de-trafico-de-organos-en-mexico-245. Consulted on June
5, 2018.
37 KRAUS, A., “Organ donation”, El Universal, April 22, 2018. Available on http://
www.eluniversal.com.mx/articulo/arnoldo-kraus/nacion/donacion-de-organos.
Consulted on June 2, 2018.
38 PROTTAS, J., “Organ and tissue procurement”, en Stephen G. Post (ed.), Encyclopedia
of Bioethics, vol. 4, 3ª ed., Nueva York: Macmillan, 2004: 1936.1940.
G. Ortiz Millán
180 Medicina y Ética 2019/1
39 ABADIE, A., y S. GAY, “The impact of presumed consent legislation on cadaveric
organ donation: A cross-country study”, Journal of Health Economics 25 (2006):
599-620.
40 SADE, R.M., N. KAY, S. PITZER, P. DRAKE, P. BALIGA, y S. HAINES, “Increasing organ
donation: A successful new concept”. Transplantation 74 (2002): 1142-1146.
41 BURDICK, J.F., A.M. CAPRON, F.L. DELMONICO, M.D. RAVENSCRAFT, C.R. RECKARD
y M. SHAPIRO, Preferred Status for Organ Donors: A Report of the UNOS
Ethics Subcommittee, 1993. Available on https://optn.transplant.hrsa.gov/resources/
ethics/preferred-status-for-organ-donors/. Consulted on June 21, 2018.
42 OFFRI, D., “In Israel, a new approach to organ donation”, The New York Times,
February 16, 2012. Available on https://well.blogs.nytimes.com/2012/02/16/in-israel-
a-new-approach-to-organ-donation/. Consulted on June 21, 2018.