Informed Consent Versus Presumed Consent The Role of the Family in Organ Donations

Two types of legislation underlie cadaveric organ donations: presumed consent (PC) and informed consent (IC). In informed consent countries, people are only donors when deceased if they registered to do so while alive. Conversely, in presumed consent countries, anybody is a potential donor when deceased. People have thus to register if they do not want to donate their body. PC has always been perceived as the “best” system for society in terms of organ donations whereas IC is supposed to be more ethical. However, in both systems, the family has a say, especially for the deceased who did not sign anything while alive. Taking the family decision into account, we show that the previous results may be reversed. The difference between both systems resides in the way an individual can commit to his/her will, eventually against the opinion of his/her family. IC can dominate PC in terms of organ donations whereas PC can be a more ethical system. In the general case, two opposite effects are at stake and the result depends on the extent to which people stay in the default situation. We discuss several causes of inactions (death taboo, procrastination, anticipated regret,...) and their impact on both the individual and the family.