Dutch and Belgium Organ Donation Acts

In Belgium there is a different post mortem organ donation law than in The Netherlands, although they both have the same main purpose: they seek to increase the supply of donors.

In Belgium it is presumed that each citizen has consented to the harvest of organs following death unless an objection to such a harvest was recorded, an opt-out system. Belgium combines presumed consent with a practice of inquiring into the wishes of the next of kin.

One advantage of presumed consent is that there is no need to refer to drivers' licenses or donor cards, which may not be carried at the relevant time. Another is that distraught family members do not need to make a positive decision to approve harvest. The patient has been able to record their objection, if any, during their lifetime, so the decision to do so will have rested with them and doctors are spared the difficult task of asking for consent. The decision whether or not to object was that of the patient made in a reasoned manner and cannot be overturned by family (1).

In The Netherlands each citizen is given the opportunity to indicate whether or not they are willing to donate their organs in the event of their death, or whether they would prefer to leave the decision to their relatives, a full decision system. General consent may be given for the removal of organs and tissues, or one may withhold consent in relation to certain parts of the body. The Organ Donation Act provides for the creation of a register of donor information, in which details of individuals´ wishes regarding organ donation are recorded. Under no circumstances can organs or tissues be removed if the deceased has indicated that he or she does not want this (1).

In my opinion, the Belgium presumed consent system would be more effective in terms of the aim of the law. It is possible that only the more advantaged or educated groups in Belgium society would be aware of their right to opt-out and the less advantaged would take no steps, more through ignorance than through a willingness to donate. Although this seems immoral, it will increase the supply of donors.

The Dutch full decision system can be very effective, if every citizen would actually send in the form. In an ideal world every Dutch citizen would respond, stating their consent or not, and every Belgium citizen would respond if they would not consent. In an ideal world it would not matter which system a country would use, both systems would increase the supply of donors.

Since we do not live in an ideal world, we have to make a choice. Either an immoral more effective system, or a moral less effective system. The Dutch system is to be preferred from a moral point of view; People -who do not want to donate organs and through ignorance do not know they have to send in a form if they do or do not want to donate organs- will not have their human rights violated.

As in Belgium there human rights will be violated, but, since the person is already dead, cannot complaint that their rights have been violated, which is immoral. If the autonomy of the donor is to be protected, a system must be available for recording objections to donation and that system must be able to be readily accessed by doctors.

I would recommend the Dutch system, because then peoples rights will not get violated, it is more moral and it will still be effective in the aim of the law, just not as effective as the Belgium system. The hypothetical provision that Dutch citizens who are asking for a public service are required to register their preference in terms of post mortem organ donation might help the aim of the law.

I do not think people would like it to be required. People may believe that their request is binding, if they do not read the information, and might feel infringed in their privacy. I think it would be better to give them the option to register their preference when they are asking for a public service, just to make them aware of the system. Giving the option will give people time to think about it, and will make people aware of the necessity to think about it, because they might safe other people's life.

Reference: 1. The Organ Donation Act International Publication Series Health, Welfare and Sport nr.3, Ministerie van Volksgezondheid, Welzijn en Sport – NL. http://www.healthlaw.nl/organdon.pdf