Conscription of cadaveric organs for transplantation: let's at least talk about it.

Renal transplantation is the optimal treatment for many patients with end-stage renal disease, and for people with other end-stage organ diseases, transplantation may offer the only hope for survival. Unfortunately, the ability to deliver this medical miracle is limited by a severe shortage of human organs. As a result, many people with irreversible organ failure die while waiting for an organ to become available. Compounding this tragic situation is the fact that many usable organs are being buried instead of being transplanted because of the relatively low efficiency of cadaveric organ procurement. One of the major barriers to procurement is family refusal. Several proposals designed to increase consent rates have been suggested, but it is highly unlikely that any of them would approach the 100% efficiency of organ procurement that patients with end-stage organ failure so desperately need. However, there is a rarely discussed alternative that would likely achieve this important goal---conscription of cadaveric organs. Under this plan, all usable organs would be removed from recently deceased people and made available for transplantation; consent would be neither required nor requested and, with the possible exception of people with religious objections, opting-out would not be possible. In this article, we review the advantages and disadvantages of this approach. We conclude that consent for cadaveric organ removal is not ethically required and that, from an ethical point of view, conscription is actually preferable. Copyright 2002 by the National Kidney Foundation, Inc.