Opt-in or opt-out for organ transplantation.

PURPOSE OF REVIEW: Opt-in or opt-out consent for organ transplantation is still a disputed subject and the determination of the more appropriate system is still debated. RECENT
FINDINGS: Europe is still divided between countries where transplantation after brain death is governed by presumed consent and other where informed consent is mandatory. Recent debate, however, has emerged in each country to determine whether shifting systems might be beneficial for organ procurement.
SUMMARY: Consent for organ donation in a brain dead patient represents an act of benevolence or of solidarity in favour of an unknown person. If one considers that the principle of autonomy must prevail over the principle of benevolence or of solidarity, the risk is depriving a potential recipient of a comparatively very important benefit. On the contrary, if one considers that the principles of benevolence should necessarily lead, the risk is high of exerting an excessive pressure to the detriments of autonomy and liberty of the individual. Whatever the system chosen, adequate and fair communication expressing loyally the way families are approached is essential.