The Opt-Out hang-up – Is radical policy change really the answer for organ donation in SA?
Posted on February 28, 2018
I am privileged to do some work in organ transplantation in Johannesburg. I’ve also done a PhD in this field, so I’m not without a pretty good understanding of it. Over the past few years I’ve witnessed the emergence of young, driven advocacy organisations with a refreshing approach to transplant in South Africa. I’ve also seen the influence that motivated transplant teams can have on changing attitudes of health professionals in hospitals. I take my hat off to all who do this inspiring work.
Then, there are the things that I have not seen…
In spite of engagement with government, I haven’t seen any decisive indication of governmental interest in advancing transplant in South Africa. I haven’t really seen the government attempt to expand access to transplant services for state patients. The conclusion I draw from all this – and you may say I’m being pessimistic – is that transplant simply isn’t a governmental priority.
Now, please indulge me. Let’s agree to take that as a given. What it means is that we can’t reasonably expect to see greater deployment of resources to transplant, or more robust national transplant protocols, or clearer transplant legislation anytime soon. And here’s the rub. In spite of all of this, much transplant conversation in South Africa – especially in academic circles – seems to revolve around the notion of Opt-Out.
What is Opt-Out?
Simplistically, it’s a government-sanctioned system that presumes all people in a country are willing organ donors after they die. If a person is unwilling, they need to object in writing. Opt-Out is opposed to Opt-In (the basis of current policy in SA) which says that people are not presumed to be donors. In SA, people who wish to donate should tell their families, because family consent will ultimately be needed. You can read more about it here.
Yes, its a very interesting theory. But I wonder if fierce advocates of opt-out have pondered exactly what it would take to implement it in SA. I think it would be a herculean task. First, we’d need the government to sanction it. This would require legislative change. ‘Nuff said. Secondly, we’d need to be able to communicate to EVERY sufficiently capacitated person in South Africa that this is the new normal, and they need to opt-out if they disagree. Also highly unlikely… How do you do this in a country where there are 11 official languages, and literacy levels vary to such an extent that many have very little comprehension of basic medical terminology – let alone organ donation? Who’s going to pay for it all? Glossy flyers are simply not going to cut it in this case. Thirdly, we’d have to establish some kind of opt-out database that was accessible to transplant professionals in hospitals. Given that we haven’t been able to do this for people who have expressed a preference to donate their organs, I find the prospect remote, to say the least.
I think one of our problems in SA is that we have trouble believing in ourselves. We hasten to call on international expertise, which often has very little understanding of or appreciation for our particular context. Why there is such a pressing need to reinvent the wheel is unfathomable to me. Why aren’t we having conversations about improving the system we have, rather than ditching it for something else that looks great on paper but seems practically unachievable? Can’t we deploy brilliant minds to this end? I think we need to ask different questions, and seek more plausible answers.
The views published in this blog are entirely my own (informed) opinions. They are open to debate, discussion and disagreement.