Issues in organ procurement: presumed consent, bioethical type II errors, and organ registries

In an effort to alleviate the current imbalance between the many in need of an organ transplant and the limited number of organs procured, a policy of presumed consent has been recently debated. Presumed consent assumes that potential organ donors agree to donate their organs in the absence of known objections to the contrary. The authors examine the bioethical principles and consequences involved in such a policy and apply hypothesis testing, borrowed from clinical epidemiology, to a "bioethical test" of presumed consent in a hypothetical clinical scenario. A possible bioethical alternative to presumed consent, an organ donor registry of advanced directives as has been established in British Columbia, is also discussed.