MANDATED CHOICE - A PLAN TO INCREASE PUBLIC COMMITMENT TO ORGAN DONATION

Objectives.-To estimate the impact of mandated choice-a system that re quires competent adults to decide prospectively whether or not they wi sh to be organ donors when they die-on public commitment to organ dona tion; and to explore who is best suited to provide consent-the family or the individual? Design.-A national, random-digit telephone survey c onducted by the Gallup Organization in July 1993. Participants.-A repr esentative sample (n=1002) of adults (aged 18 years and older) living in homes with telephones in the continental United States. Results.-Al though the majority of respondents had given at least some thought to organ donation, only 25% had carefully considered this issue. Overall, 30% had decided to donate, but 58% were undecided and only 38% had ma de their wishes known to a family member. Yet the vast majority (82%) believes that the best way to obtain consent is for each adult to deci de for himself or herself, rather than leaving this decision for the f amily. Under mandated choice, which is designed to encourage such self -determination, 63% would sign up to donate, 24% would not, and 13% we re unsure. Conclusions.-Only a small fraction of the US public is curr ently committed to organ donation and relatively few people have caref ully considered and communicated their wishes regarding this important issue. Therefore, the difficult question of consent is often left for the family. Yet most people believe that ideally all adults should an swer this question for themselves, in contrast to our present family-o riented approach, but consistent with the design of mandated choice. I f mandated choice became law, it appears that most adults would sign u p to donate, thereby increasing the pool of desperately needed committ ed donors.