**5. Social system for organ donation**

Strategic efforts by the government and local authorities, as well as individual efforts by medical personnel, are necessary to promote organ donation. These include the revision of laws, simplifying the required procedures for receiving consent, expansion of the donor card system, adoption of a presumed consent concept known as an opt-out system, and the establishment of a DCD system. The strategic processes put in place in Europe and the United States have resulted in a progressive and gradual increase of organ donation [27–30].

Asian countries have delayed the creation and adoption of social systems for organ donation. Despite the socioeconomic development of several Asian countries, the number of organ donations per million is extremely low, compared with western countries. In addition, most of the data on organ donation consent after brain death are largely based on findings from Western populations. The current opinion on organ donation after brain death is unclear in Asian countries. Traditionally, the body of a loved one should not be tampered with after death in Asian cultures, especially in Korean, Japanese, and Chinese. This belief originates from the Confucian tradition, and it is believed that this tradition may be the main reason for the low consent rate of organ donation in Asian countries. In addition to cultural differences, it is thought that widely differing opinions, perceptions, and concerns may be related to low frequency of organ donation in Asia. However, these factors are not well studied. The general opinion on brain death and organ donation appears to be quite positive in Asia [24, 32]. The perception of brain death as death is widely accepted [32]. However, there were several perceptional barriers against organ donation in Asia [32]. Evidence-based strategies focused on

*Moral principle* Outcome-based ethics

*Donation system* Social need "Opt-out" system Presumed consent Implicit consent Donor incentives Social campaign

The end justifies the means

Donor management before consent ICU screening and family approach Resuscitation for organs allowed Femoral cannulation before consent

outcome.

A morally right act is one that will produce a good

Organ Donation

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http://dx.doi.org/10.5772/intechopen.75487

these barriers should be established to increase the rate of organ donation effectively.

donation has its advantages and disadvantages.

**Deontologism Consequentialism**

information, education, and social system.

• Living and deceased donations are two sources of organs for transplantation. Each type of

• Many organs from deceased donors are still not being used worldwide because of lack of

**6. Summary**

*Moral principle*

consequences.

*Donation system* Donor's will "Opt-in" system Informed consent Explicit consent No donor incentives Individual decision

Volunteering

Duty or obligation-based ethics

Donor management after consent

Resuscitation for organs forbidden Femoral cannulation after consent

**Table 4.** Moral dilemma surrounding organ donation.

Action or process is more important than the

A moral obligation may arise from rules

Despite the effectiveness of these strategies, public acceptance of organ donation is essential before these measures can be implemented in other countries. The establishment of social systems for organ donation depends on public consensus. There are currently two moral values on organ donation: deontologism versus consequentialism. This means where we put our maximum value of some behavior, as it were, the legitimacy of process or the benefit of consequence (**Table 4**). Many procedural details in organ donation and recovery have points of conflict, which can be solved with social agreement.

Asking families for organ donations to families is generally regarded as a stressful task by primary physicians. Only a small portion of potential donors are being asked about organ donation as an option of end-of-life decision, and it is decided according to the primary physician's point of view or belief. Despite the important role of the medical staff in recommending organ donation to families, imposing this burden on physicians alone may not be adequate. If we, including local authorities and the general population, agree on the importance of organ donation, its promotion would not be the sole responsibility of individual medical staffs. The authorities have to consider establishing an advanced system that links potential donors to organ donations, known as an "opt-out" system. Many valuable lessons can be learned from the efforts of European countries to adopt it [28].

Religious beliefs were found to be important. Officially, nearly all religious groups support organ transplantation as long as it does not impede the life or hasten the death of the donor [31]. However, only a small portion of the public knows about the stance of their religion on organ donation. More active involvement of religious bodies is needed to raise the public's awareness and encourage organ donation.


**Table 4.** Moral dilemma surrounding organ donation.

Asian countries have delayed the creation and adoption of social systems for organ donation. Despite the socioeconomic development of several Asian countries, the number of organ donations per million is extremely low, compared with western countries. In addition, most of the data on organ donation consent after brain death are largely based on findings from Western populations. The current opinion on organ donation after brain death is unclear in Asian countries. Traditionally, the body of a loved one should not be tampered with after death in Asian cultures, especially in Korean, Japanese, and Chinese. This belief originates from the Confucian tradition, and it is believed that this tradition may be the main reason for the low consent rate of organ donation in Asian countries. In addition to cultural differences, it is thought that widely differing opinions, perceptions, and concerns may be related to low frequency of organ donation in Asia. However, these factors are not well studied. The general opinion on brain death and organ donation appears to be quite positive in Asia [24, 32]. The perception of brain death as death is widely accepted [32]. However, there were several perceptional barriers against organ donation in Asia [32]. Evidence-based strategies focused on these barriers should be established to increase the rate of organ donation effectively.
