**1. Legal measures**

Laws about organ transplantation have been passing attempts to provide a better system of organ donation and distribution and to encourage individuals to volunteer as organ donors.

In USA, in 1968, The Uniform Anatomical Gift Act was the first effort at providing a national organ and tissue donation policy. The act created a uniform legal procedure for persons who wish to donate organs and for hospitals and medical institutions that want to accept them. A 1986 federal law requires all hospitals participating in Medicare or Medicaid to implement a "required request" policy. Hospitals are required to discuss with potential donors and their families "the option of organ and tissue donation and their option to decline" [30].

Consent and altruism remain core values of organ donation. The term consent is typically defined as a subject adhering to an agreement of principals and regulations.

Two types of legislation concerning organ donations are at present valid worldwide:


People have thus to register if they do not want to donate their body.

Presumed consent is one of a number of different varieties of consent. The paradigm of consent in biomedical ethics is to express consent. It appears in the Uniform Anatomical Gift Act's framework for organ donation as well as in rules of voluntary, informed consent in both therapy and research involving human participants.

On the other hand presumed consent has always been perceived as the "best" system for society in terms of organ donations.

However, in both systems, the family has something to say, especially for the deceased who did not sign anything while alive.

Proposals to introduce presumed consent should have full knowledge of their organization and results in the countries in which this legal instrument is in force. In practice, the citizen is informed that his non-registration as a non-donor means that he is a donor. The experience has shown that, in general, the presumed consent has not nullified the will of the families.

In Spain and Italy, it is considered that the increase in donation is the exponent of a better institutional management rather than the result of the presumed consent law.

a concretely effective consent, according to the characteristics and organization of the institutional resources, as well as to the competence, understanding and motivation of the people.

The Society, the Barriers to Organ Donation and Alternatives for a Change

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With some notable exceptions, previous studies consider that, in practice, the laws of presumed consent have not achieved more important levels in the behavior of people toward donation [33]. In addition, it has been suggested that these results are related to the fact that,

Finally, with respect to the effectiveness of laws concerning the mode of consent, we believed

Financial incentives are considered any material gain or value obtained by those who consent directly to the process of obtaining organs, whether to the donor, the succession of the donor

The arguments in favor of financial incentives for organ donation are based on the hope that such a system will increase the supply of organs safeguarding the basic ethical concern of

A set of reimbursement of funeral expenses has also been suggested as a direct "milder" means

Finally, a form of "insurance for the donor" has been suggested, for which an individual agrees in advance of the donation, with a payment to their beneficiaries that will only take

The concept that financial incentives can offer a possible solution to the shortage of organ donors in progress has been considered and debated among experts in the field of transplan-

The essential conception of altruistic donation, unchanged in general in the last 50 years, has not been able to overcome the constant lack of organs, with a critical permanent increase in mortality on the waiting list. This constant reality has motivated the justification by different authors to invoke a fundamental change of the current altruistic criterion: financial incentives

It has been specifically pointed out in this regard that the current system generates financial gains for all concerned: doctors, coordinators, social workers, hospitals, pharmaceutical laboratories, etc. Consequently, it has been described as unjust and insensitive to the families of the donors and a source of basic distrust on the part of the public, that the donor and the family are the only ones that do not directly benefit from the donation process, which therefore,

Finally, those who promote financial incentives for organ donation conclude that their motives are ethical because they are based on concern for patients and saving lives and not only on

despite the law, the consent of the family is usually required [31, 32].

**2. Financial incentives**

or the family of the donor.

of incentive for donation.

place after the donation.

to facilitate organ donation.

tation, ethics, law and economics [34].

some type of compensation must be defined [35].

abstract theories and issues without concrete answers.

saving lives.

that hardly a law can change the moral and ethical behavior of the people.

In France according to the 1976 "Caillavet Law", a person is presumed to have consented to organ donation if he or she has never explicitly said otherwise to close relatives. But even for organs and tissue, where there is no such legal confusion, the "Caillavet Law" has not been applied uniformly in all French hospitals because there was no centralized administration in France to coordinate people's wishes.

France has modified its law on organ donation. All people are donors at death unless they record their refusal in an official registry. The new law provides for the procurement of organs, even against the wishes of the family.

Spain is routinely cited as a successful example of presumed consent. But in Spain, the nextof-kin still has veto power. Most of the growth in donation rates there happened well after the passage of presumed consent legislation.

Some people do not trust the government or the health care system. Many of them are afraid that that signing a donor card may make physicians give up on them too soon, especially if the hospital is likely to lose money on their care.

This legislation, if enacted, must take into account this relatively frequent fear of the people.

Changing the law will not be sufficient. As the experience with presumed consent in Western Europe shows, education of the public and constant training of hospital personnel are essential to achieve the improvement of the structured medical organization for the increase of organ procurement.

Another possibility for increasing donors has been developed with the modification of it acceptance criteria. This means the alternative to consider the use of donors with different medico-surgical conditions that may diminish part of their chances of long-term success.

On the other hand, improvement in the detection, prevention and better therapeutic of the pathologies leading to terminal organ failure, provides alternatives by reducing the number of requiring organs for transplantation.

It is complex to establish whether the presumed consent can justify various social behaviors in countries with or without that type of legal measure.

The medical-social people behaviors are adapted to the degree of education on the subject, the quality and formation of the responsible medical organizations and the economies of each one of the countries.

In particular, the participation of a medical group trained in excellence in the psychosocial methodology of approaching families at the time of the grief of the loss of a loved one, is undoubtedly a factor of principal importance for a positive result regarding the family response [31].

Some critics claim that presumed consent is a "fiction" [32]. However, the conception of presumed consent as tacit and silent overcomes the notion of being a fiction. Sometimes it can be a concretely effective consent, according to the characteristics and organization of the institutional resources, as well as to the competence, understanding and motivation of the people.

With some notable exceptions, previous studies consider that, in practice, the laws of presumed consent have not achieved more important levels in the behavior of people toward donation [33]. In addition, it has been suggested that these results are related to the fact that, despite the law, the consent of the family is usually required [31, 32].

Finally, with respect to the effectiveness of laws concerning the mode of consent, we believed that hardly a law can change the moral and ethical behavior of the people.
