Last Saturday 14 September, and by law, silence by Uruguayan citizens will be construed as agreement to altruistic organ donation. Everyone will be a donor unless they state otherwise. Government authorities seek to reduce the waiting list for transplants with this law.
A new law came into force in Uruguay which renders all Uruguayan citizens organ donors unless they expressly choose otherwise, having to sign a document at the National Institute of Organ Donation and Transplantation (INDT) to register their decision not to donate their organs at death.
‘This law construes silence as altruistic donation. The law places the responsibility on us as individuals. If we do not want to be donors we have to state and register our decision. It forces us to decide what we want to do’, summarizes Inés Álvarez, Director of the INDT.
This new legislation gives a new twist to the previous one. In 1971 a law was passed in Uruguay whose text was pioneering for the region. ‘It laid very firm and stringent foundations for the donation of human organs. It firmly established that donations or donation products could not be sold or purchased, and placed this within the sphere of criminal law. It led the way in the region’, Álvarez stressed.
Over ten years ago, in 2003, that law was modified, and this change was decisive for what was to come. At that moment a change in the law was introduced by which everyone who had not expressed their wishes to the contrary, and whose death did not require a forensic examination, would be a donor. If a person died suddenly, for example in an accident, and the case required legal action, the presumption was that, unless the individual had previously registered their choice to the contrary, their organs could be harvested for transplanting into another individual.
‘We value this small modification as a pilot plan for the current law, as we wanted to find out the opinion of the general public on this issue. And we realized that Uruguayans are extremely altruistic, and we rarely had problems explaining this to relatives’, says the Director of INDT.
The twist is that now a forensic examination will not be required. With this, health authorities hope to reduce the waiting list for transplants, which is longer than it should be. Many people die waiting for a transplant. The organ donation rate, at 16.6 per million people, is one of the highest in Latin America. But this is not enough.
According to Álvarez, other countries which have implemented similar laws to the one which has just come into effect have had mixed experiences. However, she considers that the law in Uruguay will be beneficial and will give a further boost to transplants. Álvarez is sure of this as users ‘trust the system’.
‘When a health system is not reliable, doubts arise. Our system is reliable. Users know that transplants do not discriminate based on race or social class. Those who need them have access to them. This allows Uruguayans to be different and open-minded in this regard. That is why the law is expected to have a positive effect’, the specialist suggests.
However, Álvarez knows that some people are distrustful and there are fears. But she stresses that the new law and the organ harvesting system will give patients ‘total guarantees’. ‘The legal process itself establishes that a diagnosis of brain-stem death has to be signed and ascertained by two medical doctors who are not part of the transplant or procurement team. And anyone operating against this will end up in prison’, she stressed.
Álvarez appreciates that procedures under the new law will ease the burden on the family of the deceased in contexts that are frequently dramatic and where one of the last things people think about are the wishes of the deceased, and whether the person wanted to be a donor or not.
Over 18 years of age
The law on organ donation applies only to citizens who are 18 years of age and older. Anyone not wishing to be a donor must visit the fourth floor of the Hospital de Clínicas to express and register their will to the contrary. Anyone who had previously said no and had recorded their wishes need not confirm their decision, as it has already been registered. Initiatives are being developed to decentralize procedures in the countryside through departmental health offices.
One thousand people on the waiting list
- In Uruguay there are some 1,000 people on a waiting list for an organ transplant, including 426 people waiting for a kidney (two of them are children); 16 for a liver (two children), 26 for a heart (one child), six for a lung, 94 for a kidney and pancreas transplant, one for a kidney and liver transplant and more than 400 for cornea transplants.
- In Uruguay 600 transplants are carried out every year, 22% are organ transplants, 61.5% are tissue transplants and 16.5% are cell transplants. There are approximately one million donors.
- In 2011, 72.5% of the patients on the waiting list failed to receive an organ for transplant and 4% died waiting for it.
- In 2012, the rate of actual organ donors was 16.6 per million people. Actual tissue donors were 28.96 per million people and the combined actual organ and tissue donors were 30.79 per million people.
- Despite long waiting lists, with nearly three times the average rate in Latin America Uruguay has one of the highest donation rates in the region.
Source: El País