Organ transplants: the costs of success.

The current U.S. policy of "encouraged volunteerism" for the procurement of organs for transplantation is judged to be a failure. Demand is not being met, a complex and inefficient network of profit-making and not-for-profit procurement agencies has developed, and the opportunity for informed consent by relatives or friends in emergency situations is seen to be a "charade." Caplan advocates a public policy of "presumed consent" whereby hospitals may harvest all suitable cadaver organs unless objection is indicated by family members or by the individual beforehand. He also proposes the establishment of a national registry of consenting organ donors to expedite tissue matching and to eliminate present surreptitious searching of existing data banks, and a national agency to evaluate and regulate transplant programs and to develop guidelines for patient selection.