Brazil Mandates Organ 'Donation' for Transplants

A Jan. 1 law presumes people are willing to have organs used - unless they say otherwise.

It's not an everyday question. But Brazilians are being forced to ask it: Who owns your body's organs?

Under a law that took effect Jan. 1, anyone's body can be used for organ transplants - unless he asks permission to be exempt.

For some critics, the Presumed Organ Donor Law stretches the definition of donor. But advocates claim lives will be saved if more organs are made available by state action.

The law has sparked fear and outrage. Many doctors say the state's priorities are misplaced, both medically and ethically.

"I wouldn't agree to be an organ donor," says Djanira de Almeida Veltri, a Rio de Janeiro housewife. "This is Brazil, my dear - doctors will take out your organs while you're still alive just to make money."

David Bento, who has been waiting for more than a year for a new kidney, says, "The intention is good, but you cannot expect to change the public's mind this way."

Only a few other countries - most notably Spain - have such laws. Doctors in Brazil say such laws work only when a country has a reliable medical system and a large, educated middle class that understands its legal rights.

Brazil Asks:Who Owns Organs?

But Brazil has mostly substandard medical care and a large underclass that doesn't have the time or money to fight the system.

Many doctors here say they will refuse to comply with the law, saying the measure violates the individual's right to choose and unfairly impacts the poor.

In addition, they say the law fuels the public's fear that there will be an increase in organ trafficking and that doctors will be pressured into misdiagnosing patients as brain dead to qualify them as organ donors.

Enforcing the law

But the Brazilian Health Ministry says doctors will be prosecuted if they refuse to comply with any part of the law. Institutions that don't comply will lose their accreditation.

"Everyone has to obey this list. No one - not the family, not the doctor - can interfere with this. They have to follow only what is on the patient's ID card," a spokeswoman for the ministry says. She says the law makes transplants faster and fairer because it unites potential transplant recipients under a single list overseen by the state health departments and prioritizes them according to criteria such as age, degree of illness, and wait time.

Under the old system, potential recipients were registered at individual transplant centers.

The law, sponsored by Sen. Lucio Alcantara, aims to boost the number of transplants performed every year from 450 to 3,000.

No transfers have been performed under the law so far, because the Brazilian Association for Organ Transplants (ABTO) has instructed doctors to continue to respect the wishes of the family.

But doctors say if that the goal is to increase the number of transplants, the new law doesn't focus on the correct issue. The rate of organ donation in Brazil is 70 percent, the same as in most countries. But the country lacks the infrastructure needed to carry out a large number of transplants.

How to not donate your organs

Dissenters can obtain documents with a "nondonor" stamp, but that entails paying for a new driver's license, national identity card, and work document and weaving through bureaucratic procedures.

Critics point out that since it is difficult for the country's poor and illiterate to do that, they will, in effect, be giving up their organs against their will.

"Autonomy would be the citizen saying explicitly that he is a donor," the president of the Federal Council on Medicine, Waldir Mesquita, told reporters in the capital, Brasila.

"In Brazil, with millions of illiterates and workers with fear of losing their jobs, is it possible to imagine that they will skip work and even pay to reject the donation of their organs?" he asked.

A government study last year showed 78 percent of 3,000 people interviewed said they agreed with presumed organ donation.

But studies conducted in November, when the law was passed, show as many as 45 percent of 70,000 people saying they would ask for the nondonor stamp. And in Brasila, 76 percent of Brazilians seeking new identity cards refused to be considered donors.

Maria Celestina de Oliveira Pinto, a domestic worker in So Paulo, said she was told she wasn't allowed to declare herself a nondonor when she went to get new documents a few weeks ago.

She had to wait in line four times and argue before authorities stamped a "non" before the word "donor" on her card.

"I think some people won't realize that the authority's no is a soft no. You have to argue, and then they will back down," Ms. Pinto says.

The Federal Council on Medicine has asked the attorney general to look into the constitutionality of the law. It says the law violates both individual rights of citizens and medical ethics because it forces doctors to perform actions that go against their conscience.

The ABTO has asked the Health Ministry to rewrite the law to include family consent and measures to prevent organ trafficking.

Meanwhile, the group has instructed doctors to continue heeding families' wishes.

The ABTO dismisses media reports of organ trafficking in Brazil as "urban myths," but says steps are needed to prevent it as a possibility.

More common are other practices that Brazil needs to control, such as poor, living donors selling their organs or the rich bribing their way to the top of the recipient list, ABTO Vice President Henry Campos says.

"These practices happen in North America, but in Brazil we have a much bigger economic difference between rich and poor, so, of course, the risk is bigger." Mr. Campos says.

While churches have not taken any official stance, Roman Catholic clergy were divided over the law. Members of other Christian churches said they disagreed with government interference in what should be a personal decision.

Archbishop of Rio Eugenio Sales says he disagrees with the law, but Catholic clergy in So Paulo say they support it.

"After a person dies, he doesn't have freedom anymore. He doesn't have any rights. His body should be used for the good of others," says Father Olivo Zolin, a priest at So Paulo's Cathedral.

People complain the law is dictatorial, but so are the laws affecting the living, he says. The main obstacle to increasing the number of transplants is the Latin culture's reverence for the dead, he notes.

Leon Jose do Nascimento, a pastor for the Evangelical Assembly of God Church, says his church is neutral on the issue of organ donation, but he disagrees with the law.

"The law forces people, and it shouldn't be that way," he says. "This is completely the government's opinion, and not the public view."