Organ Donation in Chile: How Reforms Can Save More Lives
"A closer look at Chile's organ donation and transplant system reveals the challenges and opportunities for improvement."
The global shortage of organs for transplantation continues to be a critical issue in healthcare. Thousands of people die each year while waiting for an organ that could save or significantly prolong their lives, thanks to advancements in transplantation practices. Chile has historically had low donation rates, but recent legal reforms that established a presumed consent system have led to increased numbers. In 2017, a record 457 transplants were performed thanks to 173 donors.
Despite this progress, significant challenges remain, including the loss of potential organs within the system, which accounts for approximately 30% of those that could be available for transplantation. Issues related to family involvement in final donation decisions also persist. The Chilean health authority has implemented several legal, practical, and educational modifications to the system to improve outcomes.
However, comprehensive evaluations of these reforms and suggestions for further improvements are still needed. This article aims to assess the new regulations and their acceptance by the public and healthcare providers. It will also propose recommendations to foster the development of a Chilean transplantation model that effectively meets the needs of the population.
Understanding the Challenges in Chile's Organ Donation System
Chile's organ donation and transplantation system is characterized by high demand due to the prevalence of chronic non-communicable diseases and low organ availability. Scarcity can be attributed to two main factors: losses within the system and the public's willingness to donate. Systemic losses occur within healthcare facilities due to the failure to identify potential donors or the inability to complete transplants due to management, logistical, or infrastructural issues.
- The Opt-Out System: Chile adopted a presumed consent model (opt-out) in 2010 through Law 20.413, intending to reverse declining donation rates. Initially, the law had adverse effects because it allowed individuals to express their unwillingness to donate during driver's license or ID renewals, a process with little reflection and high bureaucracy. By July 2012, 50.4% of the population had registered as non-donors.
- The Reciprocity Principle: The most recent legal amendment (Law 20.673 of 2013) reduced the ways to express the refusal to donate (replacing Article 2 bis) to a formal declaration before a notary public. It also introduced an ethical criterion called the "principle of reciprocity," prioritizing individuals who have not registered as non-donors if several candidates are equally qualified for organ donation.
- Centralized Coordination: In 2010, the system underwent significant changes with the creation of the National Coordinator of Organ and Tissue Procurement and Transplantation to improve coordination among healthcare institutions and implement transplant programs more effectively. All responsibilities previously held by the National Transplantation Corporation (a non-governmental organization founded in the early 1990s) were transferred to a governmental entity under the Ministry of Health (MINSAL).
Moving Forward: Recommendations for Improving Organ Donation in Chile
Data indicates that Chile still lacks a deeply ingrained culture of organ donation and transplantation. In addition to addressing the shortage of physical and human resources, efforts must focus on increasing public awareness and promoting discussions within families. While presumed consent appears to be the most effective donation system—evidence suggests that countries with this system have a 28% to 32% higher rate of cadaveric donation compared to those with explicit consent—legal reforms are needed to increase resources, improve screening services, and end the practice of allowing families to override a donor's wishes.