Organ donation in South Korea will increase only if the system is changed to place a person's own stated wish to donate ahead of the family's judgment, participants said at a roundtable. They also called for a legal basis to be established promptly for donation after circulatory death (DCD), in which organs are donated from patients whose hearts stop after life-sustaining treatment is withdrawn. Confusion in the field could be minimized, they said, if DCD were introduced in stages after the law takes effect, beginning with hub hospitals that already have the experience and infrastructure.
Lim Eul-gi, director general for health care resources policy at the Ministry of Health and Welfare; Lee Sam-yeol, president of the Korea Organ Donation Agency; and Son Sun-young, head of the Korean Association of Organ Transplant Coordinators, named stronger self-determination rights and DCD legislation as the top priorities at the roundtable on promoting organ donation, held on the 13th at the Seoul Economic Daily headquarters in Jongno District, Seoul, and moderated by Kim Sang-yong, head of the newspaper's bio desk. They stressed that broader recognition of donors and the spread of life-sharing education and culture must proceed alongside those changes.
— Even when people register their wish to donate while alive, donation rarely follows if the family objects.
△ Lee: Self-determination is the most important issue in organ donation. People who have registered their wish are nearly twice as likely to become actual donors as those who have not, yet when the family objects, the wish stated during the person's lifetime is not reflected in the donation process. Consent from two family members was once required; that has been eased to one family member with highest priority. Still, a legal basis is needed so that the individual's own wish carries greater weight.
△ Son: In the field, we strongly support removing the consent requirement for the highest-priority guardian and giving precedence to the individual's wish. From a clinician's standpoint, it is often difficult to judge whether one family member's signature accurately represents what the deceased wanted.
△ Lim: Policy is moving in the direction of respecting self-determination. But this is not a problem that changing the law alone can solve. It can take hold naturally only if public awareness and social consensus develop together.
— One of the issues this series examined most closely is the introduction of DCD. What is most urgent?
△ Lee: A legal basis must come first. DCD is a method in which organs are donated from a patient who has died of circulatory arrest after life-sustaining treatment is withdrawn. Under current law, however, even when a patient wishes both to end life-sustaining treatment and to donate organs, it is difficult to secure enough time to select recipients and carry out blood and tissue typing.
△ Lim: Passing the bill is the first priority. But even once the law passes, not every hospital will be able to perform DCD right away. Hospitals must draw up their own protocols and acquire the necessary equipment while also training medical staff. Rather than implementing it everywhere at once, it is appropriate to run pilot programs centered on institutions with experience and infrastructure, then expand gradually.
— How ready is the medical field for the period after the law is revised?
△ Son: Clinicians, the Korea Organ Donation Agency, the Korea Organ Transplantation and Blood Management Agency and others are now adjusting protocols for how they would operate in an actual DCD case. We are preparing procedures that can work in practice, taking into account even whether DCD-specific equipment is available, so that implementation can begin as soon as the bill passes.
△ Lim: DCD is still very unfamiliar to the public. If problems arise in the first cases, that could deepen distrust of the system itself, so we must also explain precisely how donation after death is carried out and secure the public's full understanding.
— How to honor donors and their bereaved families is also an important question.
△ Lee: What families want is not material compensation but honor for the donor and gratitude from society. We call donors "heroes," yet there are few places where they can be remembered. Abroad, there are various memorial parks and facilities commemorating donors. Korea needs more spaces and more of a culture that show society remembers its donors.
— What approach is needed to reduce vague fears about organ donation?
△ Son: Education matters. Even in medical and nursing schools, organ donation and brain death are sometimes not taught systematically. This should be taught as material clinicians must know, and students in elementary, middle and high school should be able to encounter the idea of sharing life naturally.
△ Lim: It cannot stop at one-off publicity campaigns. Rather than treating organ donation only as a heavy, frightening matter of death, we need to consider ways for the public to encounter it naturally through content such as television dramas. It is important to reduce vague fears and to keep explaining what organ donation means.
— What change is most needed to promote organ donation?
△ Son: Organ donation is a noble act of sharing life that saves the lives of waiting patients, and at the same time it can become a source of strength for the family left behind. The experience of knowing that a loved one did not die in vain but saved someone gives the bereaved family strength, and as recipients who gain a new life contribute to society again, a virtuous cycle is created.
△ Lee: Organ donation and transplantation are not someone else's story. However healthy you are now, anyone may one day be a person who needs a transplant. A culture of sharing life should start from the awareness that you may receive someone's help and, conversely, may be able to help someone else.
