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Many western countries accept the legal and medical criteria for the posthumous procurement of organs based on brain death, but the clinical deﬁnition of brain death as a diagnostic category used in medical practice to determine “a moment of death” is not accepted everywhere.Some cultures subscribe to the traditional deﬁnition of death as the irreversible cessation of cardiorespiratory functions.
Although national surveys and opinion polls demonstrate support for organ transplantation and a willingness to donate, this does not always translate to actual donation.
Some countries have legislated “opt out” or presumed consent policies to increase donation rates, with some success (e.g., Belgium, France, and Spain).
Presumed consent operates on the basis that all eligible persons are organ donors at the time of their death unless they have speciﬁcally indicated their explicit objection.
“Opt in” systems, by contrast, are based on expressed voluntarism and require consent from the potential donor or their next of kin.
For example, beliefs about preserving the bodily integrity of the dead inﬂuence donation rates in countries such as Mexico, where lay understandings of Catholic doctrine require the body to be interred whole to enable resurrection (Lock and Crowley Matoka 2008).
Yet, within Catholicism, a belief in bodily resurrection may simultaneously exist with an emphasis on charity and altruistic acts.
Additionally, progress in transplant surgery has meant more organs can be transplanted and a greater range of conditions can now be treated by transplantation than previously.
The increasing imbalance between demand and supply puts pressure on supply side practices, thereby leading to further ethical challenges.
For accomplishing organ donation, mechanical ventilation and other “life-support” measures are employed to maintain the breathing of brain-dead donors until surgical removal of organ(s) of interest for transplantation.
As the demand for transplanted organs rises, low rates of deceased donation in many countries present a problem.