LEGAL PRINCIPLES OF ORGAN DONATION: A CASE STUDY OF THAILAND'S SYSTEM AND SPAIN'S CROSSOVER DONATION SYSTEM

Abstract

Thailand employs an opt-in organ donation system, governed by strict regulations for living donors under the Medical Council Regulation of B.E. 2566 (2023). The core principle mandates that donors must be blood relatives or legal spouses of at least three years (or share a biological child) with the recipient. This framework explicitly restricts the donor pool to close relatives and family members to prevent organ trafficking. Nevertheless, the system continues to face a severe shortage of available organs. In contrast, Spain has developed the crossover donation model to address the challenge of biologically incompatible donor-recipient pairs. The Spanish principle permits the exchange of donors between unrelated pairs, eliminating the need for a blood relationship between the final donor and the ultimate recipient, as long as the initial intent was to help a specific individual. This approach operates under the condition "I donate because you donate," affirming the altruistic and non-remunerative nature of the act. To ensure genuine voluntariness, the process is supported by rigorous psychosocial and financial screening procedures. The key distinction is that Thai law mandates a direct and provable relationship between the donor and the recipient. In contrast, Spain utilizes a more flexible system that permits donations between strangers via a crossover exchange mechanism. This approach serves to increase transplantation opportunities and address biological incompatibility, a practice not yet accommodated by Thai law.