Presumed Consent: A Potential Tool for Countries Experiencing an Organ Donation Crisis

  • Sammy Saab
  • Satvir S. Saggi
  • Mizna Akbar
  • Gina Choi
Original Article



There is currently an inadequate supply of allografts to meet the number of transplant candidates worldwide. A number of controversial policies, including implementation of a presumed consent organ donation system, have been considered to rectify the organ donation crisis.


A secondary retrospective data analysis aimed to assess the impact of switching to a presumed consent organ donation model on organ donation rates.


Deceased organ donation rates were compared before and after countries adopted presumed consent.


Six countries met entry criteria. All six countries had an increase in liver donation rates, while 4 out of the six countries had an increase in kidney donation rates. The overall mean (± SD) liver donation rate was 3.23 (± 0.97) per million population (pmp) before the transition and 6.46 (± 1.81) pmp after the transition (p < 0.0001). The overall mean (± SD) kidney donation rate was 17.94 (± 3.34) pmp before the transition and 26.58 (± 4.23) pmp after the transition (p < 0.0001). The percentage increase in liver and kidney donation rates varied among countries, ranging from 28 to 1186%.


The transition from explicit to presumed consent was associated with a significant increase in liver donation rates in all countries that met our criteria, while the effect on kidney donation rates was partially realized. Although presumed consent alone is unlikely to explain the increase in donation rates, the adoption of such a policy may prove to be a worthwhile risk for countries experiencing consistently low organ donation rates.


Presumed consent Liver transplantation Kidney transplantation Organ procurement Waiting lists 



World Health Organization


Gross domestic product


Intensive care unit

R. Catholic

Roman Catholic


Per million population


No date


International Registry in Organ Donation and Transplantation


Standard deviation


Donation after cardiac death


United Arab Emirates


Organization for Economic Co-operation and Development


Institutional review board


Central Intelligence Agency


United Nations Development Program


No value

Slovak R

Slovak Republic


Per million population


Male or female


Organ Procurement and Transplantation Network


Global Observatory on Donation and Transplantation


Author’s contribution

SS and SSS were involved in study concept and design, analysis and interpretation of data; SSS and MA contributed to acquisition of data; SS, SSS and MA were involved in drafting of the manuscript; SS and GC contributed to critical revision of the manuscript for important intellectual content; SSS contributed to statistical analysis; SS was involved in study supervision.

Compliance with ethical standards

Conflict of interest

The authors of this manuscript have no conflicts of interest to disclose.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Sammy Saab
    • 1
    • 2
    • 3
    • 4
  • Satvir S. Saggi
    • 2
  • Mizna Akbar
    • 2
  • Gina Choi
    • 1
    • 2
  1. 1.Department of MedicineUniversity of California at Los AngelesLos AngelesUSA
  2. 2.Department of SurgeryUniversity of California at Los AngelesLos AngelesUSA
  3. 3.Department of NursingUniversity of California at Los AngelesLos AngelesUSA
  4. 4.Pfleger Liver InstituteUCLA Medical CenterLos AngelesUSA

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