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

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

Abstract

Background

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.

Aims

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

Methods

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

Results

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%.

Conclusion

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.

Keywords

Presumed consent Liver transplantation Kidney transplantation Organ procurement Waiting lists 

Abbreviations

WHO

World Health Organization

GDP

Gross domestic product

ICU

Intensive care unit

R. Catholic

Roman Catholic

PMP

Per million population

Nd

No date

IRODaT

International Registry in Organ Donation and Transplantation

SD

Standard deviation

DCD

Donation after cardiac death

UAE

United Arab Emirates

OECD

Organization for Economic Co-operation and Development

IRB

Institutional review board

CIA

Central Intelligence Agency

UNDP

United Nations Development Program

n/a

No value

Slovak R

Slovak Republic

PMP

Per million population

M/F

Male or female

OPTN

Organ Procurement and Transplantation Network

GODT

Global Observatory on Donation and Transplantation

Notes

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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