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A Systematic Review of Opt-out Versus Opt-in Consent on Deceased Organ Donation and Transplantation (2006–2016)

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Abstract

Background

Significant numbers of patients in the USA and UK die while waiting for solid organ transplant. Only 1–2% of deaths are eligible as donors with a fraction of the deceased donating organs. The form of consent to donation may affect the organs available. Forms of consent include: opt-in, mandated choice, opt-out, and organ conscription. Opt-in and opt-out are commonly practiced. A systematic review was conducted to determine the effect of opt-in versus opt-out consent on the deceased donation rate (DDR) and deceased transplantation rate (DTR).

Methods

Literature searches of PubMed and EMBASE between 2006 and 2016 were performed. Research studies were selected based on certain inclusion criteria which include USA, UK, and Spain; compare opt-in versus opt-out; primary data analysis; and reported DDR or DTR. Modeled effect on US transplant activity was conducted using public data from Organ Procurement and Transplantation Network and Centers for Disease Control WONDER from 2006 to 2015.

Results

A total of 2400 studies were screened and six studies were included. Four studies reported opt-out consent increases DDR by 21–76% over 5–14 years. These studies compared 13–25 opt-out countries versus 9–23 opt-in countries. Three studies reported opt-out consent increases DTR by 38–83% over 11–13 years. These studies compared 22–25 opt-out versus 22–28 opt-in countries. Modeled opt-out activity on the USA resulted in 4753–17,201 additional transplants annually.

Conclusion

Opt-out consent increases DDR and DTR and may be useful in decreasing deaths on the waiting list in the USA and other countries.

Registration number

PROSPERO CRD42019098759.

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Acknowledgements

This work was not supported by a federal or commercial grant. The authors would like to thank Mr. Reza Motallebzadeh of Cambridge University and University College London for all his support, advice, and mentorship. All data used the analyses was acquired by accessing publicly available data sources. Presentation of an earlier version of this work supported in part by USF College of Medicine. M. Usman Ahmad was also the recipient of the American Transplant Congress Student Travel Award in 2017 as part of a comprehensive mentorship, networking, and educational opportunity for students interested in a career in transplantation.

Funding

M. Usman Ahmad received a student stipend from the USF SELECT MD Program.

Author information

Authors and Affiliations

  1. Medical Edu., USF Morsani College of Medicine (MCOM), 12901 Bruce B Downs Blvd, Tampa, FL, USA

    M. Usman Ahmad, Afif Hanna & Ahmed-Zayn Mohamed

  2. Legal Edu., Stetson University College of Law, 1401 61st St S, Gulfport, FL, USA

    Ahmed-Zayn Mohamed

  3. Medical Edu., University of Cambridge School of Medicine, Cambridge, UK

    Alex Schlindwein & Caitlin Pley

  4. Department of Molecular Med, USF MCOM, 12901 Bruce B Downs Blvd MDC 7, Tampa, FL, USA

    Ingrid Bahner

  5. Office of Research, USF MCOM, 12901 Bruce B Downs Blvd MDC 27, Tampa, FL, USA

    Rahul Mhaskar

  6. Global Health, USF College of Public Health, 12901 Bruce B Downs Blvd MDC 27, Tampa, FL, USA

    Rahul Mhaskar

  7. Department of Surgery, Addenbrooke’s Hospital, University of Cambridge, Cambridge, UK

    Gavin J. Pettigrew

  8. Department of Internal Medicine, USF MCOM, 12901 Bruce B Downs Blvd, Tampa, FL, USA

    Rahul Mhaskar & Tambi Jarmi

  9. Transplant Center, Mayo Clinic Hospital, San Pablo Rd S, Jacksonville, FL, 4500, USA

    Tambi Jarmi

  10. Department of Surgery, University of Colorado School of Medicine, Aurora, CO, 80045, USA

    M. Usman Ahmad

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An earlier version of this work was orally presented at the American Transplant Congress in 2017 and can be found in [61].

Appendix

Appendix

Pubmed and Embase search terms


Embase

Limits activated: English.

(('organ'/exp OR organ) AND donation OR (('organ'/exp OR organ) AND donations) OR (('organ'/exp OR organ) AND procurement) OR (('organ'/exp OR organ) AND procurements) OR 'donation after circulatory death'/exp OR 'donation after circulatory death' OR (donation AND after AND circulatory AND ('death'/exp OR death)) OR 'donation after brain death'/exp OR 'donation after brain death' OR (donation AND after AND ('brain'/exp OR brain) AND ('death'/exp OR death)) OR dcd OR dbd OR (posthumous AND ('organ'/exp OR organ) AND procurement) OR (posthumous AND ('organ'/exp OR organ) AND donation) OR (('organ'/exp OR organ) AND ('transplant'/exp OR transplant))) AND ('explicit consent' OR (explicit AND consent) OR 'voluntary consent' OR (voluntary AND consent) OR 'informed consent'/exp OR 'informed consent' OR (informed AND consent)) AND [2006-2016]/py


AND

(('organ'/exp OR organ) AND donation OR (('organ'/exp OR organ) AND donations) OR (('organ'/exp OR organ) AND procurement) OR (('organ'/exp OR organ) AND procurements) OR (donation AND after AND circulatory AND ('death'/exp OR death)) OR (donation AND after AND ('brain'/exp OR brain) AND ('death'/exp OR death)) OR dcd OR (posthumous AND ('organ'/exp OR organ) AND donation) OR (posthumous AND ('organ'/exp OR organ) AND procurement) OR (('organ'/exp OR organ) AND ('transplant'/exp OR transplant))) AND ((((presumed AND consent OR pcs OR opt) AND out OR presuming) AND consent OR implicit) AND consent OR deemed) AND consent AND [english]/lim AND [2006-2016]/py

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Ahmad, M.U., Hanna, A., Mohamed, AZ. et al. A Systematic Review of Opt-out Versus Opt-in Consent on Deceased Organ Donation and Transplantation (2006–2016). World J Surg 43, 3161–3171 (2019). https://doi.org/10.1007/s00268-019-05118-4

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