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

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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.

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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

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Authors and Affiliations

  1. Department of Medicine, University of California at Los Angeles, Los Angeles, CA, USA

    Sammy Saab & Gina Choi

  2. Department of Surgery, University of California at Los Angeles, Los Angeles, CA, USA

    Sammy Saab, Satvir S. Saggi, Mizna Akbar & Gina Choi

  3. Department of Nursing, University of California at Los Angeles, Los Angeles, CA, USA

    Sammy Saab

  4. Pfleger Liver Institute, UCLA Medical Center, 200 Medical Plaza, Suite 214, Los Angeles, CA, 90095, USA

    Sammy Saab

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  1. Sammy Saab
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Contributions

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.

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Correspondence to Sammy Saab.

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Saab, S., Saggi, S.S., Akbar, M. et al. Presumed Consent: A Potential Tool for Countries Experiencing an Organ Donation Crisis. Dig Dis Sci 64, 1346–1355 (2019). https://doi.org/10.1007/s10620-018-5388-6

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