Showing posts with label opt out. Show all posts
Showing posts with label opt out. Show all posts

Thursday, August 25, 2022

Opt out organ donation in England and the Netherlands

 

Jansen, N. E., Williment, C., Haase-Kromwijk, B. J. J. M., & Gardiner, D. (2022). Changing to an Opt Out System for Organ Donation—Reflections From England and Netherlands. Transplant International, 133.

Abstract: Recently England and Netherlands have changed their consent system from Opt In to Opt Out. The reflections shared in this paper give insight and may be helpful for other nation considering likewise. Strong support in England for the change in legislation led to Opt Out being introduced without requiring a vote in parliament in 2019. In Netherlands the bill passed by the smallest possible majority in 2018. Both countries implemented a public campaign to raise awareness. In England registration on the Donor Register is voluntary. Registration was required in Netherlands for all residents 18 years and older. For those not already on the register, letters were sent by the Dutch Government to ask individuals to register. If people did not respond they would be legally registered as having “no objection.” After implementation of Opt Out in England 42.3% is registered Opt In, 3.6% Opt Out, and 54.1% has no registration. In contrast in Netherlands the whole population is registered with 45% Opt In, 31% Opt Out and 24% “No Objection.” It is too soon to draw conclusions about the impact on the consent rate and number of resulting organ donors. However, the first signs are positive."

...

"There had been many failed attempts to introduce Opt Out legislation to England over the last 30 years but was achieved on 20th May 2020. In October 2017 the Prime Minister stated her intention to shift “the balance of presumption in favour of organ donation” and “introduce an opt out system for donation.”

"Fortuitously a parliamentarian from the opposition party had successfully had his name drawn from a legislation ballot (a system which allows a few “Private Members Bills” to be considered by parliament from a randomly chosen subset of legislation suggestions), for a new Opt Out Bill. This led to an unusual alignment of opposing political parties, working together on a new policy. Due to this cross party support, the Bill progressed through Parliament and never had to be put to a vote.

"England’s Opt Out legislation built on the positive experience in Wales and Parliament was further reassured by the response to a public consultation on the draft Bill, which asked how Opt Out should be introduced. The Government usually expects between 200 and 500 responses; over 17,000 responses were received. The responses were supportive and gave a strong steer for the issues needing to be addressed.

"The main issues raised by the public were: the need for autonomy and individual choice; the role of the family; the need to respect faith and beliefs through the donation process. The government worked closely with NHSBT to identify ways to ensure that these issues were addressed. Ministerial commitments also secured additional resources such as increased recurrent funding.

"The final inspiration came from two young people—Max Johnson and Keira Ball. When the Bill was introduced, Max Johnson, a 9 year old boy, was in desperate need of a heart transplant. The UK media—particularly the Mirror newspaper—campaigned for the introduction of Opt Out legislation. Max’s life was saved through the gift of donation by Keira Ball, also aged nine, who tragically lost her life in a road traffic collision. The Opt Out legislation is known as Max and Keira’s Law, in their honour.


"Netherlands

"On the 1st of July 2020 the Opt Out system for organ donation was implemented in Netherlands. Changing the organ donation law from an Opt In consent system into an Opt Out system had not been easy. It took more than 12 years of political discussion to reach the milestone of a majority.

"In 2012 a member of the House of Representatives prepared a Bill to change the consent system into an “Active Donor Registration.” On the 16th of September 2016 the Bill was passed by the smallest possible majority in the House of Representatives, 75 members voted in favour of the Bill and 74 members against. On the 16th of February 2018 the vote in the Senate again ended in a close call, 38 senators voted in favour of the Bill and 36 members against. The Bill could only pass after a required amendment to develop a “Quality Standard Donation,” which describes the role of the doctor and the family in the donation conversation, based on the different outcomes of the Donor Register.

"The Active Donor Registration means that Dutch residents without a registration in the Donor Register, 7 million, will be asked by letter to register their donation preferences (same options as in the Opt In system). If they do not respond to a first and second letter, they will receive a third and final letter with the confirmation that they will be registered as having “No Objection” to organ and tissue donation. Under the new legislation “No Objection” would legally be considered the same as a registration of “Yes, I want to be an organ donor.” Registrations can be changed 24 h a day via the Internet. It could therefore be argued that while the change in law was to introduce Opt Out, it has similarities to a model of mandated choice for organ and tissue donation (6).




Tuesday, September 15, 2020

Covid has slowed transplants in the UK

The Evening Standard has the story:

Organ transplant waiting list jumps to five-year high due to pandemic, new NHS figures show

by Naomi Ackerman 

"The number people waiting for an organ transplant has soared to five-year high as a result of the coronavirus pandemic, new NHS figures have shown.

"NHS Blood and Transplant (NHSBT) said this week that an estimated 6,700 people are currently in need of a transplant across the UK - up from 6,138 prior to the start of the pandemic.

"The health body has estimated that the increase in patients waiting - expected to be the highest since 2015-16 - comes after services were impacted by the effects of the pandemic.

...

"It is hoped that the waiting list can be shortened going forward following the introduction of a new law in May, making organ donation "opt-out" rather than an active choice.

...

"The law will see that families are still consulted before organ donation goes ahead - the reason is why health officials have implored people to make their wishes about donation known to their families.

"NHSBT has said that thousands of "transplant opportunities" have been missed in recent years. In 2018-19, it reported that 835 families declined to support organ donation - with many families saying they did not know what their relative would have wanted."

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HT: Alex Chan

Thursday, July 23, 2020

Deceased organ donation by presumed consent, when families must also consent

Presumed consent to be an organ donor becomes complicated when the next of kin of the deceased potential donor must also consent:

Costa-Font, J., Rudisill, C. & Salcher-Konrad, M. ‘Relative Consent’ or ‘Presumed Consent’? Organ donation attitudes and behaviour. Eur J Health Econ (2020). https://doi.org/10.1007/s10198-020-01214-8

Abstract: "Legislation, in the form of presumed consent, has been argued to boost organ donation but most evidence disregards the practice of seeking relative’s consent, which can either ‘veto’ donation decisions, or ‘legitimize them’, by removing any possible conflict with the donor’s family. We study the effect of presumed consent alongside family consent on individuals’ willingness to donate (WTD) one’s own and relatives’ organs, and on actual organ donation behaviours. Using data from 28 European countries for the period 2002–2010, we found that presumed consent (PC) policies are associated with increased willingness to donate organs, but this effect was attenuated once internal family discussions on organ donation were controlled for. Our findings indicate that relative’s consent acts as a veto of donation intentions and attenuates the effect of regulation on actual donations. More specifically, PC increases WTD one’s own and relatives’ organs in countries where no family consent is required. Consistently, we find that family consent attenuates the influence of regulatory environment on actual donations. The effect is driven by the influence of family discussions which increased WTD, and in combination with presumed consent translated into higher organ donation rates."


Monday, July 6, 2020

Netherlands now has opt out deceased donor registration

The Netherlands Times has the story:

NEW DONOR REGISTRY OPT-OUT RULE TAKES EFFECT TODAY
By Janene Pieters on Wednesday, 1 July 2020

"The Netherlands' new organ donation law takes effect today. From now on Dutch adults who haven't told the Donor Register their wishes for their organs after death will automatically be registered as "no objection to organ donation", instead of automatically being registered as a non-donor. This means their organs can go to a patient after their death, though their next of kin will first be consulted.
"According to the government, almost 7 million Netherlands residents have not registered their wishes with the Donor Register yet. They will be sent a letter, prompting them to do so. Residents of Noord-Holland will be the first to receive this letter in September and October. A second letter will be sent six weeks later. If no response is received after the two letters, the person will be registered as "no objection to organ donation".
"Of those who have registered their wishes with the Donor Register, 53 percent are registered as organ donors. About 36 percent are non-donors, and 11 percent decided to leave this decision up to their families. "
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In the U.S., almost 50% of drivers are registered donors, close to the Netherlands rate. But it looks like the 36 percent "non donors" have given a definite "no" to donation. It will be interesting to see how the deceased donor transplantation rate evolves in the Netherlands.

Wednesday, March 11, 2020

Compensation for kidney donors? Opt in or opt out? The BBC and The Rift revisit the debates.(featuring Sally Satel and Frank McCormick)

The BBC covers the shortage of transplantable organs, and reviews the debate about compensating living organ donors, among other possibilities. Of particular interest is their discussion of 'opt-in' versus 'opt-out' systems for registering potential deceased donors, given the recent experience with the change in Wales.

Should organ donors be paid? The heavy toll of US kidney shortage
By Henri Astier


"Many countries, notably in continental Europe, have tried boosting the supply of dead donors through a "presumed consent" approach. Such a system, also known as "opt out", automatically places people on a national register of donors unless they choose not to be.

"All US states, by contrast, have "opt-in" laws. Would switching to "opt out" make a big difference? International studies suggest not. Spain, which has presumed consent, is only slightly ahead of the US in the number of transplants relative to its population; France and Belgium, with similar legislation in place, have fewer transplants.

"Wales is currently the only part of the UK with an opt-out system - England is due to follow suit later this year. But the Welsh did not see an increase in organ donations after it changed its law in 2015.
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And here's another forum for the compensation debate, at The Rift (featuring Sally Satel and Frank McCormick [click on his name next to Sally's] on the pro-compensation side...)
SHOULD ORGAN DONORS RECEIVE FINANCIAL COMPENSATION?

Wednesday, January 22, 2020

Alex Chan on deceased organ donation policy, in JAMA

Alex Chan comments on an earlier article in JAMA:
US Organ Donation Policy
Alex Chan, January 21, 2020

"To the Editor Ms Glazier and Mr Mone touted the success of the current opt-in organ donation system and argued for focusing on increasing registered donors to 75% of the adult population.1 A challenge is the intrinsic difficulty of such a task: more coordinated promotional efforts and new incentives like giving registered donors priority on organ waiting lists would likely be required.

"Even if such an increase in donor registration is possible, another challenge is the extent to which transplant centers recover organs from registered donors. Although the number of registered donors is more than half of the US population, only 36.3% of possible donors become actual donors.2 This loss of approximately one-third of registered donors suggests that obstacles to recovery of organs, such as family objection, transplant center rejections of imperfect organs, and OPO performance, are pivotal. Anecdotal evidence suggests that rejections of imperfect organs account for approximately 10% to 20%,2 leaving 10% to 20% of the loss still unaccounted for. Family consent or its lack may be a big part of the gap.
...
"Furthermore, 2 of the 3 states with the highest donor registration rates (Montana, 93%; Washington, 89%) have lower-than-average actual donation rates,1,2 but states like Nevada and Pennsylvania with registration rates lower than 50% have actual donation rates much higher than the national average.2 This suggests that registration is only part of the solution, and the ability of OPOs to obtain family consent and convert registrations into donations can bound the effectiveness of the current system."

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Here's the earlier post, about the article on which Alex is commenting

Wednesday, August 14, 2019

Wednesday, October 16, 2019

Rates of organ donation in countries with presumed consent versus those with explicit consent

Here's an illuminating figure from the 2018 paper
Sonya Norris, Legal and Social Affairs Division, 2018-02-14

Figure 5 - Deceased Organ Donor Rates (per million population), Consent Regimes and Number of Donors in Selected Countries, 2015


Presumed consent (opt-out) countries are graphed in yellow, and explicit consent (opt in) countries in blue.  Given the confusing and often confused discussion of those two regimes, it's noteworthy that both regimes appear near both the top and the bottom of the graph, i.e. there are both high and low donation rate countries using each donation regime.

Wednesday, August 14, 2019

How is the U.S. opt in system of organ donation doing compared to an opt out system? Alex Glazier and Tom Mone in JAMA

Alex Glazier and Tom Mone run, respectively, the big Organ Procurement Organizations (OPOs) in New England and Southern California.

Success of Opt-In Organ Donation Policy in the United States
Alexandra Glazier, JD, MP1; Thomas Mone, MS
JAMA. Published online August 8, 2019. doi:10.1001/jama.2019.9187

"Over the past 5 years, the United States has experienced a 30% increase in deceased organ donors, from 8269 in 2013 to 10 722 in 2018,1 although the number or organs available for transplant still does not meet the increasing need.
...
"The US practice of opt-in donation presents 2 opportunities for organ donation. The primary path to donation in the United States is through donor registries and is uniquely successful compared with other countries, with more than 152 million registered donors, representing 54% of the US adult population.2 A registered individual provides legally binding permission for donation at the time of death, and family does not have the right to override this decision. Current US practice is to proceed with a registered donation if medically suitable, even over family objection.3 The ability to move forward based on the donor’s affirmative decision is ethically supported and consistent with autonomy as a central principle in US health care decision-making. It is also in alignment with successfully maximizing opt-in policy and the UAGA state laws. The second path to donation in the United States is surrogate authorization of organ donation from an unregistered individual (ie, who has not registered as an organ donor) at the time of that individual’s death. The successful implementation of US opt-in is thus accomplished by a legal framework that is well-aligned with donation practices.
...
"Proponents of an opt-out system for the United States may have some misunderstandings about the performance and utility of the current opt-in US system. Requiring an affirmative donation decision through opt-in policies is also aligned with the US cultural emphasis on individual rights and autonomy principles that is not achieved in the opt-out international experience. As identified below, the US opt-in system donation rates routinely exceed those of the best performing opt-out international countries.
...
"In 2018, the US overall organ donation rate was 38.1 donors per 10 000 deaths, second among reporting countries only to Spain (which has an opt-out donation policy). Six individual US states had rates that were higher than Spain, and US states comprised 43 of the top 50 jurisdictions. Furthermore, in the opt-in jurisdictions, the mean donation rate was 27% higher than rates in opt-out jurisdictions (32.6 vs 25.6 donors per 10 000 deaths, respectively). The data demonstrate that opt-in policies in the United States are associated with higher organ donation rates than some countries with opt-out policies as the legal default.
...
"If the United States moved to a similar opt-out policy, the percentage of potential donors opting out combined with family objections would need to be quite small to realize any gains in donation performance. There is also the real potential for the donation rate to decline, as evidenced in Wales, which continues to have below-average international levels and most recently in the Netherlands, where an increasing number of people (currently 31%) have opted out.
...
"The United States has experienced significant growth in deceased organ donors and continues to have one of the best donation rates in the world. Nevertheless, the critical need for organ transplant is not met. International data suggest that the most effective donation authorization strategy for the United States is to build on the current opt-in system that demonstrably works and to increase the number of registered donors from today’s 54% to 75% or higher. Doing so would be an accomplishment that would increase available organs for donation and save thousands of lives.


HT: Alex Chan

Sunday, June 30, 2019

Organ donation by opt-out versus opt-in deceased donor registration (no significant effect on transplants)

In the June issue of Kidney International, there's a meta-study of organ transplantation rates in opt out versus opt in countries, that finds "no significant difference in deceased donation or solid organ transplantation activity between opt-out versus opt-in countries.":

Comparison of organ donation and transplantation rates between opt-out and opt-in systems
Adam Arshad,  Benjamin Anderson, and Adnan Sharif
Kidney International (2019) 95, 1453–1460

Abstract:
Studies comparing opt-out and opt-in approaches to organ donation have generally suggested higher donation and transplantation rates in countries with an opt-out strategy. We compared organ donation and transplantation rates between countries with opt-out versus opt-in systems to investigate possible differences in the contemporary era. Data were analysed for 35 countries registered with the Organisation for Economic Co-operation and Development (17 countries classified as opt-out, 18 classified as opt-in) and obtained organ donation and transplantation rates for 2016 from the Global Observatory for Donation and Transplantation. Compared to opt-in countries, opt-out countries had fewer living donors per million population (4.8 versus 15.7, respectively) with no significant difference in deceased donors (20.3 versus 15.4, respectively). Overall, no significant difference was observed in rates of kidney (35.2 versus 42.3 respectively), non-renal (28.7 versus 20.9, respectively), or total solid organ transplantation (63.6 versus 61.7, respectively). In a multivariate linear regression model, an opt-out system was independently predictive of fewer living donors but was not associated with the number of deceased donors or with transplantation rates. Apart from the observed difference in the rates of living donation, our data demonstrate no significant difference in deceased donation or solid organ transplantation activity between opt-out versus opt-in countries. This suggests that other barriers to organ donation must be addressed, even in settings where consent for donation is presumed.

Large image of FigureƂ 1. 

Saturday, April 13, 2019

Nova Scotia moves towards presumed consent for organ donation

The CBC is following the story:
Nova Scotia's opt-out organ donation move sparks mixed reaction
Bioethicist wonders whether rule would fit Canada's multicultural society

"Nova Scotia's decision to make all adults in the province potential organ donors unless they opt out has sparked a backlash from some Canadians.

"The goal is to increase organ donations from deceased donors to save lives of more recipients. Nova Scotia is striving to raise donation rates above 20 per cent, levels found in European countries such as Spain, officials said. About 90 per cent of Canadians say they support organ and tissue donation but less than 20 per cent have made plans to donate.

"Under presumed consent, the default decision is to donate organs on death. But families would continue to be approached to confirm the donor's wishes, said Dr. Stephen Beed, medical director for Nova Scotia's critical care organ donation program.
...
"The question is whether it's a good fit for Canadian society, said Kerry Bowman, a bioethicist at the University of Toronto.

"My first concern would be, this is a multicultural society and there are cultures and religions that really have a lot of concern about either organ donation or the steps before organ donation or the definition of death," Bowman said.

"For instance, Bowman said, the Catholic Church is very supportive of organ donation but sees presumed consent as problematic because it reduces the autonomous decision to give."
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Earlier from CBC:
Nova Scotia to become 1st in North America with presumed consent for organ donation.  Province will take 12 to 18 months after bill passes to prepare for changes
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A related post

Saturday, April 6, 2019

Saturday, April 6, 2019

Deceased organ donation: comparison of opt-in versus opt-out countries

From Kidney International
Article in Press



Studies comparing opt-out and opt-in approaches to organ donation have generally suggested higher donation and transplantation rates in countries with an opt-out strategy. We compared organ donation and transplantation rates between countries with opt-out versus opt-in systems to investigate possible differences in the contemporary era. Data were nalysed for 35 countries registered with the Organisation for Economic Co-operation and Development (17 countries classified as opt-out, 18 classified as opt-in) and obtained organ donation and transplantation rates for 2016 from the Global Observatory for Donation and Transplantation. Compared to opt-in countries, opt-out countries had fewer living donors per million population (4.8 versus 15.7, respectively) with no significant difference in deceased donors (20.3 versus 15.4, respectively). Overall, no significant difference was observed in rates of kidney (35.2 versus 42.3 respectively), non-renal (28.7 versus 20.9, respectively), or total solid organ transplantation (63.6 versus 61.7, respectively). In a multivariate linear regression model, an opt-out system was independently predictive of fewer living donors but was not associated with the number of deceased donors or with transplantation rates. Apart from the observed difference in the rates of living donation, our data demonstrate no significant difference in deceased donation or solid organ transplantation activity between opt-out versus opt-in countries. This suggests that other barriers to organ donation must be addressed, even in settings where consent for donation is presumed.

Wednesday, January 16, 2019

Organ donation in Germany

Spiegel.de has the story:
Nach langem AbwƤrtstrend, Zahl der Organspender deutlich gestiegen
(GT: After a long downward trend, the number of organ donors has increased significantly)

"Last year, 955 people left organs for other critically ill patients after their death, as the German Foundation for Organ Transplantation (DSO) announced. That was an increase of nearly 20 percent compared to 2017 with 797 donors and the first major increase since 2010.
...
"a discussion on new organ donation rules has started in parliament across parliamentary boundaries. So far, withdrawals are only allowed with expressly agreed consent, but many postpone the occupation with this topic again and again.

"Spahn is therefore campaigning for a "double contradiction solution" ["doppelte Widerspruchslƶsung"]. Accordingly, everyone is automatically considered a donor. One should be able to say no to this, otherwise - as a double barrier - relatives would have to be asked. In an open debate in the Bundestag at the end of November broad reservations against such a new regulation became clear.

"Instead, a group led by Greens leader Annalena Baerbock and left-leaning boss Katja Kipping suggests a mandatory recurring query, such as collecting new passports or identity cards - with the option of not yet deciding."
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HT: Rosemarie Nagel

Tuesday, October 9, 2018

Family consent and opt-in versus opt-out organ donation

Here's a contribution to the discussion on how opt-out versus opt-in deceased donor laws might impact transplantation (as opposed to just registration) in countries in which family consent is needed before a deceased person's organs are donated.

 2018 Aug 16. doi: 10.1037/xap0000183. [Epub ahead of print]

Underlying wishes and nudged choices.

Abstract

Is the inferred preference of a deceased relative to donate his or her organs stronger when the choice was made under a mandated rather than under an automatic default (i.e., nudged choice) legislative system? The answer to this is particularly important, because families can, and do, veto the choices of their deceased relatives. In three studies, we asked American and European participants from countries that have either a default opt-in or a default opt-out system to take on the role of a third party to judge the likelihood that an individual's "true wish" was to actually donate his or her organs, given that the decedent was registered to donate on the organ donation register. In each study participants were randomly assigned to one of four organ donation legislative systems (default opt-in, default opt-out, mandated choice, mandatory). Overall, regardless of which country participants came from, they perceived the donor's underlying preference to donate as stronger under the default opt-in and mandated choice systems as compared with the default opt-out and mandatory donor systems. We discuss the practical issues that result from using default systems in the domain of organ donation and propose potential ways to ameliorate the uncertainty around inferences of underlying preference from a nudged choice. 
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HT Axel Ockenfels

Saturday, August 11, 2018

Presumed consent: too early to declare failure, but cautions are plentiful

Frank McCormick points out a recent report in the journal Health Policy indicating that the Welsh move from opt-in to opt-out or ('deemed consent') for deceased organ donation has not so far been successful at raising transplant rates:

Welsh 2013 deemed consent legislation falls short of expectations
by Jordan Alexander Parsons

"Abstract: Wales, in 2013, was the first country in the United Kingdom to pass legislation introducing presumed (or deemed) consent for organ donation, and remains the only one. It was introduced in an attempt to increase the number of life-saving transplants taking place in the UK, in a move that policy makers hoped would mirror Spain’s success. More recently, pressure has been mounting for England to follow suit, with a public consultation currently in progress. However, the Welsh system has been far from a success, raising the question of why campaigners are so adamant that it should be replicated. Before the Welsh Government introduced the Human Transplantation (Wales) Act there had been no strong evidence to suggest it would make a difference, with countries boasting both high organ donation rates and presumed consent legislation demonstrating no clear causal relationship between the two facts. In addition, a recent report evaluating the Act has highlighted its failure to improve donation rates, and has even presented some potentially concerning statistics that may suggest a negative impact. This paper first considers presumed consent in other countries – Spain and Brazil – before illustrating the underwhelming progression of Wales’ new system and the need to look to other options."

Here's a paragraph that strikes me as important, because family consent is important in Wales, and automatic inclusion on the deceased donor registry reduces the signal value that the deceased wished to be a donor:

"Under the Welsh system, the deceased is deemed to have consented to donation unless (1) a decision as to donation by the deceased is in force, (2) the deceased had appointed a person or persons to make the decision on their behalf, or (3) a relative of friend of long standing objects on the basis of views held by the deceased and it is reasonable to assume the objection is accurate [2]. It is down to the medical team to determine whether a relative’s objection is their own, or one based on the views of the deceased. Unsurprisingly, doctors have not shown willing to challenge these objections, despite their legal right to; they consider it inappropriate to go against the wishes of the family."
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Here is a related article, which raises other potential problems:
Presumed consent will not automatically lead to increased organ donation
Sharif, Adnan
Kidney International , Volume 94 , Issue 2 , 249 - 251

"a review of the latest available data (2016) from the Global Observatory on Donation and Transplantation suggests no significant difference in overall transplantation activity between presumed versus explicit consent countries, with increased deceased organ donor rates balanced by decreased living donor rates among presumed consent countries (Table 1). Whether the consent process is presumed or explicit has no bearing on many inter-related factors that influence organ donation rates. For example, Coppen et al.4 observed a strong correlation between mortality rates and organ donation numbers (Spearman’s r = 0.81, P < 0.01) and that, after controlling for differences in relevant mortality rates, there was no significant influence of presumed versus explicit consent on organ donation rates."

Table 1 Organ donation and transplantation activity
ParameterPresumed consent (mean ± SD per million population)Explicit consent (mean ± SD per million population)P value
Kidney (deceased)30.9 ± 15.122.6 ± 11.10.078
Kidney (living)4.8 ± 2.616.9 ± 8.4<0 .001="" td="">
Liver (deceased)12.9 ± 8.510.1 ± 5.30.265
Liver (living)0.4 ± 0.92.7 ± 5.30.107
Heart4.8 ± 3.53.1 ± 2.60.108
Lung3.5 ± 4.04.2 ± 2.80.543
Pancreas1.6 ± 1.61.4 ± 1.00.579
Overall transplant activity59.1 ± 30.758.9 ± 23.40.982

Monday, December 11, 2017

Wales' organ donation opt-out law has not increased donors--BBC

Here's the story from the BBC:
Wales' organ donation opt-out law has not increased donors

"Wales' opt-out system for organ donation has not increased the number of donors in the two years since it was introduced, a study has confirmed.
"Adults in Wales are presumed to have consented to organ donation unless they have opted out.
"The data was published in a Welsh Government report about the impact of the Human Transplantation (Wales) Act.
"In the 21 months before the law changed in December 2015 there were 101 deceased donors in Welsh hospitals. The data showed there were 104 in the same time period since the law change.
Every quarter NHS Blood and Transplant releases figures for organ donation for each county in the UK.
Mr Gething acknowledged the figures and added: "The report suggests this may be because there have been fewer eligible donors over the short period since the change in law.
"It's important to remember that it's too early to know what the true impact of the change will be, but I'm confident we have started to create a culture where organ donation is openly discussed."


HT: Frank McCormick

Wednesday, January 4, 2017

France introduces opt-out policy on organ donation

The Guardian has the story:
France introduces opt-out policy on organ donation
Change in law means consent for organs to be removed is presumed unless person joins official ‘refusal register’

"France has reversed its policy on organ donations so that all people could become donors on their death unless they join an official register to opt out.
The new law presumes consent for organs to be removed, even if it goes against the wishes of the family.
Until 1 January, when the legislation took effect, unless the person who had died had previously expressed a clear wish for or against donation, doctors were required to consult relatives who, in almost a third of cases, refused.
Those who do not want all or any of their organs to be used must now put their name on a “refusal register” – so far 150,000 people have signed up. The authorities have promised to make it easier for those who wish to refuse by allowing them to join the register online instead of by registered post.
Alternatively, those vehemently opposed to their organs being used can leave a signed document with their next-of-kin or transmit their wish orally to relatives who must make a written declaration of non-consent to doctors at the time of death. The process is explained on the agency’s Facebook page.
In November, the French Agence de la BiomĆ©decine released a film, DĆ©jĆ -vu2, aimed at encouraging 15- to 25-year-olds to agree to organ donation.
The European Union has highlighted the lack of organs for transplant and the increasing number of patients on waitings lists worldwide. Its figures claim that in 2014, 86,000 people were waiting for organ donations in EU states, Norway and Turkey, and 16 people were dying every day while waiting for a transplant.

In the UK, doctors lament one of the lowest consent rates in Europe, as well as a shortage of donors from black or Asian communities. A record number of organs were donated and transplanted in the UK in 2015-16, but the rate remains short of the target of 80% by 2020. The biggest obstacle remains relatives’ opposition, who have vetoed transplants even from registered donors.
NHSBT, which is responsible for the NHS organ donor register and for matching and allocating donor organs, said it was considering further steps it could take when approaching families to ensure more potential donors’ decisions were not vetoed.
One option would be to no longer ask the next-of-kin to confirm consent or authorisation. Their permission is not required by law if someone has registered a decision to donate on the NHS organ donor register.
Families in Scotland are already required to complete a retraction form to record why they overturned a relative’s decision to donate. NHSBT said a similar form be introduced across the UK."

HT: Frank McCormick