Governance quality indicators for organ procurement policies.

Janet Delgado,Frank Jmf Dor,Silke Schicktanz,Alberto Molina-Pérez,Benjamin Söchtig,David Rodríguez-Arias,Ivar R Hannikainen,Sabine Wöhlke

doi:10.1371/journal.pone.0252686

Abstract

Consent policies for post-mortem organ procurement (OP) vary throughout Europe, and yet no studies have empirically evaluated the ethical implications of contrasting consent models. To fill this gap, we introduce a novel indicator of governance quality based on the ideal of informed support, and examine national differences on this measure through a quantitative survey of OP policy informedness and preferences in seven European countries. Between 2017-2019, we conducted a convenience sample survey of students (n = 2006) in Austria (AT), Belgium (BE), Denmark (DK), Germany (DE), Greece (GR), Slovenia (SI) and Spain (ES), asking participants about their donation preferences, as well as their beliefs and views about the policy in place. From these measures, we computed indices of informedness, policy support, and fulfilment of unexpressed preferences, which we compared across countries and consent systems. Our study introduces a tool for analyzing policy governance in the context of OP. Wide variation in policy awareness was observed: Most respondents in DK, DE, AT and BE correctly identified the policy in place, while those in SI, GR and ES did not. Respondents in opt-out countries (AT, BE, ES and GR) tended to support the policy in place (with one exception, i.e., SI), whereas those in opt-in countries (DE and DK) overwhelmingly opposed it. These results reveal stark differences in governance quality across countries and consent policies: We found a preponderance of informed opposition in opt-in countries and a general tendency towards support-either informed or uninformed-in opt-out countries. We also found informed divergence in opt-in countries and a tendency for convergence-either informed or uninformed-among opt-out countries. Our study offers a novel tool for analyzing governance quality and illustrates, in the context of OP, how the strengths and weaknesses of different policy implementations can be estimated and compared using quantitative survey data.

Highlights

Policies for deceased organ procurement (OP) aim to increase transplantable organs supply while honoring societal values regarding bodily self-determination and the afterlife
Our study introduces a tool for analyzing policy governance in the context of OP
Respondents in opt-out countries (AT, BE, ES and GR) tended to support the policy in place, whereas those in opt-in countries (DE and DK) overwhelmingly opposed it. These results reveal stark differences in governance quality across countries and consent policies: We found a preponderance of informed opposition in opt-in countries and a general tendency towards support–either informed or uninformed–in opt-out countries

Summary

Introduction

Policies for deceased organ procurement (OP) (i.e., laws, official guidelines) aim to increase transplantable organs supply while honoring societal values regarding bodily self-determination and the afterlife. In Europe, most countries have implemented an opt-out (presumed consent) model, while some countries retain the opt-in (explicit consent) model The difference between these regulations lies in the default option that applies when the deceased person has not expressed their preference. Consent policies for post-mortem organ procurement (OP) vary throughout Europe, and yet no studies have empirically evaluated the ethical implications of contrasting consent models. To fill this gap, we introduce a novel indicator of governance quality based on the ideal of informed support, and examine national differences on this measure through a quantitative survey of OP policy informedness and preferences in seven European countries

Methods

Results

Discussion

Conclusion