Organs In Countries Research Articles

\u2018Relative Consent\u2019 or \u2018Presumed Consent\u2019? Organ donation attitudes and behaviour

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.

Living-donor liver transplantation for fulminant hepatic failure in adult patients with a left-lobe graft

Living donors are practically the only source of organs in countries where the availability of cadaveric donors is severely restricted, such as Japan. A left-lobe graft, in which one third of the liver is donated, is therefore used for adult-to-adult living-donor liver transplantation (LDLT) in patients with fulminant hepatic failure (FHF). Fifteen adult patients with FHF, ranging from 22 to 59 years of age, were treated with LDLT with a left-lobe graft. Preoperative encephalopathy was grade II in 2 patients, grade III in 4 patients, and grade IV in 9 patients. The graft volume (GV) ranged from 260 to 570 mL, thus corresponding to 23% to 54% of the recipients' standard liver volume (SLV). The patients were divided into 2 groups according to their GV/SLV: a medium-size graft group (GV/SLV > or =30%; group M, n = 11) and a small-size graft group (GV/SLV <30%; group S, n = 4). The effects of GV/SLV on graft function and survival were compared. Postoperative neurologic complications were also evaluated. The donors are all doing well. Twelve (80%) of the 15 recipients are still alive, with a follow-up period of from 3 to 43 months. No statistically significant differences were observed in the postoperative serum levels of bilirubin and alanine aminotransferase, prothrombin time, or frequency of postoperative complications between the 2 groups. The graft and patient survival rates were 75% (3/4) and 75% (3/4) in group S and 73% (8/11) and 82% (9/11) in group M, respectively. All patients who survived the perioperative period recovered without any neurologic sequelae. The high success rate and low donor risk of LDLT may therefore justify its use for adult patients with FHF using a left-lobe graft.

The Relative Impact of Presumed-Consent Legislation on Thoracic Organ Donation in the Eurotransplant Area

A country's organ donation rate and hence the availability of thoracic organs can be increased by organizational measures, by legislative incentives, and by increasing awareness among the public and healthcare professionals. We analyzed the relative impact of organ procurement legislation or policy on heart and lung donation rates per million population per year in the four countries participating in the Eurotransplant organization (population, 112.7 million) between January 1992 and December 1994. Within this organization, Austria and Belgium have presumed-consent legislation, whereas Germany and the Netherlands have an opting-in (explicit-consent) policy. Although practices vary even among countries with similar policies (eg, in Belgium, relatives of the donor retain the right to object to procurement of organs in the absence of an explicit consent from the deceased before death), rates of heart and lung donation were at least twice as high in the two countries with presumed-consent legislation as in the two countries that rely on a policy of explicit consent from the donor's next of kin.

The relative impact of presumed-consent legislation on thoracic organ donation in the Eurotransplant area.

A country's organ donation rate and hence the availability of thoracic organs can be increased by organizational measures, by legislative incentives, and by increasing awareness among the public and healthcare professionals. We analyzed the relative impact of organ procurement legislation or policy on heart and lung donation rates per million population per year in the four countries participating in the Eurotransplant organization (population, 112.7 million) between January 1992 and December 1994. Within this organization, Austria and Belgium have presumed-consent legislation, whereas Germany and the Netherlands have an opting-in (explicit-consent) policy. Although practices vary even among countries with similar policies (eg. in Belgium, relatives of the donor retain the right to object to procurement of organs in the absence of an explicit consent from the deceased before death), rates of heart and lung donation were at least twice as high in the two countries with presumed-consent legislation as in the two countries that rely on a policy of explicit consent from the donor's next of kin.

Living donor for liver transplantation

Since living related liver transplantation was first performed in 1989, more than 150 cases have been performed worldwide, mostly in the United States and Japan. This paper reports the first series of living related liver transplantation in Europe. Twenty living related liver transplantation surgeries were performed over a 13-mo period, with an overall patient survival of 85%. For patients who underwent elective transplantation (n = 13), the survival rate was 100%. Technical complications included one arterial thrombosis necessitating retransplantation and five bile leaks requiring surgical revision. The technical improvements that permit avoidance of these complications are discussed. A detailed description of the living related liver procurement is given. All procurements yielded grafts of excellent quality. No intraoperative complications occurred, and no reoperations were necessary. No heterologous blood transfusion was needed. In two patients, incisional hernias developed after wound infection. Living related liver transplantation does not absolve the transplant community of efforts to promote cadaveric organ procurement. Nevertheless, living related liver transplantation does have the advantage of a readily available graft of excellent quality, permitting transplantation with optimal timing under elective conditions. Several centers are now preparing living related segmental liver transplants, following the model of our protocol, for three reasons: (a) to obtain superior results compared with cadaveric liver transplantation; (b) to overcome cadaveric organ shortage and further reduce pretransplantation mortality and (c) to provide viable organs in countries where cadaveric organ procurement is not established. When performed by a team experienced in pediatric liver transplantation and in adult liver resection, living related liver transplantation is an excellent modality for the treatment of end-stage liver disease in children.

Living donor for liver transplantation

Since living related liver transplantation was first performed in 1989, more than 150 cases have been performed worldwide, mostly in the United States and Japan. This paper reports the first series of living related liver transplantation in Europe. Twenty living related liver transplantation surgeries were performed over a 13-mo period, with an overall patient survival of 85%. For patients who underwent elective transplantation (n=13), the survival rate was 100%. Technical complications included one arterial thrombosis necessitating retransplantation and five bile leaks requiring surgical revision. The technical improvements that permit avoidance of these complications are discussed. A detailed description of the living related liver procurement is given. All procurements yielded grafts of excellent quality. No intraoperative complications occurred, and no reoperations were necessary. No heterologous blood transfusion was needed. In two patients, incisional hernias developed after wound infection. Living related liver transplantation does not absolve the transplant community of efforts to promote cadaveric organ procurement. Nevertheless, living related liver transplantation does have the advantage of a readily available graft of excellent quality, permitting transplantation with optimal timing under elective conditions. Several centers are now preparing living related segmental liver transplants, following the model of our protocol, for three reasons: (a) to obtain superior results compared with cadaveric liver transplantation; (b) to overcome cadaveric organ shortage and further reduce pretransplantation mortality and (c) to provide viable organs in countries where cadaveric organ procurement is not established. When performed by a team experienced in pediatric liver transplantation and in adult liver resection, living related liver transplantation is an excellent modality for the treatment of end-stage liver disease in children. (Hepatology 1994;20:49S-55S.)

Family Enterprise: The Story of Some North Country Organ Builders

Family Enterprise: The Story of Some North Country Organ Builders