Organ Donation Policies Research Articles

Editor's Introduction.

Editor’s Introduction Martha Montello This issue of Perspectives in Biology and Medicine introduces three new sections for the journal: Personal Perspectives, Review Essays, and Fiction. These new sections exemplify the journal’s commitment to create a unique space for innovative, thought-provoking, and eclectic work at the intersections of medicine, science, and the humanities. Our model in creating these new sections is thoroughly collaborative. The ideas come from authors. We have worked closely with prospective authors to create and define each of the new sections. Our overriding goal with these three venues is to provide scholars, researchers, and readers with new ideas framed in new ways. We hope to encourage creative thinking about the enormous shifts that are taking place in clinical medicine, health policy, and bioscientific research. Speaking across and through disciplines, our authors are exploring new ways of reshaping the goals of medicine and science. The essay format for Perspectives in Biology and Medicine emphasizes the process of exploration. The new Personal Perspectives section offers authors the opportunity to focus more directly on the intersection of the personal with the public or professional in their work than they might in a traditional scholarly essay. Our first essay of this genre is by our Deputy Editor, Frank Miller. “Changing One’s Mind in Bioethics” tells an intriguing story of his own personal transformation over the years as a bioethicist, one with profound implications for the changing field of [End Page 377] bioethics as a whole. We hope that other authors are willing to write about the ways that their own ideas have changed as they have engaged with new developments or challenging critics. We have published essay reviews in the past. With this issue, however, we introduce a new Essay Review section, with Larry Churchill as Editor. Where many journals publish book reviews, our aim in this section is to present essays that synthesize ideas about important new books, articles, films, plays, or cases. We encourage authors to submit review essays that respond to scholarly work that has appeared in any or all of these formats. We only ask that books or clusters of articles are thematically related. We hope our authors will use their essays as an occasion to speak their minds, with descriptions, comments, and analyses of questions and issues they believe deserve broader attention. Larry Churchill leads off the new section with a remarkable new essay of his own, “Conscience and Moral Tyranny.” Essays that attend to two or more books, or two or more articles, are especially welcome. We believe these essays will fill a substantial gap in the scholarship of many fields in biology and medicine, such as genetics, neurobiology, and evolution, as well as bioethics, history, philosophy, medical education, and clinical practice. Essays in the New York Review of Books or Times Literary Supplement provide examples of the approach we seek. Review Essays for Perspectives in Biology and Medicine will be indexed as peer-reviewed, published articles. And finally, for the first time in its history, Perspectives in Biology and Medicine will publish fiction. The new Fiction section recognizes that certain aspects of the truth can be told only through a story. Chris Feudtner’s extraordinary new story, “Second Time,” portrays an experience in a young physician’s life that leaves the reader with a profound understanding that only a well-told story could render. This issue as a whole gathers together essays on an array of topics, from an analysis of the implications of changes in organ donation policy to speculation about what killed Mary Todd Lincoln. We hope you enjoy it. [End Page 378] martha_montello@hms.harvard.edu Copyright © 2016 Johns Hopkins University Press

IMPORTANCE OF ORGANIZATIONAL FACTORS IN OVERCOMING THE SHORTAGE OF DONOR ORGANS

This review highlights the main problem in organ donation practice. There was done the analysis of main orga- nizational solutions and best organ donation policy practices with accent on Spain Model of organ donation, and the comparing U.S. organ donation system. Last «break through» international initiatives for improving organ donation practice were brought from WHA and WHO resolutions.

The Formation of Organ Donation Policy in Germany: Evidence, Politics and Public Opinion

The gap between the demand and supply of organs for transplantation is a worldwide phenomenon that continues to tax policy-makers. We consider recent policy reforms in Germany, drawing on evidence from Spain and Austria for comparison. Our analysis adopts Kingdon's multiple streams model which suggests that windows of opportunity for policy change open when an issue of public concern combines with a plausible solution and favorable political circumstances. Evidence is central to this process, but the type of evidence and the ways it is used, differ from technocratic formulations of evidence based policy-making. Scientific evidence may contribute to the rational appraisal of options, but this and other forms of evidence are also used rhetorically to generate political will and public support for change. We conclude by considering what the formation of organ donation policy in Germany reveals about the processes of policy-making under the competing imperatives of rationalism and democracy.

Points mean prizes: priority points, preferential status and directed organ donation in Israel

The introduction of Israel’s new Organ Transplantation Act in 2010 has enabled the development of a unique priority point system aimed at motivating individual’s to donate their organ. The priority point system rewards those who are willing to donate an organ with preferential status and an increased chance of receiving a donor organ, should they come to be in need of one. Preliminary evidence suggests it has considerable public support among Israelis, who appear willing to redress the challenge posed by those who are willing to accept an organ but not willing to donate. Since the Act’s introduction Israel has witnessed record numbers signing donor cards and there has been a significant increase in the actual numbers of transplants.One aspect of the new Israeli system that has hitherto not much been considered is its tendency towards a communitarian model of organ donation and the implications this change in emphasis may have for the existing ‘opt-in’ model based upon autonomy and consent. Gil Siegel draws our attention to this aspect when he sets out his defence of a proposal he refers to as ‘directed organ donation to other registered donors’, which encourages community responsibility without affecting the established commitment to consent and individual freedom.This commentary provides a brief overview of the new Act and its priority point system. It also examines Siegel’s proposal and considers the implications it may have for equity and justice, personal choice and dispositional authority. It is argued that although the proposal brings with it several inevitable hurdles for policy makers these are not insurmountable. Rather, its extraordinary potential to save life and avoid suffering should prompt urgent action at policy level. If such a scheme was successfully implemented in Israel it would represent a landmark change in organ donation and allocation policy, and set an example from which we all could learn.

Attitudes and acceptance of First Person Authorization

First Person Authorization (i.e., donor designation) legislation makes indicating one's intent to be a posthumous organ donor legally binding, much like a living will or advance directive. Such legislation is the most recent in a long history of organ donation policies in the United States and has received little attention in the literature. This retrospective cohort study recruited nine US organ procurement organizations (OPOs) and their staff who make requests for organ donation as well as family decision makers approached by OPO staff about organ donation. Telephone interviews (N = 1,087) with family decision makers assessed the attitudes, perceptions, and behaviors regarding the request for organ donation of families of designated donors as compared with those of patients who did not formally designate themselves as donors. Almost two thirds (65.7%) of the families of registered donors were aware of the decedent's decision to register as a posthumous donor. Family decision makers who authorized donation and those of designated donors exhibited greater knowledge of organ donation and more positive attitudes than decision makers who refused to donate. Families of designated donors had more favorable perceptions of the request for organ donation and were more satisfied with both the time spent discussing donation and the request process; fewer donor designation families were surprised at the request for donation. The enactment of First Person Authorization legislation increases the likelihood of familial authorization and satisfaction with the final donation outcome. As compared with other families approached about the option of organ donation, families of designated donors report having a more positive experience with the organ donation request process overall and greater comfort and satisfaction with the donation decision. Epidemiologic study, level II.

Understanding organ transplantation in the USA using geographical social networks

As of December 2011, 110,629 Americans are waiting for an organ transplant and yet only 28,664 people received organ transplants in 2010. This fact alone demonstrates the USA is facing an organ shortage crisis. Added to this, there is strong evidence that the organs made available are not being used efficiently, with 20 % of them going unused (for kidneys). It is tempting to investigate how new allocation policies could be implemented, but it would be more prudent to first understand the structure of the organ donation system in the USA. In spite of availability of data on transplants, to our knowledge no proper analysis has been done using the available data. This paper looks at organ transplantation data and what its structure may reveal about the allocation process currently in place. In order to structure the data, we used techniques from network sciences to build a network of locations (henceforth called a geographical social network, GSN) representing all transplants in the USA since 1987—locations represent states or zipcodes in the USA. This social structure is then analyzed using techniques from network sciences to bring clarity to the organ donation process. One of the main items in organ donation policies is the issue of locality which argues that allocation mechanisms should try to prioritize patients who are near the location where the organ became available. This is an important issue because the longer the organ takes to be transplanted the worse its quality. We show that network science techniques may shed some light on this process and demonstrate inconsistencies across different organs.

The perception of organ donation among health-care providers in the intensive care units at a tertiary center

The growing demand for organs continues to outpace the supply. The aim of our study was to evaluate the knowledge, attitude and awareness of organ donation procedures among the health-care providers in the Intensive Care Units (ICUs) at a tertiary hospital. This was a questionnaire-based study conducted in December 2011 among the health-care providers at five ICUs in a tertiary teaching hospital in Riyadh, Saudi Arabia. A total of 154 participants completed the questionnaire. Eighty percent of the participants acknowledged that organ donation is a legal practice in Saudi Arabia, but only 73% knew that the hospital had an organ donation policy. However, only 34% were willing to participate in a training program for organ donation. Interestingly, only 57% were willing to donate their organs. Our results suggest that more measures should be taken to educate the health-care providers regarding the concept of organ donation and the ethical and religious beliefs. Also, the policy of the hospital and the Saudi Center for Organ Transplantation regarding the process of organ donation should be strongly emphasized.

"Partitioning default effects: Why people choose not to choose": Correction to Dinner et al. (2011).

Reports an error in Partitioning default effects: Why people not to choose by Isaac Dinner, Eric J. Johnson, Daniel G. Goldstein and Kaiya Liu (Journal of Experimental Psychology: Applied, Advanced Online Publication, Jun 27, 2011, np). The article contained an incorrect Figure 4. Additionally, the article was missing keywords. All versions of this article have been corrected. (The following abstract of the original article appeared in record 2011-13230-001.) Default options exert an influence in areas as varied as retirement program design, organ donation policy, and consumer choice. Past research has offered potential reasons why no-action defaults matter: (a) effort, (b) implied endorsement, and (c) reference dependence. The first two of these explanations have been experimentally demonstrated, but the latter has received far less attention. In three experiments we produce default effects and demonstrate that reference dependence can play a major role in their effectiveness. We find that the queries formulated by defaults can produce differences in constructed preferences and further that manipulating queries can also mitigate default effects. The experimental context involves two environmentally consequential alternatives: cheap, inefficient incandescent light bulbs, and expensive, efficient compact fluorescent bulbs. Within this context we also measure the impact of each potential rationale for a default effect. (PsycINFO Database Record (c) 2011 APA, all rights reserved). Language: en

Community Preferences for the Allocation & Donation of Organs--the PAraDOx Study.

BackgroundTransplantation is the treatment of choice for people with severe organ failure. However, demand substantially exceeds supply of suitable organs; consequently many people wait months, or years to receive an organ. Reasons for the chronic shortage of deceased organ donations are unclear; there appears to be no lack of 'in principle' public support for organ donation.Methods/DesignThe PAraDOx Study examines community preferences for organ donation policy in Australia. The aims are to 1) determine which factors influence decisions by individuals to offer their organs for donation and 2) determine the criteria by which the community deems the allocation of donor organs to be fair and equitable. Qualitative and quantitative methods will be used to assess community preferences for organ donation and allocation.Focus group participants from the general community, aged between 18-80, will be purposively sampled to ensure a variety of cultural backgrounds and views on organ donation. Each focus group will include a ranking exercise using a modified nominal group technique. Focus groups of organ recipients, their families, and individuals on a transplant waiting list will also be conducted.Using the qualitative work, a discrete choice study will be designed to quantitatively assess community preferences. Discrete choice methods are based on the premise that goods and services can be described in terms of a number of separate attributes. Respondents are presented with a series of choices where levels of attributes are varied, and a mathematical function is estimated to describe numerically the value respondents attach to different options. Two community surveys will be conducted in approximately 1000 respondents each to assess community preferences for organ donation and allocation. A mixed logit model will be used; model results will be expressed as parameter estimates (β) and the odds of choosing one option over an alternative. Trade-offs between attributes will also be calculated.DiscussionBy providing a better understanding of current community preferences in relation to organ donation and allocation, the PAraDOx study will highlight options for firstly, increasing the rate of organ donation and secondly, allow for more transparent and equitable policies in relation to organ allocation.

The Mississippi Decision Exchanging Parole for Kidney Donation: Is This the Beginning of Change for Altruistic-Based Human Organ Donation Policy in the United States?

Governor Haley Barbour's recent decision to indefinitely suspend the life sentences of 2 Mississippi sisters convicted of a 1994 armed robbery drew considerable media attention worldwide.1-3 Jamie and Gladys Scott were reported to be traveling in a car with 2 men. When Jamie feigned illness, the driver of the car pulled over to the side of the road, at which point 3 men who had been following in a car behind robbed the 2 men at gunpoint. The 3 men who were arrested along with the Scott sisters pled guilty and were sentenced to shorter prison terms in exchange for testifying against Jamie and Gladys. That the women were black, living in the South, and sentenced to what many thought a harsh prison term for a crime netting a mere $11 prompted critical social examination. Health care professionals and bioethicists alike were further drawn to an element of Governor Barbour's decision that crossed into the realm of long-standing organ transplant policy. At the time of the suspension, Jamie was undergoing dialysis treatment at an annual cost to the state of $200,000 and was scheduled for early release because of her need for a kidney transplant. According to the governor's office, in her petition to the Mississippi parole board for early release in 2010, Gladys voluntarily offered to donate her kidney to her incarcerated sister.4 The governor explained that, after the sisters' request for early release, the Mississippi parole board recommended against either a pardon or a commuted sentence. On further review of the sisters'case, the board determined that the Scotts were no longer a threat to society and granted an indefinite suspension of their sentences.4 Gladys' indefinite suspension, which state officials describe as equivalent to parole, requires her to donate her kidney to her 36-year-old sister within 1 year after her release. The governor reportedly has said that the kidney donation “should be scheduled with urgency.”4 At the time of the sisters' release from the Mississippi Department of Corrections facility on January 7, 2011, no information was available as to tissue compatibility or other potential limitations to the prospect of a medically optimized transplant. Although the governor has yet to publically announce whether he will require the sisters to return to prison in the event of a failure to proceed with the conditioned kidney transplant, NAACP (National Association for the Advancement of Colored People) President Benjamin Jealous stated that, during his meeting with the governor, he was told that Gladys will not go back to prison if her kidney is not a match.5 The purpose of this article is to evaluate the recent decision made by Mississippi state officials in the context of current organ transplant legislation. A brief description of the theoretical concepts that involve criminal punishment and parole affords a better appreciation of whether the Mississippi decision aligns with the traditional goals established by the criminal justice system. The criminal justice market and the market for human organs are compared. Examining prior legislative efforts assists in unmasking the potential conflict introduced by combined decisions involving the criminal justice system and human organ transplant donation. Finally, this article argues that, although the State of Mississippi decision, and any further public reaction that follows, may offer some preliminary insight as to a willingness to deviate from purely altruistic motives regulating solid organ donation in the United States, it will likely fail as the first true test of a criterion for change.

Partitioning default effects: Why people choose not to choose.

Default options exert an influence in areas as varied as retirement program design, organ donation policy, and consumer choice. Past research has offered potential reasons why no-action defaults matter: (a) effort, (b) implied endorsement, and (c) reference dependence. The first two of these explanations have been experimentally demonstrated, but the latter has received far less attention. In three experiments we produce default effects and demonstrate that reference dependence can play a major role in their effectiveness. We find that the queries formulated by defaults can produce differences in constructed preferences and further that manipulating queries can also mitigate default effects. The experimental context involves two environmentally consequential alternatives: cheap, inefficient incandescent light bulbs, and expensive, efficient compact fluorescent bulbs. Within this context we also measure the impact of each potential rationale for a default effect.

Priority Setting in the Assessment for Kidney Transplant Candidacy: A Canadian Case Study

Over the last few decades kidney transplantation has transformed from an experimental treatment to the treatment of choice for end-stage renal disease. Unfortunately, however, the established organ donation models in many countries, relying chiefly on altruism, fail to motivate a sufficient number of donors. As a consequence, many lives which could be saved are lost, and others which can be improved are left to deteriorate.Dealing with the challenge of scarcity in kidney transplantation requires a dual approach. In the immediate term, we must ensure the fair distribution of kidney transplantation as a scarce medical resource. In the long term, we must find a policy level solution to mitigate the root issue of scarcity. The policy approach promoted in this thesis is the introduction of incentive based organ donation. Fair resource allocation, and incentive based donation are two themes which raise interesting normative questions, and ethical challenges. Each theme corresponds to two paperswhich form the basis for the thesis.Papers I I this is done both within Sweden's four transplant centers and the Toronto General Hospital in Canada. The criteria, values, and procedures used in clinical decision-making are analyzed to identify barriers to fairness and how such barriers can be removed.Papers III and IV, propose incentive based living kidney donation and incentive based deceased donation, respectively, as policy solutions to the organ scarcity. The most frequently raised ethical objections against incentive based models are discussed in a bid to demonstrate the moral permissibility of incentive based organ donation.The discussion about fairness, and incentive based models, highlights that the ethical challenges raised by kidney scarcity are inherently difficult. While we may not find infallible solutions we certainly can work towards better solutions. We can create clinical priority setting processes, that while not perfect, move us closer towards increased fairness by removing clear obstacles to just distribution. We can create organ donation policies while not free of ethical challenges; do not shy away from all risk, or from asking the difficult questions.

Pediatric Organ Donation and Transplantation Policy Statement: More Questions, not Answers

The American Academy of Pediatrics (AAP) released a policy statement regarding pediatric organ donation and transplantation1 in which several strategies to increase the supply of transplantable organs from pediatric donors were endorsed. A significant increase in the supply of transplantable organs from pediatric donors is also necessary to meet the demands of adults awaiting organ transplant.2 Although the AAP opted to not address unresolved problems in pediatric organ donation, the policy statement generated additional questions by positing that (1) an accurate and timely declaration of neurologic death in heart-beating donation (HBD) or circulatory-respiratory death in non–HBD (NHBD) (also known as donation after cardiac death or donation after circulatory death) is essential, (2) organ donation is an integral part of end-of-life care, (3) timely referral to organ-procurement organizations (OPOs) is critical, and (4) consent should be handled by procurement professionals. In the policy statement, HBD and NHBD were identified as appropriate venues of pediatric organ procurement, but the statement was explicitly silent on recent scientific controversies about both types of procurement practices. Both the validity of the criteria and the accuracy of the clinical standards of determining neurologic or circulatory-respiratory death in donors have been challenged.3,–,10 In the absence of scientific evidence that donors are truly dead, new philosophical, teleologic justifications have been proposed to defend redefinitions of human death for the purpose of organ procurement.3,11 …

Authors' response to letter re: The Rapid Assessment of Hospital Procurement Barriers in Donation: Assessing Hospitals for Change

Laura A. Siminoff, Heather M. Marshall TrainoTo the Editor:In their letter to the editor (this issue), Ve-rheijde, Potts, Rady, and Shewmon (2010)equate implementation of the Rapid Assess-ment of hospital Procurement barriers inDonation (RAPiD) with compromising the ba-sic principle upon which the U.S. organdonation system is founded—voluntariness.Specifically, the authors contend that theRAPiD infringes upon healthcare providers’right to ‘‘opt out’’ of or ‘‘conscientiously ob-ject’’ to engaging in ‘‘health serviceprogram[s] or research activit[ies]’’ that are‘‘contrary to his [or her] religious beliefs ormoral convictions’’ (Public Health Service Act42 USC ‰ 300a-7 (d)) (Office of the Law Re-vision Counsel U.S. House of Representatives,1973). The authors seem to overlook the factthat health practitioners’ employment withinany healthcare organization constitutes partic-ipation in neither a ‘‘health service program’’nor a ‘‘research activity.’’ Employees in health-care organizations, such as hospitals, arecontractually obligated to adhere to the poli-cies and procedures of that organization,whether codes of dress or conduct, or policiesrelated to the identification and referral of do-nor-eligible patients to regional organprocurement organizations (OPO). Moreover,these policies are in response to federal andstate regulations.Hospitals’ organ donation policies are theproduct of national regulatory efforts to in-crease the supply of transplantable organs. Inthe late 1970s, it became apparent that thoseon the transplant waiting list far exceeded thenumber of organs available. Some arguedAmericans wanted to donate and that the or-gan shortage reflected a failure on the part ofhospital staff to approach families and ask fordonation. These assumptions resulted in a se-ries of new state and federal laws intended toincrease the supply of transplantable organs.These laws, commonly called ‘‘required re-quest,’’ were designed to encourage healthcareprofessionals to speak with families about or-gan donation (Caplan, Siminoff, Arnold, V however, this didnot happen. After an initial modest increase,donations leveled off to no more than 5,000donors per year. One problem was that at least50% of all requests for organ donation to fam-ilies of brain dead patients were met withdenial (Siminoff, Arnold, Caplan, Virnig, S Cohen, 1992; Kappel, Whitlock, Parks-Thomas, Hong, & Freedman, 1993). ‘‘Re-quired notification’’ was enacted in 2001 toattempt to address this concern. This policyobligates hospitals to report all deaths to a localOPO to determine patient eligibility for organdonation. The purpose of routine notificationis to try to increase OPO involvement in thepatient identification process so as to improvethe request process (Health Care FinancingAdministration, 1998). Siminoff, Gordon, Hew-lett, and Arnold (2001) and Evanisko et al.,(1998) have demonstrated that OPO staff arebest qualified to discuss this option with fam-ilies.Thus, healthcare organizations are federallymandated to report all potential donor-eligiblepatients to regional OPOs in a timely manner.A timely referral is made within 1hr of a pa-tient meeting the clinical triggers for referral,that is the absence of brain stem reflexes, aGlascow Coma Score45 or the considerationof withdrawal of care (Ehrle, 2006). Hospitalpolicies concerning the identification and re-Vol. 32 No. 3 May/June 2010 45

Partitioning Default Effects: Why People Choose Not to Choose

Default options exert an influence in areas as varied as retirement program design, organ donation policy, and consumer choice. Past research has offered potential reasons why no-action defaults matter: (i) effort, (ii) implied endorsement, and (iii) reference dependence. The first two of these explanations have been experimentally demonstrated, but the latter has received far less attention. In three experiments we produce default effects and demonstrate that reference dependence can play a major role in their effectiveness. The experimental context involves two environmentally-consequential alternatives: cheap, inefficient incandescent lightbulbs, and expensive, efficient compact fluorescent bulbs. Within this context we also measure the impact of each potential rationale for a default effect. We find that the queries formulated by defaults can produce differences in constructed preferences and further that manipulating queries can also mitigate default effects.

Does organ donation legislation affect individuals' willingness to donate their own or their relative's organs? Evidence from European Union survey data

BackgroundMaintaining adequately high organ donation rates proves essential to offering patients all appropriate and available treatment options. However, the act of donation is in itself an individual decision that requires a depth of understanding that interacts with the social setting and the institutional framework into which an individual is embedded. This study contributes to understanding factors driving organ donation rates by examining how country regulation, individuals' awareness of regulatory setting, social interactions and socio-demographic determinants influence individuals' willingness to donate their own organs or those of a relative.MethodsWe draw representative data from the Eurobarometer survey 58.2 undertaken in 2002 with respondents throughout the European Union to capture heterogeneity in institutional setting. We use logistic regression techniques to estimate the determinants of willingness to donate one's own organs and those of a deceased relative. We employ interaction terms to examine the relationship between institutional setting and respondent's awareness of organ donation legislation in their country.ResultsOur findings indicate that individuals are more likely to donate their organs than to consent to the donation of a relative's organs. Both decisions are affected by regulation (presumed consent), awareness of regulation and social interactions such as the ability to count on others in case of a serious problem (reciprocity). Furthermore, education (more educated), age (younger), expressing some sort of political affiliation determine willingness to donate one's own organs and consent to the donation of those of a relative.ConclusionThis study confirms and develops further previous research findings that presumed consent organ donation policy positively affects the willingness of individuals to donate their own organs and those of relative by highlighting the importance of awareness of this regulation and an individual's level of social interactions in making choices about donation. Results found using interaction terms underline the importance of population awareness of organ donation legislation as well as the legislation type itself. Findings also point to the role of social interactions in influencing individuals' willingness to donate their organs or those of a relative.

Legal Authority to Preserve Organs in Cases of Uncontrolled Cardiac Death: Preserving Family Choice

The gap between the number of organs available for transplant and the number of individuals who need transplanted organs continues to increase. At the same time, thousands of transplantable organs are needlessly overlooked every year for the single reason that they come from individuals who were declared dead according to cardio pulmonary criteria. Expanding the donor population to individuals who die uncontrolled cardiac deaths will reduce this disparity, but only if organ preservation efforts are utilized. Concern about potential legal liability for temporary preservation of organs pending a search for family members appears to be one of the impediments to wider use of donation in cases of uncontrolled cardiac death in states without statutes explicitly authorizing such action. However, we think that the risk of liability for organ preservation under these circumstances is de minimis, and that concerns about legal impediments to preservation should yield to the ethical imperative of undertaking it.

They deserved better

The irony is almost palpable. At a time when the World Health Organization is seeking to develop a measure of international standardization of principles and standards for organ transplantation, our organ donation policies and programs are mired in what Canadian Society for Transplantation President

Fragmented organ donation programs hinder progress

Comparisons of international organ donation rates, systems, policies and practices often suggest most developed nations are playing chess, while Canadians are playing checkers. So varied are the nation's transplant programs that it's impossible to characterize national practice, other than to say

Assisting Altruism: Evaluating Legally Binding Consent in Organ Donation Policy

The growing need for organ and tissue transplants has led a number of states to enforce a policy that views a donor's declared intent to be an organ donor as legally binding. This allows health officials to harvest organs without the permission of the next of kin. Legally binding consent is controversial because of concerns that it may anger family members, lead to negative publicity, and discourage potential donors. We use interviews and a pooled time-series data set of cadaveric donation rates in U.S. states to evaluate the effectiveness of this policy. Our research indicates that enforcement of legally binding consent has marginally increased cadaveric donations while not significantly affecting donor registration. We also find evidence that the effect of the policy might be greater if it were more fully implemented and coordinated with efforts to improve public acceptance and awareness.