System Of Presumed Consent Research Articles

Brain death and organ transplantation

Brain death and organ transplantation

The New Greek Statute on Organ Donation — Yet Another Effort to Advance Transplants

In 2011, the new law on organ transplants was voted by the Greek Parliament. Major changes include the selection of presumed consent system (opt-out) for organ transplants from dead donors. The system will take effect in 2013. In organ donations from living donors, a class of potential donors was added: a person with whom the organ recipient has a personal relationship and is emotionally connected. In this special case though, the truth of the altruistic motives is necessarily examined in court. Also, a detailed list of risks and consequences is part of the content of the obligation to inform a potential organ donor.

The authority of next-of-kin in explicit and presumed consent systems for deceased organ donation: an analysis of 54 nations

Background.The degree of involvement by the next-of-kin in deceased organ procurement worldwide is unclear. We investigated the next-of-kin’s authority in the procurement process in nations with either explicit or presumed consent.Methods.We collected data from 54 nations, 25 with presumed consent and 29 with explicit consent. We characterized the authority of the next-of-kin in the decision to donate deceased organs. Specifically, we examined whether the next-of-kin’s consent to procure organs was always required and whether the next-of-kin were able to veto procurement when the deceased had expressed a wish to donate.Results.The next-of-kin are involved in the organ procurement process in most nations regardless of the consent principle and whether the wishes of the deceased to be a donor were expressed or unknown. Nineteen of the 25 nations with presumed consent provide a method for individuals to express a wish to be a donor. However, health professionals in only four of these nations responded that they do not override a deceased’s expressed wish because of a family’s objection. Similarly, health professionals in only four of the 29 nations with explicit consent proceed with a deceased’s pre-existing wish to be a donor and do not require next-of-kin’s consent, but caveats still remain for when this is done.Conclusions.The next-of-kin have a considerable influence on the organ procurement process in both presumed and explicit consent nations.

Do we need to change the legislation to a system of presumed consent to address organ shortage?

Organ transplantation significantly improves the health, quality of life and life-expectancy of people whose organs have failed. Most patients in the UK cannot enjoy the benefits of a transplant because of an extreme shortage of organs. This paper demonstrates the magnitude of the problem of organ shortage and identifies possible causes. The current UK legislation regarding consent to organ transplantation is analysed and compared with other jurisdictions. The hypothesis of changing the legislation to a system of presumed consent in order to address the organ shortage is explored. The main issues surrounding a change in the legislation are considered, and the effects on society and the individual are discussed. This paper argues that there is not enough convincing evidence to support a change in the legislation to a system of presumed consent at this time. Instead, an increase in organ donations could be achieved by improving the effectiveness of the current system of organ donation, and by improving the public's awareness and understanding of organ transplantation issues.

Organ donation in the UK: A question of ‘give’ or ‘take’?

Organ transplantation and the availability of donor organs has been a hot topic in the news in recent months. Anne McDermott, Nicky Crouchen and Jo Hardy discuss the current system of organ donation and the implications of a system of presumed consent.

A systematic review of presumed consent systems for deceased organ donation

A systematic review of presumed consent systems for deceased organ donation

Impact of a Bereavement and Donation Service incorporating mandatory ‘required referral’ on organ donation rates: a model for the implementation of the Organ Donation Taskforce’s recommendations

In 2008 the Organ Donation Taskforce published its recommendations for increasing organ donation in the UK by 50% over 5 years. Bolton NHS Trust has addressed the problem of low rates of organ donation by amalgamating Bereavement and Donation Services and introducing a trigger to refer automatically all potential organ donors to the regional transplant donor co-ordinators. We audited the ability of the new service to deliver the aims and recommendations of the Organ Donation Taskforce. Following the changes in service provision the number of tissue donors rose from six in 2002 to 246 in 2007. In the same period solid organ donation rates remained unchanged. The introduction of an automatic trigger for referral of potential donors in 2007 resulted in 31 referrals and 11 successful multi-organ donors. The current service exceeds the aims of the Taskforce and offers the potential to meet UK organ donation targets without resorting to an 'opt out' system of presumed consent.

A systematic review of presumed consent systems for deceased organ donation

To examine the impact of presumed consent legislation on organ donation and to review data on attitudes to presumed consent among the public, professionals and any other stakeholders. Eight electronic databases (MEDLINE, MEDLINE In-Process, EMBASE, CINAHL, PsycINFO, HMIC, PAIS International and OpenSIGLE) were searched from inception to January 2008. Supplementary internet searches were also performed. A systematic review of studies comparing donation rates in a single country before and after the introduction of a presumed consent law or in countries with and without presumed consent systems. The methodological quality of these studies was assessed and a narrative synthesis of results undertaken. Surveys of attitudes towards presumed consent legislation were also included. Over 2000 potentially relevant citations were identified, of which 13 studies met the inclusion criteria for the primary objective and 13 for the secondary objective. For the primary objective, eight studies were between-country comparisons and five were before-and-after studies. Four of the between-country comparisons were of sufficient methodological quality to provide reliable results. In all four studies presumed consent law or practice was associated with increased rates of organ donation, ranging from an increase of 2.7 donors per million population (pmp) in one study to 6.14 donors per million in another, and an increase of between 20% and 30% in two other studies. Factors other than presumed consent that had an impact on organ donation rates were mortality from road traffic accidents and cerebrovascular accident, the transplant capacity of a country, gross domestic product per capita and health expenditure per capita, religion, education, public access to information and a common law legal system. The five before-and-after studies represented three countries, all of which reported an increase in donation rates following the introduction of a presumed consent system (Austria, from 4.6 to 27.2 donors pmp over a 5-year period; Belgium, increase in kidney donation from 10.9 to 41.3 pmp during a 3-year period; Singapore, increase in kidney procurement from 4.7 to 31.3 per year in the 3 years after the change in legislation). There was very limited investigation of any other changes taking place concurrently with the changes in legislation across this set of studies. Of the 13 studies addressing the secondary objective, eight were surveys of the UK public, four were from other countries and one was an international survey of health professionals. There was variation among the UK surveys in the level of support for presumed consent, with surveys conducted before 2000 reporting the lowest levels of support (28-57%). The most recent survey by YouGov in 2007 reported that 64% of respondents supported a change to presumed consent. Presumed consent alone is unlikely to explain the variation in organ donation rates between different countries. A combination of legislation, availability of donors, transplantation system organisation and infrastructure, wealth and investment in health care, as well as underlying public attitudes to and awareness of organ donation and transplantation, may all play a role, although the relative importance of each is not clear. Further reviews could investigate the factors likely to modify donor rates, such as procedures for family involvement. The way in which families of any potential donor are approached is likely to be an important factor and a review of qualitative research examining the experience of relatives in this context would be useful.

Impact of presumed consent for organ donation on donation rates: a systematic review

Objectives To examine the impact of a system of presumed consent for organ donation on donation rates and to review data on attitudes towards presumed consent.Design Systematic review.Data sources Studies...

Patients’ refusal to consent to storage and use of samples in Swedish biobanks: cross sectional study

Objectives To estimate how many people object to storage of biological samples collected in health care in Sweden and to their use in research and how many withdraw previous consent.Design...

Legislation of Presumed Consent for End-Of-Life Organ Donation in the United Kingdom (UK): Undermining Values in a Multicultural Society

Legislation of Presumed Consent for End-Of-Life Organ Donation in the United Kingdom (UK): Undermining Values in a Multicultural Society

The organs crisis and the Spanish model: theoretical versus pragmatic considerations

In the United Kingdom, the debate about how best to meet the shortfall of organs for transplantation has persisted on and off for many years. It is often presumed that...

The problem of organ donation

The recent debate about organ donation was surprisingly heated. People complained about a ‘nanny state’ infringing on their post-mortem rights; some threatened to tear up their donor cards if the proposed change to an ‘opt-out’ system went ahead. ‘Opt out’ means presumed consent, or a legal system in which people no longer have to actively join the organ donor register (ODR) in order to become donors. Everyone is automatically treated as a potential donor, unless they actively opt-out. Supporters of presumed consent propose this system as a means of increasing the number of organs available for transplantation. Opponents say it violates their right to their body after their death. The government has recently appointed a taskforce to examine the proposed change to a presumed consent system, triggering a public debate about the pros and cons of presumed versus informed consent. This public debate, for all the strong emotions it arouses, has focused on the wrong issues. Moving to a presumed consent system is unlikely to produce the sorely-needed increase in the number of organs available for transplantation. The empirical evidence shows that opt-in (informed consent) and opt-out (presumed consent) typically yield similar results in terms of number of organs procured, so a change to opt-out will not in itself solve the problem of organ shortage. Instead of arguing about the type of legal system that ought to be in place, we should focus on investment in infrastructure, public education and organisational change, as these are the measures that will in fact increase the number of organs available for life-saving tran

Presumed consent for transplantation: a dead issue after Alder Hey?

In the wake of scandals about the unauthorised retention of organs following postmortem examination, the issue of valid consent (or the lack of it) has returned to the forefront. Emphasis...

Mandated choice. The preferred solution to the organ shortage?

A critical shortage of organs is perhaps the major barrier facing transplantation today. Adopting a system of presumed consent or mandated choice are among the solutions proposed. Under presumed consent, organs may be removed after death without explicit consent, unless the deceased had previously objected or the family objects at the time of death. Under mandated choice, all adults would be required to decide for themselves whether they wish to donate on their deaths and their decisions would be controlling. To see if educated young people would support these proposals, I carried out two surveys at the University of Maryland, College Park, Md, of a total of 418 students who were at least 18 years of age. An overwhelming 90% would support mandated choice while a smaller percentage, just over 60%, would support presumed consent. The vast majority believe that the family should not be able to override the previously expressed wishes of their recently deceased loved one. Unfortunately, only a minority of respondents had discussed organ donation with their families and even fewer had signed donor cards. Even young, educated people frequently fail to consider organ donation prospectively and this is a major barrier to organ retrieval. While presumed consent and mandated choice are designed to deal with this serious problem, mandated choice seems preferable and would likely receive widespread support. Therefore, I suggest that a small scale trial of mandated choice be undertaken as soon as possible in the hope of finding an acceptable system that will quickly and efficiently increase the supply of desperately needed organs.

Mandated Choice

A critical shortage of organs is perhaps the major barrier facing transplantation today. Adopting a system of presumed consent or mandated choice are among the solutions proposed. Under presumed consent, organs may be removed after death without explicit consent, unless the deceased had previously objected or the family objects at the time of death. Under mandated choice, all adults would be required to decide for themselves whether they wish to donate on their deaths and their decisions would be controlling.To see if educated young people would support these proposals, I carried out two surveys at the University of Maryland, College Park, Md, of a total of 418 students who were at least 18 years of age.An overwhelming 90% would support mandated choice while a smaller percentage, just over 60%, would support presumed consent. The vast majority believe that the family should not be able to override the previously expressed wishes of their recently deceased loved one. Unfortunately, only a minority of respondents had discussed organ donation with their families and even fewer had signed donor cards.Even young, educated people frequently fail to consider organ donation prospectively and this is a major barrier to organ retrieval. While presumed consent and mandated choice are designed to deal with this serious problem, mandated choice seems preferable and would likely receive widespread support. Therefore, I suggest that a small scale trial of mandated choice be undertaken as soon as possible in the hope of finding an acceptable system that will quickly and efficiently increase the supply of desperately needed organs.

Is Altruism Enough?: Required Request and the Donation of Cadaver Organs and Tissues in the United States

The lack of an adequate supply of cadaver organs and tissues for transplantation to those in need poses a major challenge to the transplant community and to those responsible for public policy. Historically, Americans have relied upon a combination of altruism and voluntarism to generate an adequate supply of cadaver organs and tissues. The ongoing shortage of organs and tissues has led, in recent years, for calls to abandon these values in favor of either a market system or a system of presumed consent. A survey of the impact of the federal and state laws that require that requests be made to next of kin for organ and tissue donation when a death occurs in a hospital setting shows that inadequate efforts have been made to implement these laws. Before abandoning altruism and voluntarism, health care professionals must insist that zealous efforts in education, enforcement, and coordination be made to implement these new laws and regulations.