Comparative report on transplantation and relevant ethical problems in five European countries, and some reflections on Japan

Abstract

Comparison of transplantation medicine in Sweden, Denmark, Germany, Spain and Portugal reveals many and important differences with respect to frequency of transplantations, frequency of life donations, legal regulations and influence of the family on organ donation. The differences observed are at least partly related to cultural and value differences between the various countries, but many questions need to be studied systematically and in more detail before useful conclusions can be drawn. One study would have to address the problem of how differences in the family influence on organ donation can be explained. Another question needing further clarification concerns the exact meaning of "medical decision" and "medical criteria" because these terms, on which access to-and selection from the waiting list largely depends, are equivocally defined and seem to differ according to different traditions. Open questions also arise with respect to the influence of "closeness or distance" on medical decision making. The findings indicate that it would be premature to propose common guidelines to be observed within Europe as long as the above mentioned and some further questions have not been systematically studied and thoroughly analyzed.

German citizens in southeastern Spain: a study of attitude toward organ donation

“…However, deceased organ donation rates in these countries vary considerably (6). These variations have been attributed, among other factors, to mainly cultural differences (7). Thus, in the year 2000, Fleischhauer et al.…”

“…Thus, in the year 2000, Fleischhauer et al. (7) presented a study about donation and transplantation carried out in five European countries (Sweden, Denmark, Germany, Spain and Portugal), indicating that the differences observed were partly related to cultural differences. If this is really the case, in Spain we are in danger of experiencing a decrease in our donation rates due to the arrival of a considerable number of citizens from other countries (8).…”

Emigration from the British Isles to Southeastern Spain: A Study of Attitudes Toward Organ Donation

“…However, it has been seen that donation rates in these countries are very disparate (12). These differences have been attributed, among other factors, mainly to cultural differences (9). However, although populational studies about attitude toward organ donation (10–11) provide disparate acceptance rates according to the country, there are generally favorable attitudes in different European countries, with rates ranging from between 65% and 90%.…”

The impact of presumed consent laws and institutions on deceased organ donation

“…The estimation results detect a sizeable but lower impact of potential donor pool on deceased donation rates than previously predicted. 9 Column (3) shows that presumed consent countries exhibit 5.3 percent higher deceased donation rates on average compared to informed consent countries after accounting for total per capita health expenditure, death rates caused by cerebro vascular diseases, motor vehicle accidents and homicides, civil rights and liberties and legal systems, whose coefficients are statistically significantly different from zero at conventional levels. 10 The impact of presumed consent laws on deceased donation can be challenged by the fact that significant variations in deceased donation rates are accounted by the way consent laws are practiced and not only by the legal framework.…”

“…The reason is that without country-specific effects, the consent legislation variable soaks up most of the explanatory power of the unobserved heterogeneity and shows a higher-than-otherwise impact of presumed consent laws. 9 The control of supply measures for donation policy purposes creates a paradox in organ collection because the promotion of deceased donation through continuous education and awareness programs contradicts policies that aim to reduce the prevalence of motor vehicle accidents and hand-gun crimes by raising awareness [2]. Recently, Dickert-Conlin et al [7] found that organ donations due to motor vehicle accidents increase by 10 percent following helmet law repeals and that a nationwide elimination of helmet laws in the US would increase the annual supply of organ donors by less than 1 percent.…”