Estimated Association Between Organ Availability and Presumed Consent in Solid Organ Transplant

DeRoos, Luke J; Marrero, Wesley J.; Tapper, Elliot B.; Sonnenday, Christopher J.; Lavieri, Mariel S.; Hutton, David; Parikh, Neehar D.

doi:10.1001/jamanetworkopen.2019.12431

Cited by 21 publications

(24 citation statements)

References 35 publications

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“…Fourth, this study assesses the quality of OP policies by focusing only on their capacity to preserve and promote societal values. It does not address the question of the effectiveness of presumptive policies, which has been extensively explored elsewhere [ 28 , 29 ]. As health policies attempt to foster optimal results while minimally compromising people’s interest, future research that combines both approaches would be much welcomed.…”

Section: Discussionmentioning

confidence: 99%

Governance quality indicators for organ procurement policies

et al. 2021

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Background 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 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. Results 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. Conclusion 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.

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Section: Discussionmentioning

confidence: 99%

Governance quality indicators for organ procurement policies

et al. 2021

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“…Most recent academic publications in this domain conclude that changes in donor numbers cannot be attributed to the organ donation system alone. [13][14][15][16][17] They contend that other factors at multiple health system and population levels require consideration.…”

Section: Overview Of Main Argumentsmentioning

confidence: 99%

Assessing Global Organ Donation Policies: Opt-In vs Opt-Out

Etheredge

2021

RMHP

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This paper argues that there is little difference between opt-in and opt-out organ donation systems for increasing donor numbers when used in isolation. Independently diverting to an opt-out system confers no obvious advantage and can harm efforts to bolster donations. Rather, it is essential to address barriers to organ donation on several levels along with a switch in system. Moreover, for many countries, it may be more beneficial to adequately capacitate the donation system already in place, rather than entertain a significant change with its attendant resource requirements. For decades, the international transplant community has been involved in vigorous debate as to the merits of moving from default opt-in systems to opt-out policies to grow organ donor numbers and better meet the everincreasing demand for lifesaving transplants. Opt-out is certainly en vogue, with Wales, England and Nova Scotia recently switching over, Scotland due to become opt-out in March 2021 and Northern Ireland and Canada seriously considering a similar move. Thanks to several countries making the switch from opt-in to opt-out over the last 20-30 years, there are sets of robust longitudinal data that aid in analysing the efficacy of donation systems. However, these data are often contradictory and largely inconclusive, suggesting other factors may be in play. This paper reviews some emerging trends in opt-in versus opt-out organ donation policies and considers recent data that elucidates some of the main contentions across each. Ethical frameworks underpinning donation systems, such as informed consent, trust and transparency, are discussed in detail. Substantial time is also devoted to opt-in vs opt-out systems in developing countries, which tend to be excluded from many analyses, and where the challenges faced are magnified by socio-economic constraints. This constitutes a major gap in recently published literature, as developing countries often lag far behind their developed counterparts in donor and transplant numbers.

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“…To illustrate the potential impact of our findings, if we were to assume that everything held constant over time and we introduced our best-performing intervention (reciprocal altruism) throughout Ontario, we could expect roughly 225,000 additional new registrations annually. While quantifying the effect of increased registrations on the ultimate goal-lives saved or enhanced-is challenging (see, e.g., DeRoos et al 2019), research has shown that those who register their consent are significantly more likely to actually donate than those who have not (Christmas et al 2008). Specifically, the majority of registered individuals in Ontario who become eligible to donate are ultimately converted to donors (Toews and Caulfield 2016), and Ontario's Trillium Gift of Life Network (2020) advertises that one single donor may save up to eight lives and enhance as many as 75 more lives.…”

Section: Conclusion and Policy Recommendationsmentioning

confidence: 99%

Increasing Organ Donor Registrations with Behavioral Interventions: A Field Experiment

Robitaille¹,

Mažar²,

Tsai³

et al. 2021

Journal of Marketing

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Although prior research has advanced our understanding of the drivers of organ donation attitudes and intentions, little is known about how to increase actual registrations within explicit consent systems. Some empirical evidence suggests that costly, labor intensive educational programs and mass media campaigns might increase registrations. However, they are neither scalable nor economical solutions. To address these limitations, the authors conducted a field experiment (N = 3,330) in Ontario, Canada testing the effectiveness of behaviorally informed promotion interventions as well as process improvements. They find intercepting customers with materials targeting information and altruistic motives at the right time, along with streamlining customer service, significantly increased registrations. Specifically, the best performing intervention, prompting perspective-taking through reciprocal altruism (“ If you needed a transplant would you have one?”), significantly increased new registration rates from 4.1% in the control condition to 7.4%. The authors followed up with seven posttests (Total N = 3,376) to find support for their theoretical predictions and to explore the mechanisms through which the interventions may have operated. This paper provides evidence for low-cost, scalable marketing solutions that increase organ donor registrations in a prompted choice context and has important implications for public policy and enhancing societal welfare.

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Estimated Association Between Organ Availability and Presumed Consent in Solid Organ Transplant

Cited by 21 publications

References 35 publications

Governance quality indicators for organ procurement policies

Governance quality indicators for organ procurement policies

Assessing Global Organ Donation Policies: Opt-In vs Opt-Out

Increasing Organ Donor Registrations with Behavioral Interventions: A Field Experiment

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