The effect on consent rates for deceased organ donation in Wales after the introduction of an opt‐out system

Abstract

Summary Organ transplantation saves and transforms lives. Failure to secure consent for organ retrieval is widely regarded as the single most important obstacle to transplantation. A soft opt‐out system of consent for deceased organ donation was introduced into Wales in December 2015, whilst England maintained the existing opt‐in system. Cumulative data on consent rates in Wales were compared with those in England, using a two‐sided sequential procedure that was powered to detect an absolute difference in consent rates between England and Wales of 10%. Supplementary risk‐adjusted logistic regression analysis examined whether any difference in consent rates between the two nations could be attributed to variations in factors known to influence UK consent rates. Between 1 January 2016 and 31 December 2018, 8192 families of eligible donors in England and 474 in Wales were approached regarding organ donation, with overall consent rates of 65% and 68%, respectively. There was a steady upward trend in the proportion of families consenting to donation after brain death in Wales as compared with England and after 33 months, this reached statistical significance. No evidence of any change in the donation after circulatory death consent rate was observed. Risk‐adjusted logistic regression analysis revealed that by the end of the study period the probability of consent to organ donation in Wales was higher than in England ( OR [95% CI ] 2.1 [1.26–3.41]). The introduction of a soft opt‐out system of consent in Wales significantly increased organ donation consent though the impact was not immediate.

Will the unusual become usual? A new legal change that aims to increase discussions around organ and tissue donation in England

“…35 For example, the upward trend in the proportion of families consenting to donation after brain death in Wales as compared with England reached statistical significance 33 months after the Welsh law change. 36 However, this increase in consent has not been reflected in the quarterly donation figures reported. 35,36 This may be because there has been lower eligibility for organ donation since the legislative change; or perhaps the law change in Wales has not yet had enough time to make an impact.…”

“…36 However, this increase in consent has not been reflected in the quarterly donation figures reported. 35,36 This may be because there has been lower eligibility for organ donation since the legislative change; or perhaps the law change in Wales has not yet had enough time to make an impact. Any complex behaviour change intervention such as this requires public and professional buy-in, both of which can be influenced by the way in which the media presents information.…”

“…38 This is in keeping with the short-term data that we have from the recent law change in Wales. 35,36 Given that the law change itself may not make a difference in England, it is worth thinking about future avenues in education, public health and psychology that can enhance the impact of the new opt-out system.…”

The rise of organ donation after circulatory death: a narrative review

“…Deemed (presumed) consent and authorisation legislation will soon be in every nation of the UK, bar Northern Ireland. Statistical analysis carried out by NHS Blood and Transport (NHSBT), comparing the impact of deemed consent in Wales with England demonstrated that consent for DCD did not reach statistical significance, unlike DBD [27]. The authors speculated that DCD was less influenced by the legislation change due to differing family experiences of the two types of donation.…”

A Program of Research to Evaluate the Impact of Deceased Organ Donation Legislative Reform in Nova Scotia: The LEADDR Program

“…As in Nova Scotia, consent model reform is typically introduced as part of a broad healthcare system transformation, making it difficult to determine the isolated impact of deemed consent. 7 While some jurisdictions, including recent data from Wales, have shown a positive impact on donation rates with deemed consent systems, 8 another report analyzing data from 35 developed countries found no significant difference between the rates of donors per million population in countries with or without a deemed consent model. 7 Other studies have reported neutral and potentially negative impacts in the short-term, particularly on living donor rates.…”