In the Journals

‘Presumed consent’ policy may help improve organ donation in the US

Neehar Parikh

According to a recently published study, implementing a policy that requires citizens to “opt-out” of being an organ donor may help increase both the number of transplants performed and candidate life-years gained, especially for those awaiting kidney transplantation.

“Thousands of patients are dying yearly because of the organ shortage; one reason for that is the lack of organs,” Neehar Parikh, MD, MS, assistant professor and medical director of the Living Donor Liver Transplantation program at the University of Michigan, told Healio/Nephrology. “A presumed consent system has been postulated to alleviate some of this burden, but we lacked estimates on what the actual impact would be. The purpose of this analysis was to take the increases seen in other countries once presumed consent was instituted and see how that would impact the waitlist in the United States.”

Researchers used data from the Organ Procurement and Transplantation Network to develop a simulation model that included 524,359 candidates who were on the waitlist for at least one solid organ transplant between January 2004 and December 2014.

Based on published changes from a presumed consent policy in several countries (including Austria, Singapore and Spain), the number of organs available for donation and life-years gained were determined considering an increase in deceased donors of 5%, 15% or 25%.

Researchers found that, with a 5% increase in presumed consent-associated deceased donors, there would be a 3.2% reduction in removals from the waiting list due to death or illness for all organs when allocated randomly. Ideal allocation was associated with a mean removal reduction of 10.4%. A sensitivity analysis further demonstrated that while waiting list removals could be decreased up to 52%, this reduction was not enough to eliminate removals.

Regarding annual life-years gained, researchers saw the largest estimated increases for kidney transplant candidates. With a 5% increase in presumed consent-associated deceased donors, there were 3,440 to 3,466 years gained (a 15% increase was associated with 10,321 to 10,399 years and a 25% increase with 17,201 to 17,332 years). Liver transplant candidates gained 898 to 905 annual life years with a 5% increase; 2,693 to 2,714 years with a 15% increase and 4,448 to 4,523 years with a 25% increase.

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Implementing a policy that requires citizens to “opt-out” of being an organ donor may help increase both the number of transplants performed and candidate life-years gained.
Source: Adobe Stock

Finally, after accounting for the survival advantages associated with transplantation, it was determined that adoption of a presumed consent policy could result in annual gains of 4,295 to 11,387 life-years for all organs.

Since transplant waitlists continue to grow, Parikh believes presumed consent policy deserves continued evaluation, including further understanding of public opinion.

“Prior to considering implementation, several important details-- such as the opt-out process and ensuring there is enough capacity to procure the increase in organs-- will have to be thought through,” he said. “[In addition], implementation in select regions in the US prior to national roll-out would likely be necessary because of the considerable uncertainty as to how such a policy would affect organ donation rates. There are no easy fixes to our organ shortage problem at this time but policy shifts to increase donation, including presumed consent, should be explored.” – by Melissa J. Webb

Disclosure: Parikh reports no relevant financial disclosures.

Neehar Parikh

According to a recently published study, implementing a policy that requires citizens to “opt-out” of being an organ donor may help increase both the number of transplants performed and candidate life-years gained, especially for those awaiting kidney transplantation.

“Thousands of patients are dying yearly because of the organ shortage; one reason for that is the lack of organs,” Neehar Parikh, MD, MS, assistant professor and medical director of the Living Donor Liver Transplantation program at the University of Michigan, told Healio/Nephrology. “A presumed consent system has been postulated to alleviate some of this burden, but we lacked estimates on what the actual impact would be. The purpose of this analysis was to take the increases seen in other countries once presumed consent was instituted and see how that would impact the waitlist in the United States.”

Researchers used data from the Organ Procurement and Transplantation Network to develop a simulation model that included 524,359 candidates who were on the waitlist for at least one solid organ transplant between January 2004 and December 2014.

Based on published changes from a presumed consent policy in several countries (including Austria, Singapore and Spain), the number of organs available for donation and life-years gained were determined considering an increase in deceased donors of 5%, 15% or 25%.

Researchers found that, with a 5% increase in presumed consent-associated deceased donors, there would be a 3.2% reduction in removals from the waiting list due to death or illness for all organs when allocated randomly. Ideal allocation was associated with a mean removal reduction of 10.4%. A sensitivity analysis further demonstrated that while waiting list removals could be decreased up to 52%, this reduction was not enough to eliminate removals.

Regarding annual life-years gained, researchers saw the largest estimated increases for kidney transplant candidates. With a 5% increase in presumed consent-associated deceased donors, there were 3,440 to 3,466 years gained (a 15% increase was associated with 10,321 to 10,399 years and a 25% increase with 17,201 to 17,332 years). Liver transplant candidates gained 898 to 905 annual life years with a 5% increase; 2,693 to 2,714 years with a 15% increase and 4,448 to 4,523 years with a 25% increase.

#
Implementing a policy that requires citizens to “opt-out” of being an organ donor may help increase both the number of transplants performed and candidate life-years gained.
Source: Adobe Stock

Finally, after accounting for the survival advantages associated with transplantation, it was determined that adoption of a presumed consent policy could result in annual gains of 4,295 to 11,387 life-years for all organs.

Since transplant waitlists continue to grow, Parikh believes presumed consent policy deserves continued evaluation, including further understanding of public opinion.

“Prior to considering implementation, several important details-- such as the opt-out process and ensuring there is enough capacity to procure the increase in organs-- will have to be thought through,” he said. “[In addition], implementation in select regions in the US prior to national roll-out would likely be necessary because of the considerable uncertainty as to how such a policy would affect organ donation rates. There are no easy fixes to our organ shortage problem at this time but policy shifts to increase donation, including presumed consent, should be explored.” – by Melissa J. Webb

Disclosure: Parikh reports no relevant financial disclosures.

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