Dr Catriona McDaid and colleagues from the United Kingdom examined the impact of a system of presumed consent for organ donation on donation rates and to review data on attitudes towards presumed consent.
The research team conducted a systematic review of studies retrieved by online searches to 2008 of Medline, Medline In-Process, Embase, CINAHL, PsycINFO, HMIC, PAIS International, and OpenSIGLE.
The team identified 5 studies comparing donation rates before and after the introduction of legislation for presumed consent, termed the before and after studies.
The team noted that 8 studies compared donation rates in countries with and without presumed consent systems, termed the between country comparison studies.
|There were increases of 25% to 30% in organ donation|
|British Medical Journal|
The research team observed 13 surveys of public and professional attitudes to presumed consent.
The 5 before and after studies represented 3 countries.
All of these reported an increase in donation rates after the introduction of presumed consent, but there was little investigation of any other changes taking place concurrently with the change in legislation.
In the 4 best quality between country comparisons, presumed consent law or practice was associated with increased organ donation.
The team found increases of 25% to 30%, and 21% to 26% in organ donation, increasing from 3 more donors per million population to 6 more donors per million population in the 4 studies.
Other factors found to increase organ donation in at least one study were mortality from road traffic accidents and cerebrovascular causes, transplant capacity, and gross domestic product per capita.
In addition, the researchers found that health expenditure per capita, religion (Catholicism), education, public access to information, and a common law legal system influenced the decision to donate.
The 8 surveys of attitudes to presumed consent were of the UK public.
These surveys varied in the level of support for presumed consent, with surveys conducted before 2000 reporting the lowest levels of support.
The most recent survey, in 2007, reported that 64% of respondents supported a change to presumed consent.
Dr McDaid’s team concludes, “Presumed consent alone is unlikely to explain the variation in organ donation rates between countries.”
“Legislation, availability of donors, organisation and infrastructure of the transplantation service, wealth and investment in health care, and public attitudes to and awareness of organ donation may all play a part, but their relative importance is unclear.”
“Recent UK surveys show support for presumed consent, though with variation in results that may reflect differences in survey methods.”