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Presumed consent only way to get more organs

Organ donation rates will only improve with a policy of presumed consent

OnMedica staff

Thursday, 06 May 2010

Experts have accused the Organ Donor Taskforce of being unrealistic in thinking that donation rates can increase sufficiently without adopting a policy of presumed consent. They argue in their Comment on bmj.com that “the taskforce did not consider all the relevant evidence, particularly on relatives’ refusal rates, and that the current policy, however reinforced, will not substantially increase the number of organs available.”

Gordon Brown commissioned the taskforce in 2008 to assess the impact of an opt-out system – presumed consent – on organ donation rates.

Authors of the Comment, Sheila Bird from the MRC Biostatistics Unit in Cambridge and John Harris from the Institute for Science, Ethics and Innovation in Manchester, say that in the late 1980s, about 70% of relatives gave consent for organ donation, and, although the rate has since fallen, it is still about 60%. They point out that this is still much higher than the current opt-in rate to the organ donor register.

They demonstrated by modelling different scenarios, that only a policy of presumed consent will substantially increase the number of donor organs available for transplantation.

Using data from the past 20 years, the assessment team analysed the effect of four scenarios to determine how many extra transplants could have been carried out over a 10-year period. The scenarios included an opt-in policy as at present but with a reduced refusal rate of 30%; a presumed consent system with an opt-out rate ranging from 5-10%; and finally a mandatory donation system.

Based on these scenarios the researchers calculate that there could have been up to 2,880 extra solid organ donors. Changing the presumption, they say, has the potential to deliver 68% of the extra solid organ donors that mandatory donation would provide.

However, the authors believe that the taskforce in its report has misreported their assessment team’s findings. The report referred to “apparent correlation” between presumed consent and donation rates, whereas the researchers had explicitly said that the association was not necessarily causal.

They say the taskforce also failed “to exploit the UK’s potential donor audit to measure, under different scenarios, the additional number of kidney, pancreatic, liver, heart and thoracic transplantations that there could have been in the past 10 years from donations after brain stem death.”

They conclude: “Twenty years after the UK’s first confidential audit, we continue to jeopardise substantial quality adjusted life years (uncounted by the Organ Donor Taskforce) for those awaiting transplantation by chasing a holy grail of enhanced consent by means other than presumption. Presumed consent, even allowing for over-rule by relatives, should ultimately cut costs, add life, and save bereaved families from anxious, as well as generous, deliberation in extremis.”

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