Geographic Variation in Organ donation

Geographic Variation In Organ Donation

Introduction

There is currently an insufficient supply of donor organs to meet the demand for organ transplantations in the United Kingdom and worldwide. The UK active transplant waiting list is increasing by about 8% a year, and the ageing population and increasing incidence of type 2 diabetes are likely to exacerbate the shortage of available organs . There were 13.2 dead organ donors per million population in the UK, substantially lower than in several other European countries and especially Spain, which had a rate of 34.3 per million population for the same year. In UK Organ Donation Taskforce was established with the task of identifying barriers to donation and making recommendations for increasing organ donation and procurement within the current legal framework. An explicit or informed consent system operates in the UK and requires that individuals authorise organ removal after death by carrying a donor card or joining a national registry. An overhaul of UK transplant services is planned following the taskforce's recommendations.1 These included establishing a UK-wide organisation to identify and allocate organs, doubling the number of transplant coordinators, having an organ donation "champion" in each hospital trust, and improving the processes for identifying potential donors and the monitoring of donation activity in all hospitals .

Geographical Data

Several countries, including Spain, Austria, and Belgium, have opted for a change in legislation and introduced presumed consent, whereby organs can be used for transplantation after death unless individuals have objected during their lifetime (an opt out system). Countries vary in how organ donation legislation functions in practice, and the terms "hard" and "soft" have been used to characterise how much emphasis is placed on relatives' views in these countries. For example, in Spain the presumed consent law is "soft" in that doctors take active measures to ascertain that the next of kin do not object to organ recovery. In Austria the presumed consent law is relatively "hard" in that organ recovery proceeds unless it is known that the deceased objected before death, and the views of relatives are not actively sought.

In the UK debate has been developing around different systems of consent, with support from the chief medical officer for a presumed consent system. The UK Organ Donation Taskforce was asked to investigate the impact of an opt out system, and its recommendations were published in November 2008. To inform the work of the taskforce, a systematic review was commissioned of the best available evidence of the effect of presumed consent legislation on organ donation rates. A secondary objective was to assess the literature on public attitudes to presumed consent.

Given the diversity of the studies investigating the impact of presumed consent, we undertook a narrative synthesis. Studies were grouped based on study design, and the results were interpreted in the context of their methodological strengths and weaknesses and any contextual factors that might affect outcomes. The data from surveys were synthesised, taking into account issues of importance identified during the quality ...