1
|
O’Neill S, Thomas K, McLaughlin L, Boadu P, Williams L, Al-Haboubi M, Bostock J, Noyes J, Mays N. Trends in organ donation in England, Scotland and Wales in the context of the COVID-19 pandemic and 'opt-out' legislation. PLoS One 2024; 19:e0306541. [PMID: 39083454 PMCID: PMC11290620 DOI: 10.1371/journal.pone.0306541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 06/18/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND In May 2020, England implemented soft 'opt-out' or 'deemed consent' for deceased donation with the intention of raising consent rates. However, this coincided with the COVID-19 pandemic, making it difficult to assess the early impact of the law change. Wales and Scotland changed their organ donation legislation to implement soft opt-out systems in 2015 and 2021 respectively. This study provides a descriptive analysis of changes in consent and transplant rates for deceased organ donation in England, Scotland and Wales. METHODS Logistic regression and descriptive trend analysis were employed to assess the probability of a patient who died in critical care becoming a donor, and to report consent rates using data, respectively, from the Intensive Care National Audit and Research Centre (ICNARC) in England from 1 April 2014 to 30 September 2021, and from the Potential Donor Audit for England, Scotland and Wales from April 2010 to June 2023. RESULTS The number of eligible donors in April-June 2020 were 56.5%, 59.3% and 57.6% lower in England, Scotland and Wales relative to April-June 2019 (pre-pandemic). By April-June 2023, the number of eligible donors had recovered to 87.4%, 64.2% and 110.3%, respectively, of their levels in 2019. The consent rate in England, Scotland and Wales reduced from 68.3%, 63.0% and 63.6% in April-June 2019 to 63.2%, 60.5% and 56.3% in April-June 2023. CONCLUSIONS While the UK organ donation system shows signs of recovery from the COVID-19 pandemic, the number of eligible potential donors and consent rates remain below their pre-pandemic levels.
Collapse
Affiliation(s)
- Stephen O’Neill
- Department of Health Services Research and Policy, Policy Innovation and Evaluation Research Unit, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Karen Thomas
- Clinical Research and Development, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Leah McLaughlin
- School of Medical and Health Sciences, Bangor University, Bangor, United Kingdom
| | - Paul Boadu
- Department of Health Services Research and Policy, Policy Innovation and Evaluation Research Unit, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Lorraine Williams
- Department of Health Services Research and Policy, Policy Innovation and Evaluation Research Unit, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Mustafa Al-Haboubi
- Department of Health Services Research and Policy, Policy Innovation and Evaluation Research Unit, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jennifer Bostock
- Department of Health Services Research and Policy, Policy Innovation and Evaluation Research Unit, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jane Noyes
- School of Medical and Health Sciences, Bangor University, Bangor, United Kingdom
| | - Nicholas Mays
- Department of Health Services Research and Policy, Policy Innovation and Evaluation Research Unit, London School of Hygiene and Tropical Medicine, London, United Kingdom
| |
Collapse
|
2
|
Long-Sutehall T, Bracher M, Mollart S, Wale J. Eye donation from palliative and hospice care contexts: the EDiPPPP mixed-methods study. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2023; 11:1-159. [PMID: 37929829 DOI: 10.3310/kjwa6741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
Background Over 2 million people in the United Kingdom are living with sight loss with costs to the United Kingdom economy reported as £4.34 billion annually. Conditions that lead to sight loss and impaired vision can be treated if eye tissue is available for corneal transplantation, reconstructive surgery and research into eye diseases. Supply of eye tissue (only available via eye donation) is currently insufficient to meet demand; therefore, new routes are needed. Hospice and hospital-based Palliative Care Services have been reported as potential donation sources of this tissue. Objectives To: (1) scope the size and clinical characteristics of the potential eye donation population from research sites; (2) map the donation climate of each research site; (3) identify factors that enable or challenge service providers to consider the option of eye donation from a local and national perspective; (4) identify service users' views regarding the option of eye donation and the propriety of discussing eye donation; and (5) develop and pilot an empirically based intervention designed to change behaviours in relation to eye donation. Design A 36-month mixed-methods, multicentre study undertaking three work packages. Settings Three hospice care and three hospital-based palliative care services situated in the North, Midlands and the South of England (one service of each type per region). Participants Work package 1 - 105 service providers. Work package 2 - 62 service users, and 156 service providers in the national survey. Work package 3 - 21 expert consultees (patient and public involvement, cross discipline). Data sources Scoping review, retrospective note review, qualitative interviews/focus groups, participant observation, secondary analysis of primary data, national survey, transparent expert consultation. Results Potential: The retrospective notes review demonstrated that of 1199 deceased patients' notes, 553 (46%) patients met the criteria for eye donation (56%, n = 337 in hospice care service settings and 36%, n = 216 in hospital palliative care service). Practice: Less than 4% of all cases agreed as eligible for donation had been approached or referred for eye donation. Eye donation is not currently an embedded practice at local and national levels. Perceptions: Service providers were motivated to discuss eye donation but lacked opportunity and capability. Service users were willing and able to hold conversations about eye donation but were not aware of the option and had not had the option discussed with them. Preferences: Service users wanted to be offered the option of eye donation, and service providers wanted bespoke education and training related to eye donation. Evaluation of the developed intervention STEPS - Support Toolkit for Eye donation in Palliative care Settings will follow implementation of the full intervention (expected to begin in October 2022). Limitations Due to the significant impact of the COVID-19 pandemic on clinical sites, partner organisations and national service providers, only two elements of the developed intervention have been pilot tested for proof of concept and the response rate to the national survey was low (8%). Conclusions Significant potential exists for eye donation from hospice care and hospital palliative care services; however, individual and organisational behaviour as well as information system-based changes are needed to maximise this potential. Future work Evaluation of the STEPS - Support Toolkit for Eye donation in Palliative care Settings; Research exploring the wider public knowledge and views regarding eye donation; research exploring the use of language by National Health Service Blood and Transplant-Tissue and Eye Services in their public-facing infographics, communications and campaigns (specifically the use of the term eye donation). Trial registration This trial is registered as ISRCTN14243635: Eye donation from palliative care and hospice care settings. Funding details This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (17/49/42) and will be published in full in Health and Social Care Delivery Research; Vol. 11, No. 20. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
| | - Mike Bracher
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Sarah Mollart
- West Suffolk Hospital NHS Foundation Trust, Suffolk, UK
| | - Jane Wale
- Milton Keynes University Hospital NHS Foundation Trust, Eaglestone, UK
| |
Collapse
|
3
|
Molina-Pérez A, Rodríguez-Arias D, Delgado J. Differential impact of opt-in, opt-out policies on deceased organ donation rates: a mixed conceptual and empirical study. BMJ Open 2022; 12:e057107. [PMID: 36441113 PMCID: PMC9462118 DOI: 10.1136/bmjopen-2021-057107] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES To increase postmortem organ donation rates, several countries are adopting an opt-out (presumed consent) policy, meaning that individuals are deemed donors unless they expressly refused so. Although opt-out countries tend to have higher donation rates, there is no conclusive evidence that this is caused by the policy itself. The main objective of this study is to better assess the direct impact of consent policy defaults per se on deceased organ recovery rates when considering the role of the family in the decision-making process. This study does not take into account any indirect effects of defaults, such as potential psychological and behavioural effects on individuals and their relatives. DESIGN Based on previous work regarding consent policies, we created a conceptual model of the decision-making process for deceased organ recovery that included any scenario that could be directly influenced by opt-in or opt-out policies. We then applied this model to internationally published data of the consent process to determine how frequently policy defaults could apply. MAIN OUTCOME MEASURES We measure the direct impact that opt-in and opt-out policies have per se on deceased organ recovery. RESULTS Our analysis shows that opt-in and opt-out have strictly identical outcomes in eight out of nine situations. They only differ when neither the deceased nor the family have expressed a preference and defaults therefore apply. The direct impact of consent policy defaults is typically circumscribed to a range of 0%-5% of all opportunities for organ recovery. Our study also shows that the intervention of the family improves organ retrieval under opt-in but hinders it under opt-out. CONCLUSIONS This study may warn policy makers that, by emphasising the need to introduce presumed consent to increase organ recovery rates, they might be overestimating the influence of the default and underestimating the power granted to families.
Collapse
Affiliation(s)
- Alberto Molina-Pérez
- Instituto de Estudios Sociales Avanzados (IESA), Consejo Superior de Investigaciones Científicas (CSIC), Cordoba, Spain
- FiloLab-UGR Scientific Unit of Excellence, Department of Philosophy 1, University of Granada, Granada, Spain
- Ethical, Legal and Psychosocial Aspects of Transplantation (ELPAT), European Society for Organ Transplantation, Padua, Italy
| | - David Rodríguez-Arias
- FiloLab-UGR Scientific Unit of Excellence, Department of Philosophy 1, University of Granada, Granada, Spain
- Ethical, Legal and Psychosocial Aspects of Transplantation (ELPAT), European Society for Organ Transplantation, Padua, Italy
| | - Janet Delgado
- FiloLab-UGR Scientific Unit of Excellence, Department of Philosophy 1, University of Granada, Granada, Spain
- Ethical, Legal and Psychosocial Aspects of Transplantation (ELPAT), European Society for Organ Transplantation, Padua, Italy
| |
Collapse
|
4
|
Midtgaard SF, Albertsen A. Opt-Out to the Rescue: Organ Donation and Samaritan Duties. Public Health Ethics 2021. [DOI: 10.1093/phe/phab010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Abstract
Deceased organ donation is widely considered as a case of easy rescue―that is, a case in which A may bestow considerable benefits on B while incurring negligent costs herself. Yet, the policy implications of this observation remain unclear. Drawing on Christopher H. Wellman’s samaritan account of political obligations, the paper develops a case for a so-called opt-out system, i.e., a scheme in which people are defaulted into being donors. The proposal’s key idea is that we may arrange people’s options in specific ways for the sake of others.
Collapse
|
5
|
Naghavi N, Mubarik MS, Rasiah R, Sharif Nia H. Prioritizing Factors Affecting Deceased Organ Donation in Malaysia: Is a New Organ Donation System Required? Int J Gen Med 2020; 13:641-651. [PMID: 32982381 PMCID: PMC7507418 DOI: 10.2147/ijgm.s253372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 08/26/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose The gap between the demand and the supply of human organs for transplantation is on the rise in Malaysia, despite the efforts of governments to promote donor registration. Factors affecting willingness to donate are contextual and vary from country to country. This research mainly focuses on the selection of most suitable organ donation system through factors affecting willingness to donate in Malaysia. The objectives of this study are to prioritize those factors acting as the pillars of the organ donation system and further to select the most suitable organ donation system for Malaysia. Patients and Methods The data were collected from 35 experts by using a bipolar questionnaire. The study applied an analytical hierarchal process (AHP) for prioritization factors contributing to willingness to donate and then selection of a suitable organ donation system based on prioritized factors. Results Based on the AHP results, it is evident that donation perception (0.36) has the highest priority in influencing organ donation rates, followed by socioeconomic status (0.32), demographic factors (0.23), and financial incentives (0.09). Further, our results challenge the existing opt-in donation system in Malaysia and present a presumptive approach as a suitable system for increasing deceased donation rate in Malaysia. Presumptive approach promotes the role of health-care professionals in securing the family consent. Conclusion This approach is a person-oriented rather than process-oriented strategy and it relies on designated requesters' skills to evoke altruism among bereaved families. Based on results, the authors recommended that relevant government agencies focus on training nurses to discuss donation with bereaved families and raising public awareness.
Collapse
Affiliation(s)
- Navaz Naghavi
- Faculty of Business & Law, Taylor's Business School, Taylor's University, Lakeside Campus, Subang Jaya 47500, Selangor, Malaysia
| | - Muhammad Shujaat Mubarik
- Faculty of Business Administration & Social Sciences, Mohammad Ali Jinnah University, Karachi 7500, Pakistan
| | - Rajah Rasiah
- Asia-Europe Institute, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Hamid Sharif Nia
- Department of Nursing, Mazandaran University of Medical Science, Sari, Iran
| |
Collapse
|
6
|
Chan HY. Remapping the organ donation ethical climate: a care ethics consideration. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2020; 23:295-308. [PMID: 31811525 DOI: 10.1007/s11019-019-09934-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Organ donation has gained much attention as the need for transplant exceeds the supply of organs. Various proposals have been put forward to address the organ shortage challenge, ranging from offering incentives to donors, addressing family refusals to donations and instituting presumed consent laws. Presumed consent as the favoured approach has not been universally effective in increasing actual transplants despite its appeal. Few considerations have been given to the broader ethical climate influencing the organ donation debate. This paper examines the ethical climate surrounding organ donation and identifies the challenges existing within such environments. It explores care ethics and its application to the donation system, demonstrating how it can influence the organ donation phases. The conclusion drawn from the analysis is that a caring ethical climate in the pre, during and post-transplant system respects donor autonomy, addresses family reluctance to agree to donation, facilitates the needs of the donee and creates an environment that promotes non-maleficence for all stakeholders.
Collapse
|
7
|
Shaw DM. The side effects of deemed consent: changing defaults in organ donation. JOURNAL OF MEDICAL ETHICS 2019; 45:435-439. [PMID: 31230037 DOI: 10.1136/medethics-2019-105482] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 05/20/2019] [Accepted: 05/22/2019] [Indexed: 06/09/2023]
Abstract
In this Current Controversy article, I describe and analyse the imminent move to a system of deemed consent for deceased organ donation in England and similar planned changes in Scotland, in light of evidence from Wales, where the system changed in 2015. Although the media has tended to focus on the potential benefits and ethical issues relating to the main change from an opt-in default to an opt-out one, other defaults will also change, while some will remain the same. Interaction of these other defaults with the principal one raise several ethical issues that may complicate efforts to use deemed consent to increase donation rates. Most significantly, changing the main default will have the effect of changing the default for patients' families, who play a vital role in the consent process.
Collapse
Affiliation(s)
- David M Shaw
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
- Department of Health, Ethics and Society, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| |
Collapse
|
8
|
Prabhu PK. Is presumed consent an ethically acceptable way of obtaining organs for transplant? J Intensive Care Soc 2019; 20:92-97. [PMID: 31037100 PMCID: PMC6475984 DOI: 10.1177/1751143718777171] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The near-universal acceptance of cadaveric organ donation has been based on the provision of explicit consent by the donor while alive, either in the form of a formal opt-in or informal discussion of wishes with next of kin. Despite the success of transplantation programmes based on explicit consent, the ongoing imbalance between demand and supply of organs for transplantation has prompted calls for more widespread introduction of laws validating presumed consent with facility for opt-out as a means of increasing organ availability. The Department of Health (UK) has recently concluded a consultation on the introduction of such a law for England. This article explores the debate on presumed consent from an ethical point of view and summarises the key arguments on both sides of the ethical divide.
Collapse
|
9
|
Jensen AMB, Larsen JB. The public debate on organ donation and presumed consent in Denmark: Are the right issues being addressed? Scand J Public Health 2019; 48:480-485. [PMID: 30973069 DOI: 10.1177/1403494819833797] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The legal framework for organ donation in Denmark is informed consent. But due to the unsatisfactory number of organ donors, Denmark is considering changing legislation to presumed consent. This article discusses the public debate on organ donation and presumed consent in Denmark, and asks whether the right issues are being addressed in the quest towards more available organs and better donor rates? Basing our considerations on the various arguments in the debate and on scientific findings, we question the potential benefits of presumed consent and challenge some of the assumptions and rationalizations that characterize the discussions in Denmark regarding public support, public trust and the role of the family in donation decisions.
Collapse
Affiliation(s)
- Anja M B Jensen
- Centre for Medical Science and Technology Studies, University of Copenhagen, Denmark
| | - Johanne Bjørg Larsen
- Centre for Medical Science and Technology Studies, University of Copenhagen, Denmark
| |
Collapse
|
10
|
Janssens U, Michels G, Karagiannidis C, Riessen R, Busch HJ, Welte T, Werdan K, Buerke M, John S, Kluge S. [Presumed consent for organ donation? : A survey among members of the German Society of Medical Intensive Care and Emergency Medicine]. Med Klin Intensivmed Notfmed 2019; 115:239-244. [PMID: 30969352 DOI: 10.1007/s00063-019-0579-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 02/26/2019] [Accepted: 03/01/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Since 2010, the number of organ donations has decreased by 30% in Germany; however, stricter organizational structures in clinics and improved payment for hospital services associated with organ removal should increase the current decline in the number of organ donations in Germany. In addition, the Federal Minister of Health proposed introduction of the double presumed consent solution for organ donation. This proposal is currently being discussed very controversially. Against this background, we conducted an online survey of all members of the German Society of Medical Intensive Care and Emergency Medicine (DGIIN) in order to evaluate the attitude towards organ donation. METHOD The present work is an anonymous online survey among the members of DGIIN, which took place from 10-23 September 2018. In addition to a few demographic queries, the personal opinion on the regulation of organ donation was collected. RESULTS A total of 1019 (51.9%) of 1964 invited DGIIN members took part at the survey: 79.3% of the participants were male; average age 47.5 ± 11.2 years; 97.7% were physicians, of whom 89.2% were specialists and 62.7% had the additional degree in critical care; 20.6% voted for the current decision-making solution, 43.1% for the presumed consent, 33.1% for the double presumed consent, whereas 3.2% of the respondents were uncertain in their decision. CONCLUSION A clear majority of the surveyed members of DGIIN support the concept of presumed consent.
Collapse
Affiliation(s)
- U Janssens
- Klinik für Innere Medizin, St.-Antonius Hospital, Dechant-Deckers-Str. 8, 52249, Eschweiler, Deutschland.
| | - G Michels
- Klinik III für Innere Medizin, Universitätsklinikum Köln, Köln, Deutschland
| | - C Karagiannidis
- Lungenklinik Köln-Merheim, Kliniken der Stadt Köln, Klinikum der Universität Witten/Herdecke, Köln, Deutschland
| | - R Riessen
- Internistische Intensivstation, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - H-J Busch
- Universitäts-Notfallzentrum, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - T Welte
- Klinik für Pneumologie, Medizinische Hochschule Hannover, Hannover, Deutschland
- Deutsches Zentrum für Lungenforschung (DZL), Gießen, Deutschland
| | - K Werdan
- Klinik und Poliklinik für Innere Medizin III, Universitätsklinikum Halle (Saale), Martin-Luther-Universität Halle-Wittenberg, Halle, Deutschland
| | - M Buerke
- Klinik für Kardiologie, Angiologie und internistische Intensivmedizin, Marien Kliniken, Siegen, Deutschland
| | - S John
- Klinik für Innere Medizin, Universitätsklinik, Paracelsus Medizinische Privatuniversität Nürnberg, Nürnberg, Deutschland
| | - S Kluge
- Klinik für Intensivmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| |
Collapse
|
11
|
Arshad A, Anderson B, Sharif A. Comparison of organ donation and transplantation rates between opt-out and opt-in systems. Kidney Int 2019; 95:1453-1460. [PMID: 31010718 DOI: 10.1016/j.kint.2019.01.036] [Citation(s) in RCA: 103] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 12/10/2018] [Accepted: 01/10/2019] [Indexed: 12/16/2022]
Abstract
Studies comparing opt-out and opt-in approaches to organ donation have generally suggested higher donation and transplantation rates in countries with an opt-out strategy. We compared organ donation and transplantation rates between countries with opt-out versus opt-in systems to investigate possible differences in the contemporary era. Data were analysed for 35 countries registered with the Organisation for Economic Co-operation and Development (17 countries classified as opt-out, 18 classified as opt-in) and obtained organ donation and transplantation rates for 2016 from the Global Observatory for Donation and Transplantation. Compared to opt-in countries, opt-out countries had fewer living donors per million population (4.8 versus 15.7, respectively) with no significant difference in deceased donors (20.3 versus 15.4, respectively). Overall, no significant difference was observed in rates of kidney (35.2 versus 42.3 respectively), non-renal (28.7 versus 20.9, respectively), or total solid organ transplantation (63.6 versus 61.7, respectively). In a multivariate linear regression model, an opt-out system was independently predictive of fewer living donors but was not associated with the number of deceased donors or with transplantation rates. Apart from the observed difference in the rates of living donation, our data demonstrate no significant difference in deceased donation or solid organ transplantation activity between opt-out versus opt-in countries. This suggests that other barriers to organ donation must be addressed, even in settings where consent for donation is presumed.
Collapse
Affiliation(s)
- Adam Arshad
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Benjamin Anderson
- Department of Nephrology and Transplantation, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK
| | - Adnan Sharif
- Department of Nephrology and Transplantation, Queen Elizabeth Hospital, Edgbaston, Birmingham, UK; Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK.
| |
Collapse
|
12
|
Parsons JA. Ensuring appropriate assessment of deemed consent in Wales. JOURNAL OF MEDICAL ETHICS 2019; 45:210. [PMID: 30061170 DOI: 10.1136/medethics-2018-104935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 07/06/2018] [Indexed: 06/08/2023]
Abstract
Albertsen, in his recent article, offers an assessment of the recently introduced opt-out system for organ donation in Wales. However, he focuses on whether concerns raised prior to the enactment of the new system have been realised, rather than any positive impact on the number of actual donors. This side-lining of the main issue has resulted in a strangely positive portrayal of a system that has not yet yielded the results hoped for. Further, his failure to examine data over a number of years-instead opting for just 2-fails to even provide a fair assessment of the concerns he acknowledges.
Collapse
|
13
|
Albertsen A. Assessing deemed consent in Wales - the advantages of a broad difference-in-difference design. JOURNAL OF MEDICAL ETHICS 2019; 45:211-212. [PMID: 30072484 DOI: 10.1136/medethics-2018-105015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Accepted: 07/12/2018] [Indexed: 06/08/2023]
|
14
|
Weiss J, Elmer A, Béchir M, Brunner C, Eckert P, Endermann S, Lenherr R, Nebiker M, Tisljar K, Haberthür C, Immer FF. Deceased organ donation activity and efficiency in Switzerland between 2008 and 2017: achievements and future challenges. BMC Health Serv Res 2018; 18:876. [PMID: 30458762 PMCID: PMC6247533 DOI: 10.1186/s12913-018-3691-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 11/05/2018] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Various actions have been taken during the last decade to increase the number of organs from deceased donors available for transplantation in Switzerland. This study provides an overview on key figures of the Swiss deceased organ donation and transplant activity between 2008 and 2017. In addition, it puts the evolution of the Swiss donation program's efficiency in relation to the situation in the neighboring countries. METHODS This study is an analysis of prospective registry data, covering the period from 1 January 2008 to 31 December 2017. It includes all actual deceased organ donors (ADD) in Switzerland. Donor data were extracted from the Swiss Organ Allocation System. The "donor conversion index" (DCI) methodology and data was used for the comparison of donation program efficiency in Switzerland, Germany, Austria, Italy and France. RESULTS During the study period there were 1116 ADD in Switzerland. The number of ADD per year increased from 91 in 2008 to 145 in 2017 (+ 59%). The reintroduction of the donation after cardiocirculatory death (DCD) program in 2011 resulted in the growth of annual percentages of DCD donors, reaching a maximum of 27% in 2017. The total number of organs transplanted from ADD was 3763 (3.4 ± 1.5 transplants per donor on average). Of these, 48% were kidneys (n = 1814), 24% livers (n = 903), 12% lungs (n = 445), 9% hearts (n = 352) and 7% pancreata or pancreatic islets (n = 249). The donation program efficiency assessment showed an increase of the Swiss DCI from 1.6% in 2008 to 2.7% in 2017 (+ 69%). The most prominent efficiency growth was observed between 2012 and 2017. Even though Swiss donation efficiency increased during the study period, it remained below the DCI of the French and Austrian donation programs. CONCLUSION Swiss donation activity and efficiency grew during the last decade. The increased donation efficiency suggests that measures implemented so far were effective. The lower efficiency of the Swiss donation program, compared to the French and Austrian programs, may likely be explained by the lower consent rate in Switzerland. This issue should be addressed in order to achieve the goal of more organs available for transplantation.
Collapse
Affiliation(s)
- Julius Weiss
- Swisstransplant, the Swiss National Foundation for Organ Donation and Transplantation, Bern, Switzerland
| | - Andreas Elmer
- Swisstransplant, the Swiss National Foundation for Organ Donation and Transplantation, Bern, Switzerland
| | - Markus Béchir
- Zentrum für Innere Medizin, Hirslanden Klinik Aarau, Aarau, Switzerland
| | - Christian Brunner
- Zentrum für Intensivmedizin, Luzerner Kantonsspital, Luzern, Switzerland
| | - Philippe Eckert
- Service de Médecine Intensive Adulte et Centre des Brûlés, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Susann Endermann
- Klinik für Anästhesiologie, Intensiv-, Rettungs- und Schmerzmedizin, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Renato Lenherr
- Chirurgische Intensivmedizin USZ, Universitätsspital Zürich, Zürich, Switzerland
| | - Mathias Nebiker
- Transplantationszentrum, Direktion Medizin und Universitätsklinik für Intensivmedizin, Inselspital, Universitätsspital Bern, Bern, Switzerland
| | - Kai Tisljar
- Medizinische Intensivstation, Universitätsspital Basel, Basel, Switzerland
| | - Christoph Haberthür
- Klinik Hirslanden, Institut für Anästhesiologie und Intensivmedizin, Zürich, Switzerland
| | - Franz F Immer
- Swisstransplant, the Swiss National Foundation for Organ Donation and Transplantation, Bern, Switzerland.
| | | |
Collapse
|
15
|
Hulsbergen AFC, Broekman MLD. Organ donation after acute subarachnoid hemorrhage: opt in or opt out? Acta Neurochir (Wien) 2018; 160:1515-1516. [PMID: 29931412 DOI: 10.1007/s00701-018-3602-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 06/14/2018] [Indexed: 11/30/2022]
Affiliation(s)
- A F C Hulsbergen
- Computational Neurosurgery Outcomes Center (CNOC), Department of Neurosurgery, Brigham and Woman's Hospital, Boston, MA, USA
| | - M L D Broekman
- Computational Neurosurgery Outcomes Center (CNOC), Department of Neurosurgery, Brigham and Woman's Hospital, Boston, MA, USA.
- Department of Neurosurgery, Haaglanden Medical Center, The Hague, The Netherlands.
- Department of Neurosurgery, Leiden University Medical Center, PO Box 9600, 2300, RC, Leiden, The Netherlands.
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.
| |
Collapse
|