Differences in Organ Donation and Transplantation in States Within the United States and in European Countries: Is There a Benefit to Opting Out?

BACKGROUND

Organ donation in the United States currently requires explicit consent by an "opt-in" approach. Some European countries have reported an increase in donation rates with an "opt-out" strategy. We hypothesized that regional differences in decision making affect organ donation rates in different countries and suggest no single approach will reliably increase organ donation rates.

METHODS

Donation and transplantation rates in European countries and states within the United States with populations of >10 million and a minimum organ donation rate of 10 donors per million were compared. 2016 International Registry in Organ Donation and Transplantation data and the 2016 Scientific Registry of Transplant Recipients annual report were used for European countries and US states, respectively. Comparisons by region and donation model were made.

RESULTS

Deceased organ donor rates and transplants did not differ between opt-in and opt-out models. Living donation was increased in all opt-in entities. When comparing European countries, there was a trend toward higher organ donation rates in opt-out countries than in opt-in countries. Donation and transplantation rates of US states were higher than both European opt-in and opt-out countries.

CONCLUSION

There were no differences in deceased donor organ donation when considering the donation consent model. These data do not support that an opt-out approach will increase the number of transplants in the United States.

Cryoglobulinemia: caution for patients undergoing cardiac surgery

We describe the case of a 65-year-old man with cryoglobulinemia undergoing cardiac surgery for combined mitral and aortic endocarditis, his preoperative management, and postoperative complications including purpura fulminans as the result of a cryoglobulinemia crisis, ending in death.

Right ventricular outflow tract obstruction: a quest for ideal management

Management of right ventricular outflow tract obstruction has undergone much change over the last century. Techniques described in the literature include anatomical repairs and the use of various patches, conduits, and innovative grafts. However, many of these approaches require reoperations or catheter-based interventions, leading to increased morbidity, mortality, and cost. The search for the ideal long-lasting conduit continues and there are new techniques on the horizon, using genetic engineering and nanotechnology. This review discusses the evolution of various techniques for repair of right ventricular outflow tract obstruction, past and current conduits, as well as ongoing research.