Governance quality indicators for organ procurement policies Rodríguez Arias Vailhen, David Molina Pérez, Alberto Rodríguez Hannikainen, Ivar Allan Delgado, Janet Söchtig, Benjamin Wöhlke, Sabine Schicktanz, Silke We would like to thank all members of the ISSATO working group for data collection coordination: Gabriele Werner-Felmayer and Magdalena Flatscher-Tho¨ni (Austria), Kristof van Assche (Belgium), Anja Jensen (Denmark), Thalia Bellali (Greece), and Tanja Kamin (Slovenia). We are also thankful to other members of the ELPAT-ESOT (Ethical, Legal and Psychosocial Aspects of Transplantation-European Society of Organ Transplantation) for their help in shaping the questionnaire: Hagai Boas, Myfanwy Morgan, and Gurch Randhawa. Yolanda Ramallo Fariña and Miguel Angel Garcı´a Bello helped us with methodological advice. Finally, we thank ELPAT-ESOT board for organizing working-group meetings between 2016 and 2018. Background Consent policies for post-mortem organ procurement (OP) vary throughout Europe, and yet no studies have empirically evaluated the ethical implications of contrasting consent models. To fill this gap, we introduce a novel indicator of governance quality based on the ideal of informed support, and examine national differences on this measure through a quantitative survey of OP policy informedness and preferences in seven European countries. Methods Between 2017–2019, we conducted a convenience sample survey of students (n = 2006) in Austria (AT), Belgium (BE), Denmark (DK), Germany (DE), Greece (GR), Slovenia (SI) and Spain (ES), asking participants about their donation preferences, as well as their beliefs and views about the policy in place. From these measures, we computed indices of informedness, policy support, and fulfilment of unexpressed preferences, which we compared across countries and consent systems. Results Our study introduces a tool for analyzing policy governance in the context of OP. Wide variation in policy awareness was observed: Most respondents in DK, DE, AT and BE correctly identified the policy in place, while those in SI, GR and ES did not. Respondents in opt-out countries (AT, BE, ES and GR) tended to support the policy in place (with one exception, i.e., SI), whereas those in opt-in countries (DE and DK) overwhelmingly opposed it. These results reveal stark differences in governance quality across countries and consent policies: We found a preponderance of informed opposition in opt-in countries and a general tendency towards support–either informed or uninformed–in opt-out countries. We also found informed divergence in opt-in countries and a tendency for convergence–either informed or uninformed–among opt-out countries. Conclusion Our study offers a novel tool for analyzing governance quality and illustrates, in the context of OP, how the strengths and weaknesses of different policy implementations can be estimated and compared using quantitative survey data. 2021-06-18T11:09:32Z 2021-06-18T11:09:32Z 2021-06-04 journal article Rodrı´guez-Arias D, Molina-Pe´rez A, Hannikainen IR, Delgado J, So¨chtig B, Wo¨hlke S, et al. (2021) Governance quality indicators for organ procurement policies. PLoS ONE 16(6): e0252686. [https://doi.org/10.1371/journal.pone.0252686] http://hdl.handle.net/10481/69279 10.1371/journal.pone.0252686 eng http://creativecommons.org/licenses/by/3.0/es/ open access Atribución 3.0 España Public Library of Science