Differential impact of opt-in, opt-out policies on deceased organ donation rates: a mixed conceptual and empirical study
Metadatos
Afficher la notice complèteEditorial
BMJ
Date
2022-09-08Referencia bibliográfica
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. doi:[10.1136/bmjopen-2021-057107]
Patrocinador
Spanish Government; European Commission FJCI-2017-34286 MINECO FFI2017-88913-PRésumé
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.