Presumed consent may not increase overall rates of kidney donation

Presuming that people want to donate their organs unless they specifically say otherwise may not help to bolster overall kidney donations, according to a study by Dr. Amit Garg and colleagues at The University of Western Ontario and Lawson Health Research Institute.

The study, published in the Annals of Internal Medicine, reviewed kidney donation rates for 44 nations performing the transplants between 1997 and 2007 to determine whether one method increased donation rates over another.

In 2008 over 4000 Canadians were on a waiting list for an organ transplant. Two hundred and fifteen of these individuals died waiting. Some policymakers believe adopting a presumed consent system would help bolster donation rates and save hundreds of lives.

Kidneys are the most frequently transplanted organs and the need for these organs greatly surpasses supply. While kidneys can be transplanted from living donors, deceased donors are an important source of kidneys. As such, policymakers are considering various strategies for increasing donation at the time of death.

Some countries allow organs to be taken from people when they die, as long as the individual did not expressly request not to be considered for donation. This policy is called presumed consent. Currently in Canada we have explicit consent system for organ donation where Canadians "opt-in" by signing their organ donation card or expressing their wish to donate their organs to family members. However, individuals in support of a presumed consent system feel more people would like to donate their organs, but simply fail to express this wish or sign their donor card.

The research team reviewed rates of living and deceased kidney donation in 22 nations with presumed consent and 22 nations with explicit consent policies. "We wanted to quantify the effects of introducing presumed consent legislation and see whether or not it would bolster overall kidney donation rates," says Dr. Garg, an associate professor in the Departments of Medicine and Epidemiology & Biostatistics.

Not surprisingly, the research team found that nations with presumed consent have higher rates of deceased kidney organ donation than in nations with explicit consent; however, they also discovered that living donation rates were much lower in these nations than in nations with explicit consent. For this reason, presumed consent may not help to bolster overall kidney donations as much as expected unless donation from living donors continues to be supported and encouraged. It is interesting to see that despite the demand for kidneys in countries which practice presumed consent, such countries have not achieved rates of living donation as seen in countries with explicit consent.

As the debate on whether or not Canada should adopt a presumed consent system continues, the research team hopes that policymakers will look at the results of this study for guidance. "Any nation deciding to adopt presumed consent should carefully consider and reduce any negative impact on rates of living donation," says Dr. Garg. "We must ensure that overall organ donation rates in Canada meet the demand and this must include an increase in both living and deceased organ donations."

The research team consisted of Dr. Amit Garg, Lucy Horvat, Dr. Joseph Kim, Dr. John Koval and Dr. Ann Young.