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International Study of Consent for Kidney Transplantation FREE

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The summary below is from the full report titled “Informing the Debate: Rates of Kidney Transplantation in Nations With Presumed Consent.” It is in the 16 November 2010 issue of Annals of Internal Medicine (volume 153, pages 641-649). The authors are L.D. Horvat, M.S. Cuerden, S.J. Kim, J.J. Koval, A. Young, and A.X. Garg.

Ann Intern Med. 2010;153(10):I-48. doi:10.7326/0003-4819-153-10-201011160-00003
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What is the problem and what is known about it so far?

Many persons have organ failure and need an organ transplant to survive; however, available organs, either from deceased or living donors, are limited. Although many types of organs can be transplanted, most are kidneys. Worldwide policymakers have been trying to find the best way to increase the number of available organs for transplantation. Some countries allow organs to be taken from a person who dies (when they are usable), regardless of whether the person previously agreed (presumed consent). Other countries require persons to agree ahead of time whether to donate their organs (explicit consent). It is unclear whether presumed or explicit consent is better for promoting organ donation because kidneys from deceased persons may not survive as well as those from living donors.

Why did the researchers do this particular study?

The researchers used data about kidney donations from many countries to study whether there are differences in rates of deceased versus living kidney donation depending on the type of consent for an organ.

Who was studied?

44 countries and rates of different types of kidney donation from 1997 to 2007.

How was the study done?

The authors analyzed data from national and regional transplant registries, national health ministries, transplant centers, and other data sources. They then verified the data with country representatives. They examined whether the 2 types of consent for organ donation differed by the following: size of the country's population, measures of the country's financial status, proportion of the population that was Catholic, and other factors associated with the availability of organs.

What did the researchers find?

In countries with presumed consent, the rates of deceased kidney donations were higher, but the rates of living kidney donations were lower than in countries with explicit consent. This pattern was the same when the researchers examined specific country characteristics.

What were the limitations of the study?

Because this study only observed patterns of the 2 types of organ donation in these countries, it is not clear whether the type of consent is the reason for different rates of deceased versus living kidney donations. Other factors in these countries may explain these differences.

What are the implications of the study?

Presumed consent may not be a better strategy for a country because transplanted kidneys from living donors have better survival rates than kidneys from deceased persons. In these countries, potential living donors may think the need for donations has been met by transplantations from deceased persons when in fact it has not. The authors suggest that countries need to investigate these patterns further before they decide what type of consent process they should adopt.





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