Academic journal article Bulletin of the World Health Organization

Increasing Organ Donation by Presumed Consent and Allocation Priority: Chile/ Chili: Augmentation Des Dons D'organes Par Consentement Presume et Priorite d'attribution/Aumentar la Donacion De Organos Por Consentimiento Supuesto Y Prioridad De Asignacion: Chile

Academic journal article Bulletin of the World Health Organization

Increasing Organ Donation by Presumed Consent and Allocation Priority: Chile/ Chili: Augmentation Des Dons D'organes Par Consentement Presume et Priorite d'attribution/Aumentar la Donacion De Organos Por Consentimiento Supuesto Y Prioridad De Asignacion: Chile

Article excerpt

Introduction

In recent years, technical, political and public opinion in many countries has shifted towards the view that opt-out provisions can help promote organ donation. Two components of transplantation legislation--presumed consent and allocation priority--are thought to increase the donor population by decreasing the ease of opting out and giving registered donors priority among the pool of individuals in need of an organ transplant. The joint implementation of these components is believed to have yielded beneficial effects in Israel and Singapore. (1,2) To address disappointing results in the number of organ donors, Chile amended its Organ Donor Act in 2013 to include these components.

This paper discusses opting out and prioritizing allocation to increase organ donors in the light of the Chilean experience. Although transplantation legislation in Chile is not ideal, it sets a precedent. The experience gained may be a useful resource to countries seeking to increase their pool of potential organ donors.

Legislation to increase donations

Organ transplantation statutes can be categorized on the basis of the nature of donor consent, the means of exercising consent and the relationship between consent status and prioritization for transplant receipt. Explicit opt-in organ donation systems require an individual to express their consent to become a potential donor, whereas explicit opt-out systems presume consent unless an individual expresses their refusal to become a potential donor. (3) Universal donor systems place no special conditions on the relationship between donor status and transplant allocation, whereas contingent entitlement systems mandate reciprocity by giving consenting potential donors priority for transplant receipt.

Explicit opt-out laws have long been among the major interventions used to increase the pool of potential donors in countries such as Austria, Belgium, the Czech Republic, Finland, France, Greece, Hungary, Israel, Italy, Luxembourg, Norway, Poland, Slovenia, Spain, Sweden and Turkey. There is evidence that supports the association between presumed consent and increased donation rates and that countries with opt-out laws have rates 25 to 30% higher than those in countries requiring explicit consent. (4) However, presumed consent appears to be only one of several influential factors. (5) Other factors include potential donor availability, transplantation infrastructure, health care spending and public attitudes, (6) as well as familial consent and donor registries. (7)

In 1987, Singapore passed the Human Organ Transplant Act, which applies the priority rule with an opt-out system. (2) If a person objects to donating their organs upon death, they give up priority for receiving an organ should they need one in future. The opt-out with priority system provides a dual-incentive for donation: avoiding the cost of opting-out and receiving priority on the waiting list. (8) A concern with combining the opt-out and priority allocation system is that the priority rule cannot prevent the free-rider problem if the introduction of an opt-out system has already generated a sufficient organ supply. (9) Singapore's combination of presumed consent and priority status appears to have been somewhat successful in increasing organ donations. (10,11)

In January 2010, the Organ Transplant Act 2008 came into effect in Israel, which governs organ donation and allocation. The new law introduced a priority point system to motivate individuals to donate their organs. This system rewards those who are willing to donate an organ with preferential status as a recipient. A person can gain priority points by signing a donor card, making a non-directed/ non-specified organ donation during their lifetime, or being a first-degree relative signing a donor card or consenting to procurement of organs after death. The resulting tiered system includes maximum priority, regular priority and second priority. …

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