NIce and interesting post. I am working on this matter and I would be pleased if you could tell me any data source about organ donor per country in the internet. Thank you very much.

However, I’m afraid of how it’ll actually be executed if approved…

The problem is – UK does not exactly have a good record when it comes to dealing with sensitive data. Either storing it or using it. :) Just look at all the recent cock ups with DVLA, Home Office and NHS losing anywhere from tens to hundreds of thousands of records. Or the Home Office having illegal immigrants working security! (You’d think they’d be able to check that…)

So, what if the presumed consent approach is instituted but misused? Shouldn’t that result in criminal proceedings against medical teams for using organs when they shouldn’t have? Which of course would not happen since apparently no amount of misdoing can lead to prosecution in the UK. :) Recent examples would be the cash for honours case and the Northern Rock bank debacle – the managements must so be sued over that, but they said they are sorry and just got a slap on the wrist. But I’m digressing. The current system of informed consent works to protect both the dead person and the medical staff – you have to definitely establish the consent. If you don’t have to do that anymore, that opens up room for mistakes. And who is going to deal/pay for that?

My response:

http://www.medhumanities.org/2008/01/on-presumed-con.html

Tim #12, and other interested parties:

I’ve written an essay, forthcoming from the Cato Institute, on the Iranian system of organ procurement. I’ll also be speaking at Cato on Feb 21, alongside a critic or two, on the same subject.

The short version: Iran has permitted the sale of kidneys between nationals (only) from living vendors (rather than ‘donors’) since 1987, and the waiting list for kidneys was eliminated in 1997. Long-term recipient outcomes (i.e. 10+ years) for recipients of purchased kidneys is comparable to outcomes from recipients of conventionally donated kidneys, and outcomes for both are favorably comparable to recipient outcomes in the U.S. This is of interest, because reports of outcomes for both vendors and recipients who participate in grey-market, cross-border organ trafficking are horrendous.

One salient problem with the Iranian system is that long-term outcomes for vendors are simply not known, and vendors tend to disproportionately come from the impoverished classes. The majority of organ vendors fall below the Iranian poverty line of < U.S. $5 a month.

The long version is better. I’d be pleased to provide a copy (once published) offline to anyone interested.

I suspect it’s because many states now combine the process with one’s application for a driver’s license. (It’s generally indicated on the license whether you’ve consented.)

Having someone at the DMV ask you whether you’d like to be a donor is different from the British practice—at least, when I did it [mumble] years ago—of picking up a donor card from a tray at the post office counter. It’s also a non-medical setting, which may prompt a different response rate from a medical setting. That’s to say, when the DMV official asks, you may well think of the consequences of being in a car accident, whereas being asked at the doctor’s surgery might lead you to believe that you’re being sized up as a bag of organs.

Specifically, I’m thinking that if you improve logistical capabilities you ensure that a greater number of potential donor organs actually find recipients before they spoil, but changing the consent law makes a great many more organs available for transplant. If your logistical structure is already operating at near-capacity, increasing the number of available donor organs won’t do much to improve transplant rates, but if a country were in a situation where nearly 100% of donor organs were reaching recipients, increasing the supply of organs would actually have a significant effect, especially if they increase investment in the logistical side of things so it can expand.

So it’s actually an issue of determining where the bottleneck is. Fact or crap?

I thought the post was excellent by the way.

But some critics say the state should not automatically decide what happens to people’s bodies after they die.

The decision about whether or not to donate needs to happen fairly prompty or it is rendered irrelevant by natural decay processes, so assuming non-consent is in fact “automatically decid[ing] what happens to people’s bodies after they die.”

The decision to do nothing is still a decision.

I have data on provincial rates of donation in Italy for 1998-2004 and over that period there has been a lot of growth, though it has been unevenly distributed across northern, central and southern regions. The south has pretty low rates and not much growth.

Sure, You can see the time series here. Informed consent countries are on the top row; presumed consent countries on the bottom. They’re arranged within each row from lowest on average to highest. You can see that Spain has always been at the high end (and growing) while Italy started off near the very bottom and grew rapidly to end up in the middle of the distribution.

Also, you graphs suggest that several countries, suc as the Netherlands, Australia and Sweden have seen a serious decline in organ donations. Are there common explanations for this?

All in all a very interesting piece, thank you