A Systematic Review of Opt-out Versus Opt-in Consent on Deceased Organ Donation and Transplantation (2006-2016).

Authors

M Usman Ahmad
Afif Hanna
Ahmed-Zayn Mohamed
Alex Schlindwein
Caitlin Pley
Ingrid Bahner
Rahul Mhaskar
Gavin J Pettigrew
Tambi Jarmi

Publication/Presentation Date

12-1-2019

Abstract

BACKGROUND: Significant numbers of patients in the USA and UK die while waiting for solid organ transplant. Only 1-2% of deaths are eligible as donors with a fraction of the deceased donating organs. The form of consent to donation may affect the organs available. Forms of consent include: opt-in, mandated choice, opt-out, and organ conscription. Opt-in and opt-out are commonly practiced. A systematic review was conducted to determine the effect of opt-in versus opt-out consent on the deceased donation rate (DDR) and deceased transplantation rate (DTR).

METHODS: Literature searches of PubMed and EMBASE between 2006 and 2016 were performed. Research studies were selected based on certain inclusion criteria which include USA, UK, and Spain; compare opt-in versus opt-out; primary data analysis; and reported DDR or DTR. Modeled effect on US transplant activity was conducted using public data from Organ Procurement and Transplantation Network and Centers for Disease Control WONDER from 2006 to 2015.

RESULTS: A total of 2400 studies were screened and six studies were included. Four studies reported opt-out consent increases DDR by 21-76% over 5-14 years. These studies compared 13-25 opt-out countries versus 9-23 opt-in countries. Three studies reported opt-out consent increases DTR by 38-83% over 11-13 years. These studies compared 22-25 opt-out versus 22-28 opt-in countries. Modeled opt-out activity on the USA resulted in 4753-17,201 additional transplants annually.

CONCLUSION: Opt-out consent increases DDR and DTR and may be useful in decreasing deaths on the waiting list in the USA and other countries.

REGISTRATION NUMBER: PROSPERO CRD42019098759.

Volume

43

Issue

12

First Page

3161

Last Page

3171

ISSN

1432-2323

Published In/Presented At

Ahmad, M. U., Hanna, A., Mohamed, A. Z., Schlindwein, A., Pley, C., Bahner, I., Mhaskar, R., Pettigrew, G. J., & Jarmi, T. (2019). A Systematic Review of Opt-out Versus Opt-in Consent on Deceased Organ Donation and Transplantation (2006-2016). World journal of surgery, 43(12), 3161–3171. https://doi.org/10.1007/s00268-019-05118-4

Disciplines

Medical Education | Medicine and Health Sciences

PubMedID

31428836

Department(s)

USF-LVHN SELECT Program

Document Type

Article