US initiatives to boost organ donation have had little effect, study finds

BMJ 2015; 350 doi: (Published 05 June 2015) Cite this as: BMJ 2015;350:h3103
  1. Michael McCarthy
  1. 1Seattle

Policies adopted in the United States to boost organ donations over the past two decades have had little or no effect, researchers report in a new study.

Currently, about 79 000 patients in the US are on active waiting lists for organs, and more than 6000 patients die each year awaiting donation of a suitable organ. The gap between the demand for organs and supply is expected to grow as the US population ages and the prevalence of chronic disease rises.

In the study, the researchers looked at the effect of six types of policy that had been adopted in US states to encourage organ donation:

  • Dedicated revenue pools to fund efforts to promote donation

  • Public education programs

  • Leaves of absence for donors

  • Donor registries

  • Tax benefits to help cover costs of donation, and

  • First person consent laws that allow donors to register their intent to donate before donation so that family consent does not need to be obtained.

The lead author of the study, published in JAMA Internal Medicine,1 was Paula Chatterjee from Brigham and Women’s Hospital, Boston, Massachusetts. Chatterjee and her colleagues reported that from 1988 to 2010 all 50 US states had adopted at least two of the policies and six had adopted all six types. However, only the policy of creating dedicated revenue pools was associated with a significant increase in the number of transplantations. This increase of 5.3% (95% confidence interval 0.57% to 10.1%; P=0.03) represented the equivalent, on average, of just 15 additional transplantations per state each year.

The researchers wrote, “First-person consent laws, donor registries, public education programs, paid leave, and tax incentives had no robust, significant association with either donation rates or number of transplants, even after allowing for prolonged delays for policies to take effect.”

The researchers speculated that existing incentives may not be enough to sway people to become donors. For example, the cash value of tax deduction policies is only about $600 (£390; €530), whereas earlier studies have indicated that $10 000 was the threshold needed to motivate someone to donate a solid organ, and leave of absence policies do nothing to help donors cover the cost of lost wages and other expenses, which can total about $3650 on average for kidney donors and be more than $7500 for about 15% of donors.

Funding pools may be more successful, because in addition to supporting public education efforts they are used to educate physicians, lawyers, funeral directors, and other professionals who may be able to influence potential donors, the researchers wrote.

“New policy designs are needed to increase donation rates and curtail the widening gap between organ supply and demand,” the researchers concluded.


Cite this as: BMJ 2015;350:h3103


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