Organ donation during economic hardship: an untold end for Prometheus?
 Instructor in Primary Health Care, Dept. of Social Medicine,
Faculty of Medicine, University of Crete, Heraklion, Greece
 King's College London, Dept. of Primary Care and Public Health
Sciences, London, UK
 Emeritus Professor of General Practice, King's College London, UK
* corresponding author firstname.lastname@example.org
Recent news from Ireland reports a dramatic drop in organ donation
rates for the year 2010, attributed to a less active approach of families
of potential donors by hospital staff due to staffing shortages and heavy
workload  as well as to regulatory constraints. Although the health
impact of debt crises in EU countries under economic surveillance, such as
Greece, Ireland and Portugal, merits special consideration, the possible
effects on organ donation or transplantation activity of a harsh economic
environment have not been widely discussed.
In the case of Greece, a country dealing with unprecedented economic
hardships, there are several indications that blood and organ donation is
in jeopardy. News media reports already suggest a 10% reduction in
volunteer blood donors for 2010 . To compensate, the country has
imported 40,000 units of blood, at great expense. In terms of organ
transplantations, there was a 58% reduction compared to 2008 . This
impacted not only on patients on waiting lists but also on transplant
teams, putting them in a state of "hibernation". Questions have also been
raised about healthcare professionals' inertia in the recruitment of
potential donors, as well as institutions' inaction in promoting a viable
plan to overcome these problems.
These disturbing trends could be attributed to several factors.
Reductions in national healthcare expenditures and subsequent
administrative or operational deficiencies could be the most prominent
contributors. A less obvious factor could be the population's adoption of
social negativism within the wider context of national panic over the
possible bankruptcy of the country. Social negativism, reinforced by
inertia that inhibits individuals or communities from acting upon their
decision to register as donors , currently presents a major risk for
the viability of the transplantation system. Loss of social cohesiveness
 could prove detrimental for contemporary Greek society.
It has been proposed that a new national management structure should
be installed to drive organ donation forward in Ireland, while retaining
the current opt-in system . In Greece the proposed sweeping legislative
changes towards presumed consent for donation come at a timely, yet
critical moment . Although presumed consent or opt-out is expected to
lead towards greater transplant availability, this model is at odds with
an individual's spontaneous intention or decision, possibly leading to
conflicts and a lack of trust in the system . Such reforms of the
donation system therefore require to be embraced by the society, with
provision for public participation and debate involving all interested
These challenges underscore the urgency for Greek policy makers and
legislators to proceed vigorously but cautiously in addressing the issues
of organ donation. Safeguarding a culturally sensitive system based on
equity, cost-effectiveness and transparency is imperative. Otherwise, the
economic crisis could signal the end for Prometheus.
Competing interests: None declared
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Competing interests: No competing interests