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BMJ 2010; 341 doi: (Published 23 November 2010) Cite this as: BMJ 2010;341:c6640

N Engl J Med 2010;363:2004-14

The ups and downs of “opt-out” consent for organ donation

Presumed consent for organ donation is a controversial policy designed to increase the supply of organs for donation and close the widening gap between the number of people waiting for transplants and the number of organs available. A specific effect is hard to prove, although a cross national comparison recently suggested that countries operating presumed consent do more renal transplants using kidneys from dead donors than nations operating explicit “opt-in” consent (median, 22.6 v 13.9 transplants/million population; adjusted rate ratio 2.0, 95% CI 1.2 to 3.4). The analysis was confined to 44 countries with established transplant infrastructure and enough accurate national data for meaningful comparisons. Two of the world’s biggest nations, China and India, had to be excluded. Half the included countries had legislation mandating presumed consent. The other half had legislation mandating explicit consent.

The authors acknowledge that their crude comparisons have limitations, mostly to do with variations in national characteristics that they were unable to control for. They also warn legislators that presumed consent was associated with a significantly lower rate of living donor transplantation than explicit consent (2.4 v 5.9 transplants/million population). Because kidneys from living donors work better than those from dead donors, this result should be considered carefully by any nation currently considering a change in policy.

Prescription drugs implicated in road traffic crashes

Researchers estimate that 3.3% (95% CI 2.7% to 3.9%) of road traffic crashes in France are attributable to prescription drugs, such as antidepressants and anxiolytics. They explored associations between “injurious crashes” recorded nationally over three years and use of prescription drugs recorded in the national healthcare insurance database. Drivers judged to be responsible for crashes were significantly more likely than other drivers to have used drugs classified as risky by the French authorities. The difference wasn’t explained by age, sex, social …

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