Intended for healthcare professionals

Rapid response to:


Ireland has record fall in number of organ donations

BMJ 2011; 342 doi: (Published 11 February 2011) Cite this as: BMJ 2011;342:d982

Rapid Response:

Organ donation during economic hardship: an untold end for Prometheus?

[2] Instructor in Primary Health Care, Dept. of Social Medicine,
Faculty of Medicine, University of Crete, Heraklion, Greece

[3] King's College London, Dept. of Primary Care and Public Health
Sciences, London, UK

[4] Emeritus Professor of General Practice, King's College London, UK

* corresponding author

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 [1] 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 [2]. 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 [3]. 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 [4], currently presents a major risk for
the viability of the transplantation system. Loss of social cohesiveness
[5] 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 [1]. In Greece the proposed sweeping legislative
changes towards presumed consent for donation come at a timely, yet
critical moment [6]. 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 [7]. 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


1. Houston M. Ireland has record fall in number of organ donations.
BMJ 2011, 342:d982.

2. Karlatira P. They have cut down even orange juice from blood
donors! [in Greek] Proto Thema (Athens), 2011. (accessed April 20, 2011).

3. Agrolabos B. Crisis even in transplantations. [in Greek]
Kyriakatiki Eleftherotypia (Athens), 2011. (accessed April 20, 2011).

4. Symvoulakis EK, Stavroulaki E, Morgan M, Jones R: Kidney organ
donation: developing family practice intiatives to reverse inertia. BMC
Health Serv Res 2010, 10:127.

5. Stuckler D, Basu S, Suhrcke M, Coutts A, McKee M. The public
health effect of economic crises and alternative policy responses in
Europe: an empirical analysis. Lancet 2009; 374:315-23.

6. Organ donation and transplantation. [in Greek]. Ministry of Health
and Social Solidarity, Athens, 2011. prosxedio-nomoy-laquo-dwrea-kai-
metamosxeysh-organwn-kai-alles-diatakseis- raquo (accessed April 20,

7. Organ Donation Taskforce. Organ for transplants: a report from the
Organ Donation Taskforce. Department of Health, London, 2008.
(accessed April 20, 2011).

Competing interests: No competing interests

26 May 2011
Emmanouil K. Symvoulakis [1]
Scientific Collaborator
Adelais Markaki [2], Myfanwy Morgan [3], Roger Jones [4]
[1] Dept. of Blood Donation, University General Hospital of Heraklion, Greece, and Honorary Research