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Potential Limitations of Presumed Consent Legislation

Boyarsky, Brian J.1; Hall, Erin C.1,2; Deshpande, Neha A.1; Ros, R. Lorie1; Montgomery, Robert A.1; Steinwachs, Donald M.3; Segev, Dorry L.1,4,5

doi: 10.1097/TP.0b013e31823173e0
Editorials and Perspectives: Forum

A causal link has been proposed between presumed consent (PC) and increased donation; we hypothesized that too much heterogeneity exists in transplantation systems to support this inference. We explored variations in PC implementation and other potential factors affecting donation rates. In-depth interviews were performed with senior transplant physicians from 13 European PC countries. Donation was always discussed with family and would not proceed against objections. Country-specific, nonconsent factors were identified that could explain differences in donation rates. Because the process of donation in PC countries does not differ dramatically from the process in non-PC countries, it seems unlikely that PC alone increases donation rates.

1Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD.

2Department of Surgery, Georgetown University School of Medicine, Washington, DC.

3Department of Health Policy and Management, Johns Hopkins School of Public Health, Baltimore, MD.

4Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD.

The authors declare no funding or conflicts of interest.

Address correspondence to: Dorry L. Segev, M.D., Ph.D., Transplant Surgery, Johns Hopkins Medical Institutions, 720 Rutland Avenue, Ross 771B, Baltimore, MD 21205. E-mail:

Received 9 May 2011. Revision requested 4 July 2011.

Accepted 4 August 2011.

© 2012 Lippincott Williams & Wilkins, Inc.