ArticleBMJ open2022
Differential impact of opt-in, opt-out policies on deceased organ donation rates: a mixed conceptual and empirical study.
Article in BMJ open, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers, 1 of them a synthesis that pooled it.
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Who cites it
18 citing papers in PubMed, 1 synthesis or guideline pooled it, 41 citations in OpenAlex.
- Barriers to conversations about deceased organ donation among adults living in the UK: a systematic review with narrative synthesis.BMJ open · 2025Pooled it
- Education and Ethical Guidance for Organ Donation at the End-of-Life: An Ethical Guidance Statement from the Neurocritical Care Society.Neurocritical care · 2026Review
- Emotional landscape of organ donation: a qualitative study of families' experiences in Spain.BMJ open · 2026Article
- Custodians of Controversy: Navigating Stewardship Challenges With Non-Consensual Anatomized Human Skeletonized Individuals in South Africa.American journal of biological anthropology · 2026Article
- Seven-year experience (2018-2025) of a hospital-based cardiovascular tissue bank in Israel: operational insights and clinical impact.Cell and tissue banking · 2026Article
- Association of reduced physician requirements with brain death confirmation pathway duration and organ donation outcomes in the ICU: a retrospective cohort study.BMC anesthesiology · 2026Article
- Determinants of Family Members' Willingness to Donate Organs in Intensive Care Units: A Cross-Sectional Study.Patient preference and adherence · 2026Article
- Review
- Kidney transplantation versus maintenance dialysis in 14 EU countries: cost savings, payback time, and budget impact.Frontiers in public health · 2026Article
- Innovative strategies to increase cardiac donor availability.World journal of transplantation · 2025Review
- Perceptions and experiences of healthcare professionals of implementing the Organ Donation (Deemed Consent) Act in England during the Covid-19 pandemic.BMC health services research · 2025Article
- Promoting and Supporting Positive Conversations and Knowledge Mobilisation About Organ Donation in NHS Staff: a Hashtag "#" Series of Projects.Transplant international : official journal of the European Society for Organ Transplantation · 2025Article
- Article
- Article
- Organ Donation Awareness among Family Members of ICU Patients.Medicina (Kaunas, Lithuania) · 2023Article
- How clinicians discuss patients' donor registrations of consent and presumed consent in donor conversations in an opt-out system: a qualitative embedded multiple-case study.Critical care (London, England) · 2023Article
- NHS staff awareness, attitudes and actions towards the change in organ donation law in England-results of the #options survey 2020.Archives of public health = Archives belges de sante publique · 2023Article
- Organ and Tissue Donation Consent Model and Intent to Donate Registries: Recommendations From an International Consensus Forum.Transplantation direct · 2023Article
Corrections and comments
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Authors and funding
3 authors at 2 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesTo increase postmortem organ donation rates, several countries are adopting an opt-out (presumed consent) policy, meaning that individuals are deemed donors unless they expressly refused so. Although opt-out countries tend to have higher donation rates, there is no conclusive evidence that this is caused by the policy itself. The main objective of this study is to better assess the direct impact of consent policy defaults per se on deceased organ recovery rates when considering the role of the family in the decision-making process. This study does not take into account any indirect effects of defaults, such as potential psychological and behavioural effects on individuals and their relatives.
designBased on previous work regarding consent policies, we created a conceptual model of the decision-making process for deceased organ recovery that included any scenario that could be directly influenced by opt-in or opt-out policies. We then applied this model to internationally published data of the consent process to determine how frequently policy defaults could apply.
main outcome measuresWe measure the direct impact that opt-in and opt-out policies have per se on deceased organ recovery.
resultsOur analysis shows that opt-in and opt-out have strictly identical outcomes in eight out of nine situations. They only differ when neither the deceased nor the family have expressed a preference and defaults therefore apply. The direct impact of consent policy defaults is typically circumscribed to a range of 0%-5% of all opportunities for organ recovery. Our study also shows that the intervention of the family improves organ retrieval under opt-in but hinders it under opt-out.
conclusionsThis study may warn policy makers that, by emphasising the need to introduce presumed consent to increase organ recovery rates, they might be overestimating the influence of the default and underestimating the power granted to families.
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