Presumed consent

The Netherlands, like many other European countries, has recently switched to a so-called "Presumed consent", or opt-out system for organ donation. This means that all residents are automatically organ donors upon death, unless they choose to be deregistered from the donor registration system. In countries with such a consent system, the number of organ transplants from deceased donors is significantly higher than in countries with an informed consent or opt-in system, where people have to register themselves as donors. This is expected to lead to fewer deaths among organ patients, but the research by Golsteyn and Verhagen shows that this is not necessarily the case.

Difference per type of organ

“We have discovered that there are differences per type of organ. For example, the death rate of heart patients is indeed lower in countries with an opt-out system, where the number of heart transplants is higher on average. ” According to Golsteyn, professor of Human Capital and Social Economy at UM. "Heart transplants are relatively rare, so they can only contribute minimally to the total number of lives saved for organ patients." More than half of all transplants with deceased donors are kidney transplants, and a quarter are liver transplants. Heart transplants make up less than 10 percent.

The difference between consent systems in the number of transplants from deceased donors is greatest for kidney transplants. Verhagen, PhD candidate at UM: “Countries with an opt-out system perform significantly more kidney transplants with organs from deceased donors than countries with an opt-in system. This is the deciding factor for many countries to introduce an opt-out system, hoping to be able to reduce the mortality rate among organ patients. However, our research shows that the death rate among kidney patients hardly differs between consent systems. This means that apparently there is no one-to-one relationship between the number of kidney transplants from deceased donors and the death rate among kidney patients”.

Other factors play a role

A possible explanation for these results is that an opt-out system is not only an incentive for people to become organ donors after death, but that it also unintentionally provides other incentives. Golsteyn and Verhagen show that in countries with an opt-out system significantly fewer kidney transplantations from living donors are performed . "This could be because more kidneys from deceased donors are available in these countries," said Verhagen. “Donating a living kidney can be drastic for the potential donor, so it is understandable that he or she would would prefer not to donate if there is a good chance that a kidney from a deceased donor will become available soon. As a result, the total number of kidney transplants in countries with an opt-out system is, however, smaller than expected, which explains why we hardly see any differences between consent systems in the mortality rate among kidney patients. ”

Golsteyn: “More research is needed into the ways in which consent systems for organ donation affect death rates among organ patients. For example, we would like to know whether countries with an opt-out system might invest less in the development of medical technologies that can keep organ patients alive longer. ”