What drives people to donate organs for transplant in the European Union?
Although progress in medical science and technology has vastly improved success rates for organ transplants, a severe shortage of donated organs means that many patients die while on the waiting list.
In Western Europe, nearly 40,000 patients were waiting for a kidney transplant in 2003. In the US, demand for organs overstretches supply partly because only 42 per cent of eligible organ donors end up actually donating.
Efforts to expand the available organ supply have become increasingly crucial for meeting transplant demand. However, this usually depends on country-specific regulations as well as people's awareness of this legislation.
Recent LSE Health research by Professor Elias Mossialos, Dr Joan Costa-Font and Dr Caroline Rudisill examined factors driving willingness to donate organs in the EU.
The study uses Eurobarometer survey data from 15 European Union countries. Eurobarometer surveys are designed by the EU to regularly monitor social and political attitudes in the region.
It found that individuals are more likely to be willing to donate their own organs than to consent to the donation of a relative's organs. Both decisions are affected by existing legislation and people's awareness of that legislation. People with lots of close friends who they can count on to help them out with a serious problem are more likely to be willing to donate. Also, younger, more educated people who express some sort of political affiliation are more likely to be willing to donate their own organs and consent to the donation of those of a relative.
The study confirms and develops further previous research findings that presumed consent, where you have to opt out of organ donation rather than opt in, encourages organ donation. In countries with informed consent, or opt in legislation, such as the UK, Germany and Sweden, an individual or his family must give explicit permission for organ removal. Presumed consent countries, such as Spain, Portugal and Austria, assume universal consent without explicit registration otherwise. It means that those who have not opted out of organ donation will automatically donate their organs upon time of death if they are in a suitable clinical condition.
In practice, most families are consulted with regard to a deceased relative's organ donation even if this relative has already expressed willingness to be a donor. Approximately half of families in the US and 42 percent of families in the UK refuse requests for the donation of a relative's organ in comparison to 20 percent objecting to donation in Spain.
Presumed consent is more prominent in the EU, although countries with presumed consent legislation can differ in enforcement levels.
Though European survey data show widespread public support for organ donation, donor card signing (opt-in) does not reflect this opinion. In Germany, only 7–10 percent of individuals who are in favour of organ donation carry a donor card. Only 19 percent of all adults in the UK have registered on the national donor registry.
In June 2006, the European Commission issued a consultation document concerning the state of organ donation and transplant policy at the European level. The discussion of European Union level policy regarding organ transplant and donation policy highlights not only the wide variation in organ donation policy throughout Europe but also the importance of understanding what successful policies could be enacted. A clearer picture of the decision-making process behind organ donation rates should inform this policy process.
This paper has pointed toward the importance of awareness about legislation on individuals being more willing to donate their organs or consent to the donation of their relative's organs. It also finds that legislation alone may not be the answer to improving donation rates, but also informing individuals about their country's type of organ donation legislation.
Does organ donation legislation affect individuals' willingness to donate their own or their relative's organs? Evidence from European Union survey data is published in BMC health services research, 8 (48).
For full details of Joan Costa-i-Font's and Elias Mossialos' research and publications, see their profiles in the LSE Experts Directory: Dr Joan Costa-i-Font; Professor Elias Mossialos