says Neehar Parikh, an
author of the study and a Transplant Hepatologist at Michigan Medicine.
On what could
be the best policy to tackle the situation, Dr. Parikh commented that, "It speaks to the magnitude of the deficit
we have for organ transplantation
in the U.S. At the same time, we did find that
such a policy could potentially translate to large gains in life years for the
thousands of patients awaiting organ transplantation in the U.S."
Impact Simulations in the Study
team built a computer model in order to simulate how a policy shift would have
affected patients on the waiting list for heart, kidney, liver, lung or pancreas
Data from Organ Procurement and Transplantation Network Standard Transplant
Analysis and Research files between 2004 and 2014 was used for this exercise.
It was found
that, for over half a million patients on the list during the study period,
between 4,300 and 11,400 life-years could have been added through presumed
consent or opt-out. The number of people taken off the list due to illness or
death would have reduced by between 3 and 10 percent, under the most
conservative estimate. On the other hand, opt-out may have, under ideal circumstances,
reduced the number of people on the waiting list by 52 percent. This, however,
would still not be adequate to provide organs for all those who need one in
equation of 'one available organ
equals one life saved'
may appear simple, the reality is highly
complicated, the research team says. Multiple factors, including, the location
of the organ, compatibility with the patient, allocation of the organ to the
most critical patient and the judgment of surgeons and clinicians form a
complex web that affects the organ transplant.
"Organ donation is such a personal
thing, and general surgeons and other clinicians are looking at one
patient at a time. But it's also useful to take sort of a 50,000-foot view of
all the levers we can pull to see which ones can improve outcomes for most
patients. That's the kind of thing that engineers like me can bring to the
said Luke DeRoos, the first author of the paper.
Impact of Organ Transplant Policies
consent adopted by many other countries has given mixed results. Earlier
studies of these cases suggest that an increase of 5-25 percent in organ donation
be possible. The research team also simulated rises within this range in their
team is of the view that with the opt-in system the United States currently
practices, it has one of the highest organ donation rates, and hence the gains
other countries may have witnessed, might not be apparent in the country. The
impact of adopting a system like presumed consent remains unpredictable.
Surveys show, while 93 percent of American adults support organ donation, only
just over half of them are registered donors
Donations from up to 40 percent of eligible donors are averted owing to a lack
"Everyone in the transplant field has very
strong opinions about opt-out donation, one way or the other. And so we've
tried to be very objective, understanding that there is a lot of uncertainty
around our estimates,"
DeRoos said. "There are numerous
strategies for increasing organ donations, so I hope that
policymakers can take numbers like these to get an idea of what the impact such
a policy may be associated with,"
has emphasized on the many different tactics that would have to work alongside
each other to address the growing need. He was quoted saying that, "The U.S. population is aging with more
comorbidities, making the pool of organ donors smaller. There are several novel
technologies, like machine perfusion of organs, that
can increase the utility of marginal organs, so we can use more of them for
transplant. Another way to increase the donor pool is to break down barriers to the
living donation of kidneys and livers."
"However, to really push the needle in terms of
impacting the waitlist, we need to increase donation dramatically, and presumed consent is one strategy that has
been proposed to do that potentially. But, our study has shown that it will
likely not be enough to alleviate the organ shortage on its own. Nevertheless,
given its potential impact, we believe this policy warrants further debate and
Dr. Parikh went on to add. Reference :
- How opt-out organ donation could affect U.S. waiting lists - (https://news.umich.edu/how-opt-out-organ-donation-could-affect-u-s-waiting-lists/)