Determinants of organ donation

1. Introduction In many developed countries, increasing the number of donors and thereby decreasing waiting lists for donor organs is an important subject on the health policy agenda as organ transplantation is an important, and sometimes even the only, option to treat organ failures (Cameron and Forsythe, 2001). Donor organs can save lives, but supply cannot keep up with demand, creating and increasing waiting lists. Still, when comparing cadaveric donation rates of different countries, large differences exist. The Netherlands for example, had a cadaveric donation rate of 13 donors per million people in 2009, while neighbouring country Belgium had 25 cadaveric donors per million people; meaning Belgium had more than two times as much cadaveric donors per million inhabitants than the Netherlands last year (Transplant procurement management, 2010). This implies it might be instructive to look the way to deal with this problem of other countries when trying to increase donation rates. But it also raises questions on what determinants are actually influencing these donation rates. Existing studies on this subject mainly focus on the effect of different legislative systems on donation rates (For example; Gimbel, 2003; Abadie and Gay, 2006; Neto, 2007; Healy, 2005; Johnson and Goldstein, 2003). Two of those systems exist; presumed consent policy and the informed consent system. A presumed consent system implies inhabitants of a country should opt-out if they do not want their organs to be used for donation purposes after their death. If they do not opt-out, they are considered to have permitted they want to be donors. In countries applying an informed consent system, people are expected to opt-in if they do want to be a donor. In daily practice, differences between the systems are faded as in both systems family consent is often a condition for extracting organs (Cameron and Forsythe, 2001). These between country comparisons try to study the effect of presumed consent law on donation rates and correct for other variables, such as GDP, predominant religion in a country, the number of traffic deaths and health expenditure. Countries with a presumed consent system often do show significantly higher donation rates than countries using an informed consent system to register donors. In this thesis the goal is to study a broader range of determinants and to check their influence on donation rates. In the studies mentioned before that study the effect of presumed consent law, just a few factors are studied in isolation. In this thesis, the factors taken account for in other studies are studied jointly and some new factors, such as population density and acute care beds, are included in the analysis. The main question of this thesis therefore is: what are the determinants of organ donation? Using ordinary least squares regression method, the analysis shows that GDP, the number of traffic deaths, religion, population density and acute care beds have the strongest effect on a country’s donation rates. Also, confirming other studies, countries with presumed consent systems have significantly higher donation rates (Gimbel, 2003; Abadie and Gay, 2006; Neto, 2007). After this introduction, the organ shortage problem will be stressed in chapter two. In chapter three, an overview will be presented on articles studying which variables might influence donation rates. In paragraph 3.5, the so called ‘Spanish Model’ will be explained. In chapter four, a multiple regression will be performed, using independent variables discussed in chapter three together. Also, limitations of this analysis will be discussed. Chapter five concludes.