The Impact of First-Person Consent Legislation on the Supply of Deceased Organ Donors

From 1988 to 2001, the supply of transplantable organs grew by 140%, an accomplishment dwarfed by the simultaneous rise in the number of individuals awaiting a transplant, which increased by 650%. In response to the immense shortage and historically high family refusal rates, nearly all states have adopted first-person consent legislation, which allows for a donor card or one’s name on a state donor registry to stand as sufficient consent to donate, and further prevents the family from overriding the decision of the donor. To date, no study has examined the efficacy of the policy across adopting states. I exploit the varied timing in the adoption of first-person consent legislation to examine the change in the supply of donors among states that adopted first-person consent in the late ‘90’s and early 2000’s using states with no such laws as controls. I demonstrate that states that passed first-person consent legislation before 2003 saw donation rates increase 10-15% beyond donation rates in non-adopting states. Taken together with typically low family consent rates when the wishes of the donor are unknown, my results strongly reinforce the need for actions that encourage more individuals to communicate their donation preferences, either explicitly via a registry or by discussing them with family. This work was supported in part by Health Resources and Services Administration contract 234-2005-37011C. The content is the responsibility of the authors alone and does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government. The data and analyses reported in the 2011 Annual Data Report of the US Organ Procurement and Transplantation Network and the Scientific Registry of Transplant Recipients have been supplied by UNOS and the Minneapolis Medical Research Foundation under contract with HHS/HRSA. The authors alone are responsible for reporting and interpreting these data; the views expressed herein are those of the authors and not necessarily those of the US Government.