Do Presumed Consent Laws Raise Organ Procurement Rates?

In Western countries, the legal procurement of cadaveric human organs is everywhere organized as a gi!-exchange. Yet despite this basic similarity, donation rates vary widely, and this fact is o!en overlooked in debates about the merits of gi!versus marketbased systems. I investigate the sources of variation in procurement rates using time-series data from seventeen oecd countries. I focus on the e.ect of laws that (at least in principle) allow for the consent of the donor to be presumed, and the wishes of the next-of-kin to be overridden. Countries with presumed consent laws are found to have higher procurement rates, but the e.ect is relatively weak. Evidence from two presumed-consent countries where procurement rates have grown rapidly (Spain and Italy) suggests that presumed consent laws are a marker for organizational practices that boost procurement rates rather than real causes of higher donation. Gi!-giving and voluntary donation are the standard ways of obtaining organs for transplant, particularly organs like hearts and lungs whichmust come from the dead.1 Yet this gi!-exchange does not happen everywhere in the same way or to the same extent. Despite the universality of voluntary donation, there is considerable crossnational variation in donor procurement rates. Some countries do much better than others. /is variability has not received the attention it deserves, partly because the dominant ethical and policy debates focus on the relative merits of voluntary versus market systems. /is has had two consequences. First, these debates tend to draw a sharp contrast between gi!and market-based systems, encouraging us to think in terms of a clear choice between the two. /e assumption is that once the overall exchange system is 0xed, certain consequences for the volume and composition of the supply will tend to follow more or less directly. Second, there is a tendency for 1Donation is also the main source of organs from living donors, a growing illegal trade in organ sales notwithstanding. See Scheper-Hughes (2000) and Cohen (1999) for accounts of the black market in organs. consentlaw.tex 1 Rev 1.1 2005/10/07