Presumed consent legislation failed to improve organ donation in Chile

Abstract

Background: Presumed consent legislation has been advocated by some as an effective measure to improve organ donation. In Chile, a new presumed consent legislation was passed, replacing an informed consent legislation. As of January 2010, Chilean citizens older than 18 years were considered to be organ donors unless they had previously declined donation. The aim of this study was to evaluate the impact of this legislation on donation rates at 2 years after its implementation.

Methods: Retrospective review of donor registries from Corporació del Trasplante and Coordinación Nacional de Trasplante between January 2000 and December 2011 revealed donation rates (donors per million population [pmp]), family refusal, and number/percentage of nondonors.

Results: Organ donation rates decreased after passage of the new law from 6.5 (n = 111) in 2009 to 5.4 in 2010 (n = 92) and 6.5 donors pmp in 2011 (n = 113). Mean donation rate from 2000 to 2009 (before presumed consent) was 8.31 and from 2010 to 2011 (after presumed consent) 5.95 donors pmp; which represents a 29% decrease. Family refusal fluctuated between 32% and 41% between 2000 and 2009, but increased to an all time high of 50.4% in 2011. Finally as of December 2011, 2,520, citizens appeared to be nondonors in the Registry, which roughly represents 37% of those renewing their identification card (IC) or driving license (DI).

Conclusion: In Chile, presumed consent legislation not only did not increase but seems to have had a deleterious effect on organ donation, reflecting an increase in family refusals and a high percentage of nondonors in the registry.