How to reduce the persistent shortage of organ donors in Scandinavia

The determinants of the willingness to donate an organ among young adults: Evidence from the United States and the European Union

The total value of life lost due to death because of waiting for an organ transplant was close to $5 billion in 2006 in the United States, and the excess demand for organs has been increasing over time. To shed light on the factors that impact the willingness to donate an organ, we analyze individual-level data from the United States and the European Union collected in 2001-2002. The rate of willingness to donate an organ is 38% among young adults in the US, and it is 42% in Europe. Interesting similarities emerge between the US and Europe regarding the impact of gender, political views and education on the willingness to donate an organ. In the US, Blacks, Hispanics and Catholics are less likely to donate. In Europe, individuals who reveal that they are familiar with the rules and regulations governing the donation and transplantation of human organs are more likely to donate. In both data sets, individuals who had some encounter with the health care sector-either through a recent emergency room visit (in the US), or perhaps because of a long-standing illness (in the EU), are more likely to become organ donors. Mother's education has a separate positive impact. These results point to some avenues through which organ donation propensities can be enhanced and organ shortages can be alleviated.

Substantial Increase in Cadaveric Organ Donors in Hospitals Implementing the Donor Action Program in Finland

The results of solid organ transplantation have improved during the last decade. Five-year patient survivals over 80% and graft survivals over 70% are common in many transplant centers. Also, quality-of-life assessments show that not only adults but even small children have a good quality of life after successful organ transplantation. Furthermore, transplantation programs have proved to be cost-effective. However, the organ shortage is a worldwide problem, which has in many countries led to prolonged waiting times, deaths on the waiting list, increased living related donations, acceptance of lower-quality organs, and in some instances even commercialization of the organ supply. Thus, it is extremely important to find strategies that increase the number of cadaveric organs for donation. In Finland organ transplantation is concentrated in one center with about 250 transplantations of different organs performed annually. The number of patients needing a new cadaveric organ is steadily increasing, but the number of donors has remained the same during the last decade. To improve cadaveric organ procurement the Donor Action (DA) program, which consists of a Hospital Attitude Survey and a medical records review performed by the donor hospital, has proved to increase the number of cadaveric donors. We introduced the DA program in Finland in 2000. Here in we report the results of this program in terms of its impact on the availability of cadaveric donors.

Medical and legal considerations of brain death

Brain death was first defined in 1968, and since then laws on determining death have been implemented in all countries with active organ transplantation programs. As a prerequisite, the aetiology of brain death has to be known, and all reversible causes of coma have to be excluded. The regulations for the diagnosis of brain death are most commonly given by the national medical associations, and they vary between countries. Thus, the guidelines given in the medical textbooks are not universally applicable. The diagnosis is based on clinical examination, but confirmatory tests, such as angiography or EEG, are allowed on most occasions. Brain death is followed by cardiovascular and hormonal changes, which have implications in the management of a potential organ donor. Spinal reflexes are preserved, and motor and haemodynamic responses are frequently observed in brain dead patients.