University of Western Ontario, London; University of Waterloo, Waterloo; and University of Toronto, Toronto, Ontario, Canada.
Ann Intern Med. 2010 Nov 16;153(10):641-9. doi: 10.7326/0003-4819-153-10-201011160-00006.
The kidney is the most common transplanted organ, accounting for almost all living donor transplantations and most deceased donor organ transplantations. The organ shortage has caused policymakers in many nations to debate the merits of adopting presumed consent legislation as a way to increase donor organ donation from deceased donors.
To compare characteristics and kidney transplantation rates for countries with presumed consent for deceased organ donation with countries with explicit consent.
A longitudinal study of international kidney transplantation from 1997 to 2007.
44 nations performing kidney transplantation.
Recipients of deceased and living kidney donor transplants.
Rates of transplantation of kidneys from deceased and living donors.
National characteristics, such as population size, proportion of the population self-identified as Catholic, per capita gross domestic product, health expenditures, and physician density, varied widely for the 22 nations with presumed consent and the 22 nations with explicit consent. Deceased donor kidney transplantation rates were higher in nations with presumed consent (median, 22.6 transplantations per million population [pmp]; interquartile range [IQR], 9.3 to 33.8) versus nations with explicit consent (median, 13.9 transplantations pmp; IQR, 3.6 to 23.1). Living donor kidney transplantation rates were lower in nations with presumed consent (median, 2.4 transplantations pmp; IQR, 1.7 to 4.3) versus nations with explicit consent (median, 5.9 transplantations pmp; IQR, 2.3 to 12.2). The findings were consistent when nations were classified according to per capita gross domestic product, health expenditures, and physician density.
As with any observational study, associations may not be causal.
Nations with presumed consent have higher rates of deceased donor kidney transplantation than nations with explicit consent. Any nation deciding to adopt presumed consent should carefully consider and reduce any negative effect on rates of living donation.
Canadian Institutes of Health Research and Lawson Health Research Institute.
肾脏是最常见的移植器官，几乎所有活体供者移植和大多数已故供者器官移植都是肾脏。器官短缺导致许多国家的政策制定者争论采用推定同意立法作为增加已故供者器官捐献的一种方式的优点。
比较采用推定同意的国家与明确同意的国家在已故器官捐献者的器官捐献特征和肾脏移植率方面的差异。
对 1997 年至 2007 年国际肾脏移植的纵向研究。
44 个进行肾脏移植的国家。
接受已故和活体供者肾脏移植的患者。
已故和活体供者的肾脏移植率。
22 个采用推定同意的国家和 22 个采用明确同意的国家的国家特征，如人口规模、自认为天主教徒的人口比例、人均国内生产总值、卫生支出和医生密度，差异很大。采用推定同意的国家的已故供者肾脏移植率更高（中位数，每百万人口 22.6 例移植[每百万人口 22.6 例移植；四分位距（IQR），9.3 至 33.8]），而采用明确同意的国家的已故供者肾脏移植率中位数为 13.9 例移植（IQR，3.6 至 23.1）。采用推定同意的国家的活体供者肾脏移植率较低（中位数，每百万人口 2.4 例移植；IQR，1.7 至 4.3），而采用明确同意的国家的中位数为 5.9 例移植（IQR，2.3 至 12.2）。按照人均国内生产总值、卫生支出和医生密度对国家进行分类时，结果仍然一致。
与任何观察性研究一样，关联可能不是因果关系。
采用推定同意的国家的已故供者肾脏移植率高于采用明确同意的国家。任何决定采用推定同意的国家都应仔细考虑并降低对活体捐献率的任何负面影响。
加拿大卫生研究院和劳森健康研究所。
