London School of Economics and Political Science (LSE), Houghton Street, London, WC2A 2AE, UK.
Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
Eur J Health Econ. 2021 Feb;22(1):5-16. doi: 10.1007/s10198-020-01214-8. Epub 2020 Jul 10.
Legislation, in the form of presumed consent, has been argued to boost organ donation but most evidence disregards the practice of seeking relative's consent, which can either 'veto' donation decisions, or 'legitimize them', by removing any possible conflict with the donor's family. We study the effect of presumed consent alongside family consent on individuals' willingness to donate (WTD) one's own and relatives' organs, and on actual organ donation behaviours. Using data from 28 European countries for the period 2002-2010, we found that presumed consent (PC) policies are associated with increased willingness to donate organs, but this effect was attenuated once internal family discussions on organ donation were controlled for. Our findings indicate that relative's consent acts as a veto of donation intentions and attenuates the effect of regulation on actual donations. More specifically, PC increases WTD one's own and relatives' organs in countries where no family consent is required. Consistently, we find that family consent attenuates the influence of regulatory environment on actual donations. The effect is driven by the influence of family discussions which increased WTD, and in combination with presumed consent translated into higher organ donation rates.
立法以推定同意的形式被认为可以增加器官捐赠，但大多数证据都忽略了寻求亲属同意的做法，因为亲属同意可以通过消除与捐赠者家庭的任何可能冲突来“否决”或“使捐赠决定合法化”。我们研究了推定同意和家庭同意对个人自愿捐赠（WTD）自己和亲属器官的意愿以及实际器官捐赠行为的影响。我们使用了 2002 年至 2010 年期间来自 28 个欧洲国家的数据，发现推定同意（PC）政策与增加器官捐赠意愿有关，但一旦控制了内部家庭对器官捐赠的讨论，这种影响就减弱了。我们的研究结果表明，亲属同意是捐赠意愿的否决权，并削弱了监管对实际捐赠的影响。更具体地说，在不需要家庭同意的国家，PC 增加了个人和亲属的器官捐赠意愿。同样，我们发现家庭同意会削弱监管环境对实际捐赠的影响。这种影响是由家庭讨论的影响推动的，家庭讨论增加了 WTD，再加上推定同意，导致器官捐赠率上升。
