Speaker: Lessons can be learned from Europe on how to expand organ donor pool
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While not without flaws, opt-out laws that presume citizens will donate organs have expanded the donor pool in Europe and provide lessons for the United States, said a speaker at the National Kidney Foundation Spring Clinical Meetings.
“In the U.S., no organs are recovered from many potential older donors, perhaps because of the perception of a low probability that any transplant program would accept the organs,” David Serur, MD, medical director of the kidney-pancreas transplant program at Hackensack University Medical Center, said at the meeting, which was held as a virtual event.
The discard rate of organs in the United States is 18% compared to 9% in France, he said.
Serur said efforts, such as the “old-for-old” approach to procure organs among people older than 65 years through the Eurotransplant Senior Program, have helped to reduce the organ discard rate. The Eurotransplant Senior Program transplants the older organs into people who are older than 65 years.
Larger donor pool
Spain leads France, the Netherlands, the United Kingdom and Finland in the number of transplant procedures performed, according to data presented by Serur. Spain moved to a ”soft opt-out" organ donor register in 1979. When someone dies, it is presumed they want to donate their organs unless the person has actively opted out of the system. Family members can still object and withhold the donation.
“Spain has done well with only 13% of residents opting out of the donation process,” Serur said. “Residents have an average wait time of 8 months for a kidney.”
Serur said patients who are potential donors are referred early to the ICU, even if it is futile. Spain also accepts expanded criteria and high-risk donors.
“There is less emphasis on biopsy and more emphasis on renal function and gross inspection of the kidney,” he said.
Besides embracing an opt-out system, Spain and other countries have been progressive with the management of donated organs, he said. The country uses in-house coordinators who work in the ICU instead of transplant coordinators as is done in the United States. Transplant coordinators also report to the medical board of the hospital, not to the transplantation teams, Serur said.
“That leads to less downtime between acceptance of donation and procuring the organ,” he said.
European consortiums
European countries have agreements with the Consortiums-Eurotransplant and ScandiaTransplant organizations. Eurotransplant countries includes Austria, Belgium, Croatia, Germany, Hungary, Luxembourg, the Netherlands and Slovenia, while ScandiaTransplant includes Denmark, Finland, Iceland, Norway, Sweden and Estonia. Spain, France and the United Kingdom are independent, Serur said.
Since 2010, the United Kingdom has been able to reduce its waitlist time for an organ by 30%, Serur said. The country started an opt-out program in 2020. Wales started an opt-out program in 2015 and, at 77%, it has the highest consent rate of all the U.K. nations, Serur said.
Despite positive results and access to more organs, Serur said opt-out countries, like Spain have one-third of the living kidney donation rate of voluntary opt-in countries. He said opt-out may not be the complete picture to increasing overall organ donors.
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Serur, D. Session #271. Presented at: National Kidney Foundation Spring Clinical Meetings (virtual meeting); April 6-10, 2021.
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