[Moins de dons de rein de son vivant dans un système légal de "consentement présumé", comme en France]
(Reuters Health) - "Countries that have tried to address donor-organ shortages with so-called 'presumed-consent' systems do have higher rates of kidney transplantation from deceased donors than other nations, a study published Monday finds.
However, researchers conclude, the flip side of this 'opt-out' approach may be a lower rate of transplants from living donors. A number of countries, mainly in Europe and South America, have presumed-consent organ-donation systems.
This means that people have to opt out of the system if they do not wish to have their organs harvested after they die; surviving family members are still consulted and can object if they want.
In contrast, countries such as the U.S., Canada, Australia and the U.K. have explicit-consent systems, where people have to designate themselves as organ donors; in cases where a deceased person's wishes are unknown, the family can grant permission for organ donation.
Advocates of presumed consent say it helps address donor-organ shortages.
And several studies have found that nations with presumed consent tend to have higher rates of deceased-donor organ donation than those with explicit consent.
Those studies did not, however, look at effects on organ transplants from living donors, the vast majority of which are kidney transplants. (Living donors can also give a segment of the liver or, in a small number of cases, a portion of lung, pancreatic or intestinal tissue.)
For the new study, reported in the Annals of Internal Medicine, researchers examined rates of living- and deceased-donor kidney transplants in 44 countries between 1997 and 2007.
Half of the countries had presumed-consent systems, including France, Germany, Italy and Spain; the other half, including the U.S., Canada, Japan and Australia, had explicit consent.
In general, presumed-consent nations had a higher rate of deceased-donor transplants than explicit-consent nations did -- with a median, or midpoint, rate of 22.6 transplants per million people in the population, versus 13.9 per million in countries with explicit consent.
When it came to living donations, however, presumed-consent nations had a transplant rate of 2.4 per one million people, compared with 5.9 per million in explicit-consent countries.
'We were surprised to see such low rates of living kidney donation in nations with presumed consent,' senior researcher Dr. Amit X. Garg, of the London Health Sciences Center in Ontario, Canada, told Reuters Health in an e-mail.
The findings do not prove that a presumed-consent system itself discourages kidney donations from living donors, according to Garg and his colleagues. But one possibility, they speculate, is that in countries with the policy, 'the public perceives that the need for kidneys is addressed by presumed consent legislation.'
Another potential explanation is that in countries with presumed consent, there is more reluctance to have healthy living donors face the risks of surgery. 'I think this shows there is a nervousness, ethically, about using living donors,' Dr. Arthur L. Caplan, director of the Center for Bioethics at the University of Pennsylvania in Philadelphia, told Reuters Health.
The findings do not mean that presumed consent is an ineffective way to address donor-organ shortages, according to Caplan, who was not involved in the study and supports presumed-consent donation -- or what he terms 'default to donation.' He noted that whole organs other than the kidneys -- including the heart, lungs, pancreas and intestines -- must come from deceased donors, so boosting the availability of cadaver organs across the board is vital.
There are nevertheless reasons to be concerned about the potential for driving down living donations for kidney transplants: those done with living donors tend to be more successful than transplants using cadaver kidneys."
By Amy Norton, NEW YORK
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