1. First-person consent laws, donor registries, public education, paid leave and tax incentive policies had no significant effect on organ donation or transplantation rates.
2. Revenue based policies increased transplantation rates by 5.3%, in large part due to increased number of transplants from deceased donor organ donations.
Evidence Rating Level: 2 (Good)
Study Rundown: The lack of supply of organs for transplantation remains an important issue in the United States. In response to this gap of supply and demand, all states have implemented different policies in hopes of increasing organ donations. However, the impact of these policies has not been studied. This study looked to investigate what policies were implemented and when, which policies increased organ donation and transplantation per capita, whether some were more effective than others, and whether policies have a different effect on living and deceased donors.
First-person consent laws, donor registries, public education, paid leave, and tax incentive policies had no significant effect on organ donation or transplantation rates. However, the establishment of revenue policies (i.e., where individuals contribute to a protected state fund for donation promotion activities) were associated with a 5.3% increase in the number of transplantations. Strengths of this study included looking at all states and all policies, thus giving a thorough examination of organ donation on a national scale. However, limitations include using state-level data, which may not be sensitive enough to determine smaller effects of policies.
Relevant Reading: Increasing the pool of deceased donor organs for kidney transplantation
In-Depth [quasi-experimental]: This study used data from the United Network for Organ Sharing Network databases and primary legal sources between January 1988 and December 2010 to determine organ donation, transplantation rates, and passage of organ donation state policies. Information on control variables, such as measures of economic environment and health system, were also gathered. The assessment of the effect of state policies on the primary outcome of organ donors per capita was done using difference-in-differences regression models.
Over the 22 year study period, all states enacted at least one donation-related policy. First-person consent laws, donor registries, public education, paid leave and tax incentive policies had no significant effect on organ donation or transplantation rates. The only policy that showed a significant association with donation rates or number of transplants was the establishment of revenue policies, which resulted in a 5.3% increase in absolute number of transplants (95%CI 0.57% to 10.1%; p = 0.03). This increase was driven by a 4.9% increase in deceased organ donors per capita (95%CI 0.97% to 8.7%; p = 0.01), in addition to an 8.0% increase in the number of transplants from deceased donors (95%CI 3.1% to 12.9%; p = 0.001). The increase shown to be associated with revenue policies remained robust through sensitivity analyses.
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