The authority of next-of-kin in explicit and presumed consent systems for deceased organ donation: an analysis of 54 nations

Nephrol Dial Transplant. 2012 Jun;27(6):2533-46. doi: 10.1093/ndt/gfr619. Epub 2011 Nov 25.

Abstract

Background: The degree of involvement by the next-of-kin in deceased organ procurement worldwide is unclear. We investigated the next-of-kin's authority in the procurement process in nations with either explicit or presumed consent.

Methods: We collected data from 54 nations, 25 with presumed consent and 29 with explicit consent. We characterized the authority of the next-of-kin in the decision to donate deceased organs. Specifically, we examined whether the next-of-kin's consent to procure organs was always required and whether the next-of-kin were able to veto procurement when the deceased had expressed a wish to donate.

Results: The next-of-kin are involved in the organ procurement process in most nations regardless of the consent principle and whether the wishes of the deceased to be a donor were expressed or unknown. Nineteen of the 25 nations with presumed consent provide a method for individuals to express a wish to be a donor. However, health professionals in only four of these nations responded that they do not override a deceased's expressed wish because of a family's objection. Similarly, health professionals in only four of the 29 nations with explicit consent proceed with a deceased's pre-existing wish to be a donor and do not require next-of-kin's consent, but caveats still remain for when this is done.

Conclusions: The next-of-kin have a considerable influence on the organ procurement process in both presumed and explicit consent nations.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Conflict, Psychological*
  • Decision Making*
  • Family / psychology*
  • Humans
  • Informed Consent / psychology*
  • International Agencies
  • Presumed Consent / legislation & jurisprudence*
  • Tissue and Organ Procurement / legislation & jurisprudence*
  • Tissue and Organ Procurement / standards*
  • Tissue and Organ Procurement / statistics & numerical data