State policies put in place from 1988 to 2010 to boost organ donation and transplantation have had little or no effect, a new study suggests.

During that 22-year period, initiatives such as first-person consent, which allows people to donate organs without family consent, establishment of organ donation registries that officially register consent for donation, tax incentives, and paid leave have had no statistically significant effect on donation and transplantation rates, researchers led by Erika G. Martin, PhD, MPH, of the State University of New York at Albany, reported in JAMA Internal Medicine (2015;175:1323-1329). The only policy with a statistically significant effect was the establishment of state revenue policies that dedicate funds for donor and transplant promotional activities. This was associated with a significant 5.3% increase in the absolute number of transplants, an increase equivalent, on average, to 15 additional transplants per state per year. This increase was driven by a significant 4.9% increase in the number of deceased donors per capita and 8.0% increase in the number of transplants of organs from deceased donors, according to Dr. Martin and her colleagues.

“New policy designs are needed to increase donation rates and curtail the widening gap between organ supply and demand,” the investigators concluded.

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Existing incentives, they observed, may not be enough to motivate the behavioral change needed to become an organ donor. For example, under existing policies, the maximum cash value of tax deduction policies is about $600, an amount substantially less than the suggested $10,000 threshold to motivate donation of a solid organ as described in previous studies. Similarly, potential living donors may not be willing to accept the loss of wages associated with leave-of-absence policies. “Future policies may consider incentives that offer sufficient benefit to outweigh the various costs associated with any act of donation,” the researchers noted.

Dr. Martin’s team said their findings offer the first examination of the national effect of a variety of policies on organ donation.

Didier Mandelbrot, MD, professor of medicine and medical director of kidney and pancreas transplantation at the University of Wisconsin in Madison, does not necessarily see the study’s findings as entirely negative. He pointed out, for example, that while tax deductions may have had little impact on living donation, policies to increase revenue to promote donation were associated with a significant 4.9% increase in deceased donation per capita and public leave laws were associated with a borderline significant 7.7% increase in living donation per capita.

“While some might agree with the authors that these benefits are small, and that the effects of state laws to increase organ donation are minimal, others might argue that an increase of 8 transplants from deceased donors per state attributed just to laws to increase revenue for donation is actually a successful and substantial outcome,” Dr. Mandelbrot told Renal & Urology News. “In addition, a number of factors might contribute to the finding that many policies have had limited impact on donation.”

In particular, he noted, many societal, governmental, and scientific factors influenced organ donation from 1988 to 2010.  Although the authors use extensive and sophisticated modeling techniques to address the impact of individual laws, no randomized controlled trials have been conducted in this field, so the conclusions are far from definitive.  Also, as the authors point out, state by state differences may be obscured by the collective analyses in this study.

While it would be premature to conclude that all government efforts to increase organ donation are futile, Dr. Mandelbrot said, most readers of the study will agree with the authors that more work needs to be done to increase organ donation, he said.

“There is a strong consensus in the transplant community that increasing organ donation is an important goal, and would save lives of patients with organ failure,” Dr. Mandelbrot said. “Many of the efforts to increase donation occur not at the level of individual caregivers or transplant centers, but at the level of government policy. Thus, it is important to assess the effect of government policies regarding organ donation.”