title: The authority of next-of-kin in explicit and presumed consent systems for deceased organ donation: an analysis of 54 nations.
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.
authors: Division of Nephrology, Department of Medicine, London Health Sciences Centre, London, Canada.
authors: Amanda M
authors: AM
authors: Rosenblum
authors: Lucy D
authors: LD
authors: Horvat
authors: Laura A
authors: LA
authors: Siminoff
authors: Versha
authors: V
authors: Prakash
authors: Janice
authors: J
authors: Beitel
authors: Amit X
authors: AX
authors: Garg
mesh_terms: D003220:Conflict, Psychological; D003657:Decision Making; D005190:Family / Q000523:psychology*; D006801:Humans; D007258:Informed Consent / Q000523:psychology*; D007390:International Agencies; D019724:Presumed Consent / Q000331:legislation & jurisprudence*; D009927:Tissue and Organ Procurement / Q000331:legislation & jurisprudence* / Q000592:standards* / Q000706:statistics & numerical data