title: Current progress in public health models addressing the critical organ shortage.
abstract: Since its inauguration in 1954, the field of modern transplantation has made great strides in surgical technique, the prevention of acute and chronic rejection, the minimization of immunosuppression-related side-effects and transplant tolerance. As such, organ transplantation is used worldwide as a curative, life-saving treatment for people with end-stage organ failure. However, the successes of organ transplantation have resulted in the number of patients on transplant waiting lists far exceeding the number of organs available, with growing numbers of patients dying while awaiting transplants. In order to address this critical organ shortage, a number of legislative changes have been implemented worldwide to increase the number of individuals registering as organ donors. These have included presumed consent donation, incentivized organ donation, commercial organ transplantation and mandated choice models. This article will address these public health policies in turn. The implementation of these strategies and the evidence for their efficacy will be evaluated. Based on this, we have identified that well-supported transplant coordinators approaching next-of-kin, incentives and public health campaigns are key factors that increase organ donation. Finally we propose a modified mandated choice model that may be an alternative option to maximize the number of available organs for transplantation.
authors.affiliation: Transplantation Biology Research Center, Massachusetts General Hospital, Building 149, 13th Street, Charlestown, Boston, MA 02114, USA; Department of Surgery & Cancer, Imperial College London, Exhibition Road, London SW7 2AZ, United Kingdom. Electronic address: kumaran.shanmugarajah@tbrc.mgh.harvard.edu.
authors.forename: Kumaran
authors.initials: K
authors.lastname: Shanmugarajah
authors.affiliation: Transplantation Biology Research Center, Massachusetts General Hospital, Building 149, 13th Street, Charlestown, Boston, MA 02114, USA.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Villani
authors.affiliation: Transplantation Biology Research Center, Massachusetts General Hospital, Building 149, 13th Street, Charlestown, Boston, MA 02114, USA; Department of Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02129, USA.
authors.forename: Maria Lucia L
authors.initials: ML
authors.lastname: Madariaga
authors.affiliation: Department of Surgery & Cancer, Imperial College London, Exhibition Road, London SW7 2AZ, United Kingdom.
authors.forename: Joseph
authors.initials: J
authors.lastname: Shalhoub
authors.affiliation: Transplantation Biology Research Center, Massachusetts General Hospital, Building 149, 13th Street, Charlestown, Boston, MA 02114, USA; Department of Cardiac Surgery, Ludwig-Maximilians-Universität München, Munich D-81377 Germany.
authors.forename: Sebastian G
authors.initials: SG
authors.lastname: Michel
mesh_terms: D006801:Humans; D008297:Male; D019724:Presumed Consent; D011634:Public Health; D014019:Tissue Donors / Q000600:supply & distribution*; D009927:Tissue and Organ Procurement / Q000331:legislation & jurisprudence / Q000458:organization & administration
keywords: Donation; Explicit consent; Mandated choice; Organ shortage; Policy; Presumed consent