Working Paper of Public Health Volume 2012 - Azienda Ospedaliera ...

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Azienda Ospedaliera Nazionale“SS. Antonio e Biagio e Cesare Arrigo”Working Paper of Public Healthnr. 3/2012lies between 21-24% when the GDP per capita is used as proxy for income, and 24-26%when health expenditure per capita is used instead. There is a slight variation among thequantile coefficients, with the median (50 th quantile) as the biggest one. These estimatesare smaller than the one from panel data, which is about 40%.From the model analyzed in Table 2, the GDP per capita has the biggest impact oncadaveric organ donation. Countries situated in the lowest quantiles were the mostaffected (81% at the 25 th quantile and 74% at the 50 th quantile). That pattern could beinterpreted as decreasing returns of scale, since the marginal contribution of income islower when we go through the upper side of the distribution.The coefficients of health expenditure per capita also show the same pattern (see Table 3).Table 3: The effect of presumed consent law on cadaveric organ donation: Estimates from paneldata and quantile regression for panel dataDependent variable: log cadaveric organdonation PD 25 th 50 th 75 thPresumed Consent 0.3829 0.2540 0.2630 0.2370(0.000) (0.000) (0.000) (0.000)Log Brain 0.1990 0.1430 0.1430 0.1020(0.000) (0.017) (0.012) (0.044)Log Traffic 0.1772 0.2260 0.1830 0.2200(0.001) (0.000) (0.000) (0.000)Log Health Expenditure per capita 0.6180 0.5210 0.4710 0.4240(0.000) (0.000) (0.000) (0.000)Log Internet access 0.1812 0.1220 0.0250 0.0400(0.000) (0.000) (0.053) (0.001)Catholic Country 0.2439 0.1110 0.0460 -0.0010(0.000) (0.000) (0.011) (0.480)Common Law 0.1970 0.1100 0.1740 0.1520(0.000) (0.000) (0.000) (0.000)Constant -4.2819 -3.1480 -2.2660 -1.7370(0.000) (0.000) (0.002) (0.004)Analysing the potential donor coefficients, only the traffic accident coefficients arestatistically significant at the conventional levels, having a positive effect on cadavericvariable, as one would expect. However, in model 2 (Table 3), both of them arestatistically significant at least at the 5% level, showing a positive impact on the responsevariable.15
Azienda Ospedaliera Nazionale“SS. Antonio e Biagio e Cesare Arrigo”Working Paper of Public Healthnr. 3/2012Religious belief seems to play a role in organ donation as well, at least in the left tail ofthe distribution. Predominately-Catholic countries show a positive effect of around 11-15% in the 25 th quantiles in both models, while in the 50 th quantiles they are practicallythe same, 5%. Anbarci and Caglayan (2005) found a negative effect for religious belief,but their dummy was set for Islam and Judaism. We were not able to test their variable,since our sample has only one country that follows that religious belief (Israel - Judaism).While most countries with Islam and Judaism, as the prominent religions do not stimulatethe population to become potential donors, catholic countries recognize organtransplantation as a new way of serving the human family. Pope John Paul II (1991) inhis speech to the medical community expressed his agreement to cadaveric organdonation, since it takes place in a context of love, communion, solidarity and absoluterespect for the dignity of the human person.We also tested the impact of the legal system on cadaveric organ donation, using adummy for the existence of common law. It was statistically significant at the 1% level inall quantiles. The biggest coefficients were in model 2 (Table 3), varying between 11-17%. Based on this, people from countries that place more emphasis on individual rightstend to donate more their organs. However, further research must be done to understandthe link between common law and cadaveric organ donation.5. Final ConsiderationsThe aim of this paper was to discuss some issues related to the presumed consent law,and to bring up empirical evidence of the supposed impact of this legislation on cadavericorgan donation. In order to do this, a review of related works was carried out. For theempirical part, a sample of 34 countries over 5 years was analyzed. The method appliedwas quantile regression for panel data, which we believe is an appropriate way toinvestigate such a heterogeneous sample, as there has been criticism of results obtainedby conditional mean approaches due to some outliers (especially the Spanish case, whichhas the biggest cadaveric organ donation rate by far). This paper is the first to apply thismethod of investigation to this subject.16
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