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. 3/2012As it has been stressed, in this paper and others, the two kinds of legislation on cadavericorgan donation are imperfect, because there are always people whose true wills are notexecuted. In this way, policy makers must weigh the pros and cons of each piece oflegislation. The results reported in this paper could be used to clarify the benefits ofadopting presumed consent, which has a positive effect of 21-26% on cadaveric organdonation related to informed consent countries. In addition, the methodology applied inthis paper was able to provide evidence against a common belief in related literature thatpresumed consent has a positive effect only because of the outstanding Spanish donationrate. The left tail of distribution (countries with lower organ donation rate) has shown apositive impact on the response variable, which contradicts this common belief.Organ shortages can be worse since both celebro-vascular disease and traffic accidentrates have decreased over the years (-5.2% and -8.6%, respectively, from 1998 to 2002),because of specific public health policies in these areas. Based on this, the trend for thecontribution from these variables on organ donation can be lower over time. Therefore,health policy makers must be aware of that problem. The presumed consent law could bean alternative, not to solve the problem completely, but at least to reduce the gap betweendemand and supply of organ donation.There are other ways that the policy maker can improve the organ supply: increasinghealth expenditure and intensifying the dissemination of information about organdonation. A strong relationship was found between health expenditure and donation rates,especially in countries that are situated in the lower quantiles of the conditionaldistribution. This seems to be the most effective way of increasing organ donation forcountries that do not want to change the law to presumed consent or even for those thatalready have one, because the health policy maker has control of health expenditure,unlike other factors such as religious belief and the legal system (which also have apositive effect on the organ donation rate).Although educational campaigning has not been explicitly tested in this paper, it seems toplay an important role in organ donation, since a representative part of the population haslittle knowledge about legislation on organ donation. As our proxy for information(access to the Internet) has shown, there is a positive impact between it and the response17
Azienda Ospedaliera Nazionale“SS. Antonio e Biagio e Cesare Arrigo”Working Paper of Public Healthnr. 3/2012variable. Based on this, more information must be made available on different media.Educational campaigns also can avoid some problems as verified in the Brazilianexperience with presumed consent. Some authors have pointed out that presumed consentwas unsuccessful in Brazil because there was not a huge discussion about the law andrelated issues with transplantation, such as the strict proceedings to diagnose brain deathand the coordination of the waiting list.Finally, if health policy makers follow these recommendations a significant increase inorgan donation should be achieved and more transplants could be carried out, generatingbetter quality of life for patients, particularly in cases when such transplants are the onlyway to keep them alive. In this way, efficiency and equity -- the main goals for publichealth policies -- could be achievedReferencesABADIE, Alberto e GAY, Sebastien (2006). The Impact of Presumed ConsentLegislation on Cadaveric Organ Donation: a Cross-Country Study. Journal of HealthEconomics, vol. 25: 599-620ABREVAYA, Jason and DAHL, Christian (2005). The effect of smoking and prenatalcare on birth outcomes: evidence from quantile estimation on panel data.http://www.ssc.wisc.edu/~bhansen/workshop/abrevaya.pdf.ANBARCI, Nejat & CAGLAYAN, Mustafa (2005). Cadaveric vs. live-donor kidneytransplants: the interactions of institutions and inequalities. Working Paper FloridaInternational University (department of economics), number 05-17.http://www.fiu.edu/orgs/economics/wp2005/05-17.pdf.ANZOD. 2006. The Australia and New Zealand Organ Donation Registry. 2002 AnnualReport. http://www.anzdata.org.au/ANZOD/ANZODReport/anzodreport.htmBAGHERI, A. (2005). Organ Transplantation law in Asia Countries: A ComparativeStudy, Transplantation Proceeding, vol. 37:159-162.BALTAGI, Badi H. (2001). Econometric analysis of panel data. Second edition.18
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