Author(s): Brad Theel, Joshua Hammond
Mentor(s): Mohammad Islam, Ruhul Kuddus
Institution UVU
Background: About 90% of the global annual demand for donor organs is left unmet, causing a long wait and significant morbidity mortality. The COVID-19 pandemic (C19P) exacerbated the donor organ shortage. This study investigates the effects of consent policies on the average transplantation rate (ATR) per million population (PMP) before, during, and after the C19P. Methods: Transplantation data (2015-2023) of ten solid organs in 66 countries was obtained from GODT and IRODaT databases. The countries were divided into four clusters based on WHO/World Bank data on six key health/economic variables. The ATR for the pre-C19P (2015-2019), during C19P (2020), and post-C19P (2021-2023), were analyzed to find the adjusted effect of consent policies using longitudinal multilevel modeling. Results: Of the 66 countries, 39 implemented the opt-in, and 27 implemented the opt-out system. Opt-out countries had higher ATRs in all periods: pre-pandemic (52.7 vs. 35.9 PMP), during the pandemic (43.0 vs. 29.7 PMP), and post-pandemic (49.5 vs. 34.8 PMP). The opt-out countries had a significantly higher ATR in six of the ten transplant types. Deceased donor kidney transplantations were 10.60 PMP higher in opt-out countries (p-value=<0.01, 95%CI: 4.57 to16.63), while live donor kidney transplantations were 5.48 PMP higher in opt-in countries (p-value=<0.01, 95% CI: -8.88 to -2.07). Adjusted analyses showed opt-out countries performed 12.95 PMP more transplants overall (p = 0.04, 95% CI: 1.11 to 24.79). Conclusions: Opt-out policies were associated with higher transplant rates before, during, and after the pandemic, with smaller pandemic-related declines, suggesting universal transitioning to the opt-out policy.