State Policies on Organ Donation and Transplantation

Study Questions:

What are the effects of state policies regarding organ donation and transplantation on incentivizing volunteer donation?


Using data derived from United Network for Organ Sharing, the study authors estimated the effect of policies in the District of Columbia and all 50 states on organ donors per capita and the number of transplantations from January 1, 1988, to December 31, 2010. The policies of interest were the presence of first-person consent laws, donor registries, dedicated revenue streams for donor recruitment activities, population education programs, paid leave for donation, and tax incentives. They obtained information on states’ passage of various policies from primary legislative and legal sources. The study authors utilized a quasi-experimental design and difference-in-differences regression analyses to analyze data. They stratified their data by type of donor (living or deceased). The main outcome and measures included the number of organ donors and transplantations per state, per year, during the study period.


The investigators found that during the study period, the number of states passing at least one donation-related policy increased from 7 (14%) to 50 (100%). In this national study of organ donation and transplantation, the study investigators found that state policies have had a modest effect during the past two decades. The establishment of revenue policies, in which individuals contribute to a protected state fund for donation promotion activities, was associated with a 5.3% increase in the absolute number of transplants (95% confidence interval [CI], 0.57%-10.1%; p = 0.03). This increase is equivalent, on average, to 15 additional transplants per state, per year. These associations were driven by a 4.9% increase in organ donations (95% CI, 0.97%-8.7%; p = 0.01) and an 8.0% increase in transplants (95% CI, 3.1%-12.9%; p = 0.001) from deceased donors, as opposed to changes among living donors or transplants from living donors. Other policies such as first-person consent laws, donor registries, public education, paid leave, and tax incentives had no robust, significant association with either donation rates or number of transplants.


The authors concluded that the only state policy to have a meaningful impact on encouraging organ donation was the establishment of revenue policies to promote organ donation. They argued that new policies are needed to increase donation rates and curtail the widening gap between organ supply and demand.


Traditionally, organ donation has always resulted from altruistic motives. This is an important study because it suggests that organ donation rates have reached a cap with the altruistic approach. Aligning incentives for organ donation is a worldwide challenge. Ethicists will rightly caution the utilization of financial incentives to increase organ donation. Further studies are needed to evaluate the merits and demerits of using financial incentives to increase organ donation.

Clinical Topics: Heart Failure and Cardiomyopathies, Acute Heart Failure

Keywords: Heart Failure, Living Donors, Motivation, Tissue Donors, Tissue and Organ Procurement, Transplantation, Volunteers

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