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The Political Economy of Presumed Consent

  • Author(s): Healy, Kieran
  • et al.
Abstract

The legal procurement of cadaveric human organs in Western countries is institutionalized in different ways, and donation rates vary widely. In particular, law in some countries allows for the consent of the donor to be presumed, and thus — in principle — the wishes of the next-of-kin to be overridden. I investigate the sources of variation in procurement rates using time-series data from seventeen OECD countries. Countries with presumed consent laws are found to have higher procurement rates, but the effect is relatively weak. Evidence from two presumed-consent countries where procurement rates have grown rapidly (Spain and Italy) suggests that the legal regime is a marker for other organizational practices rather than a causal mechanism in itself. More broadly, donor procurement takes place within societies that have institutionalized different relationships between the individual, the market and the state. The social organization of organ procurement may reflect aspects of these broader features of society: states with corporatist or conservative welfare regimes are likely to have adopted presumed consent laws, while liberal regimes always have informed consent rules.

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