Modeling the Effect of Presumed Consent on Waitlist Candidate Quantities

L. DeRoos¹, W. Marrero¹, M. Lavieri¹, D. Hutton², N. Parikh³

¹Industrial and Operations Engineering, University of Michigan, Ann Arbor, MI, ²School of Public Health, University of Michigan, Ann Arbor, MI, ³Department of Internal Medicine, University of Michigan, Ann Arbor, MI

Meeting: 2019 American Transplant Congress

Abstract number: D226

Keywords: Public policy, Waiting lists

Session Information

Session Name: Poster Session D: Non-Organ Specific: Public Policy & Allocation

Session Type: Poster Session

Date: Tuesday, June 4, 2019

Session Time: 6:00pm-7:00pm

Presentation Time: 6:00pm-7:00pm

Location: Hall C & D

*Purpose: Organ transplantation is a life-saving and cost-effective treatment for patients with end-organ failure. However, the current supply of donors is unable to match demand, resulting in poor access to transplantation for recipients. A presumed consent, opt-out, donor registration policy could increase deceased donor donation in the U.S., yet the impact of presumed consent on the waitlist is uncertain. We aimed to model the impact a presumed consent policy could have on patients on the organ transplant waitlist over a 10-year period.

*Methods: Our model used waitlist and waitlist removal data by organ type from the OPTN database from 2004-2014. Based on published data on the impact of presumed consent policies, we modeled a 5% to 25% range of increases in the number of available deceased donors. The model incorporated waitlist additions and separated waitlist removal causes into 4 primary categories: living donor transplant, deceased donor transplant, illness or death, and other causes.

*Results: Our waitlist model began with 15,249 liver patients, 54,779 kidney patients, 3,665 pancreas patients, 3,252 heart patients, and 3,641 lung patients. Under the current opt-in policy, the net change in the patients on the waitlist over the 10-year time frame varied from a 55% decrease in lung patients, to an 83% increase in kidney patients. The impact on waitlist quantities over this range is shown in Table 1. When comparing a 5% increase in deceased donors to the current opt-in policy, we found that there would be a 4% reduction in kidney patients, a 6% reduction in liver patients, a 7% reduction in pancreas and lung patients, and a 9% reduction in heart patients on the waitlist after 10 years.

Table 1: Percent Change in Number of Patients on Waitlist 2004-2014
Organ	Opt-In	Presumed Consent – Deceased Donor Increase				Deceased Donor increase needed to eliminate waitlist over time frame
Organ	Baseline	5%	10%	15%	25%
Liver	-3%	-9%	-15%	-21%	-32%	83%
Kidney	83%	79%	73%	67%	55%	156%
Pancreas	-20%	-27%	-34%	-42%	-56%	56%
Heart	12%	3%	-7%	-17%	-38%	60%
Lung	-55%	-62%	-68%	-75%	-89%	33%

*Conclusions: In all cases, even a 25% increase in deceased donors would not have eliminated the waitlist over the time frame. This study suggests that presumed consent would reduce the number of patients on the waitlist but would need to be supplemented by other initiatives to alleviate the shortage of organs available for transplant.

To cite this abstract in AMA style:

DeRoos L, Marrero W, Lavieri M, Hutton D, Parikh N. Modeling the Effect of Presumed Consent on Waitlist Candidate Quantities [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/modeling-the-effect-of-presumed-consent-on-waitlist-candidate-quantities/. Accessed May 9, 2025.

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