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. 3/2012The data come from the Transplant Procurement Management Organization (TPM), theWorld Health Organization (WHO), World Bank (WB) and the SociedadLatinoamericana de Nefrología e Hipertensión (SLANH). The sample contains 34countries 14 over 5-year period (1998-2002). The choice of the countries is related toavailability of data 15 .The variables used in this paper follow Abadie and Gay (2004), Healy (2005) andAnbarci and Caglayan (2005). They are: number of deaths by traffic accident per 100,000population; number of deaths by brain vascular disease per 100,000 population, GDP percapita; total health expenditure per capita; percentage of population that has access to theInternet; dummy for catholic country (=1 if 50% or more of population are catholic); anddummy for legal system (=1 if the country has common law). The dependent variable isthe rate of cadaveric organ donation per million population (pmp) and the variable ofinterest is a dummy for countries that have presumed consent as law on organ donation.Figure 1 shows a panoramic view of cadaveric organ donation in the sample. In the upperhalf of the Figure are countries with presumed consent law on cadaveric organ donationand the other half in blue are countries with informed consent. Spain has the highestdonation rates, followed by Austria and Portugal, these three countries having presumedconsent law. In 2002, the USA had the highest donation rate of the countries withinformed consent law, and which was close to the rates achieved by Austria and Portugalthat year. In 2002, on average, cadaveric organ donation rate by countries that havepresumed consent was 14.91 pmp, and 10.51 for countries with informed consent.Countries with presumed consent had an increase of 12% in their rates from 1998 to 2002,while the others a decrease of 12%. In absolute value, Italy was the country that14 The 34 countries we have analyzed in this paper are reported in Table 1.15 A well-known problem in health empirical works is the presence of some missing values, particularlywhen the analysis uses countries over time. Our sample has 4% missing values, related to two variables:number of deaths from celebro-vascular diseases and number of deaths from traffic accidents. If we dropthese missing values, 20% of the sample information would be missed. To avoid this loss, we imputedvalues from an OLS trend, using the previous four years. We believe that this method is a good way to treatthe problem, since there are very small variations over years for brain diseases and traffic accident.7
Azienda Ospedaliera Nazionale“SS. Antonio e Biagio e Cesare Arrigo”Working Paper of Public Healthnr. 3/2012improved its cadaveric donation most, with an increase of 5.8 (12.3 in 1998 to 18.1 in2002). Brazil is one of the countries that do most transplants in the world, but itscadaveric organ donation pmp is one of the lowest (4.16 on average among 1998-2002).Figure 1: Cadaveric organ donation per million population (pmp) by country (1998-2002)Cadaveric Organ Donation rate pmpCountriesPanamaGreeceSlovakCroatiaIsraelCosta RicaSwedenPolandNorwayCzech RepublicHungaryLatviaFinlandItalySloveniaFrancePortugalAustriaSpainRomaniaVenezuelaBrazilArgentinaChileNew ZealandSwitzerlandAustraliaGermanyNetherlandsDenmarkCanadaUKIrelandUSA0 5 10 15 20 25 30 35 4020021998Brazil was the only country that changed the law on organ donation during the yearsanalyzed in this paper, as presumed consent commenced in 1998. At this time, everyBrazilian citizen became a potential donor after death, unless he/she had registered anobjection against donation in personal documents. However, this law was highlycriticized by different institutions. Due to this pressure, the Brazilian governmentabolished presumed consent in 2000. The main problems related to the Brazilianexperience with presumed consent were: i) lack of ample discussion about organ8
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