Opt-out policy and the organ shortage problem: Critical insights and practical considerations

The legal shift to an opt-out system of consent for deceased organ donation is now official in England, Wales and Scotland. While it is commendable that national governments across the United Kingdom have publicly signalled their serious engagement with organ donation, it remains questionable that opt-out policy can in and of itself solve the public health issue of organ shortage. Opt-out policy risks becoming a futile solution if it fails to attend to key factors in clinical practice. Thus, this article provides critical insights and practical considerations in order to work towards increasing the availability of organs for transplantation: 1) organ donation specialists on their own are not enough, a collaborative hospital culture of donation is also needed; 2) investment in innovative perfusion technologies is fundamental to increase both the quantity and quality of organs utilised for transplants; and 3) opt-out does not solve the enduring problem of consent or authorization for donation, rather than hoping that opt-out will shift the societal culture of donation and make donation the default choice, it is necessary to acknowledge that families' authorization remains essential and their emotional experience can neither be minimized nor excluded altogether. Importantly, consent rates are not the only factor to account for overall deceased donation rates. The organ shortage cannot be solely attributed to a matter of negative public attitudes reversible by law. Doing that does a disservice to the public and diverts strategic attention and resources from fostering the organizational and technological enablers of organ donation in clinical practice.     

Measuring the costs of crime using the willingness-to-pay method

Background

Criminal justice policy decisions are increasingly being influenced by the ratio of the monetary benefits to the monetary costs. While policies based on evidence and analysed via cost-benefit studies are a welcome development, cost-benefit calculations are only as robust as the data upon which they are based. For England and Wales up to the present, cost-of-crime estimates used in cost-benefit analyses have been calculated by the Home Office using a multi-method approach. However, the intangible costs of crime have not been estimated adequately in England and Wales.

Aim

The main aim was to quantify the intangible costs of crime using the willingness-to-pay (WTP) method. Also, stated preferences for different crime reduction methods were investigated.

Method

This study utilises samples from the City of Cambridge (n = 534) and from Criminal Justice Practitioners (n = 124), to assess their WTP to prevent a range of crimes from happening in their neighbourhood, and their preferred crime reduction techniques. A Contingent Valuation Survey (CVS) was used.

Results

Overall, both samples gave a higher WTP for low volume, high harm crimes than for high volume, low harm crimes. Both samples supported funding youth programmes in preference to other forms of crime reduction initiatives.

Conclusion

It is proposed that a CVS should be included in the next Crime Survey for England and Wales, in order to collect relevant WTP data on crime at the national level.