A Qualitative Content Analysis of Comments on Press Articles on Deemed Consent for Organ Donation in Canada
Danielle E. Fox, Maoliosa Donald, Christy Chong, Robert R. Quinn, Paul E. Ronksley, Meghan J. Elliott, Ngan N. Lam
Clinical Journal of the American Society of Nephrology, October 2022
Abstract
Background and objectives
In 2019, two Canadian provinces became the first jurisdictions in North America to pass deemed consent legislation to increase deceased organ donation and transplantation rates. We sought to explore the perspectives of the deemed consent legislation for organ donation in Canada from the viewpoint of individuals commenting on press articles.
Design, setting, participants, & measurements
In this qualitative descriptive study, we extracted public comments regarding deemed consent from online articles published by four major Canadian news outlets between January 2019 and July 2020. A total of 4357 comments were extracted from 35 eligible news articles. Comments were independently analyzed by two research team members using a conventional content analysis approach.
Results
Commenters’ perceptions of the deemed consent legislation for organ donation in Canada predominantly fit within three organizational groups: perceived positive implications of the bills, perceived negative implications of the bills, and key considerations. Three themes emerged within each group that summarized perspectives of the proposed legislation. Themes regarding the perceived positive implications of the bills included majority rules, societal effect, and prioritizing donation. Themes regarding the perceived negative implications of the bills were a right to choose, the potential for abuse and errors, and a possible slippery slope. Improving government transparency and communication, clarifying questions and addressing concerns, and providing evidence for the bills were identified as key considerations.
Conclusions
If deemed consent legislation is meant to increase organ donation and transplantation, addressing public concerns will be important to ensure successful implementation.

An ex-ante cost-utility analysis of the deemed consent legislation compared to expressed consent for kidney transplantations in Nova Scotia
Research
Prosper Koto, Karthik Tennankore, Amanda Vinson, Kristina Krmpotic, Matthew J. Weiss, Chris Theriault, Stephen Beed
Cost Effectiveness and Resource Allocation, 6 October 2022; 20(55)
Open Access
Abstract
Background
This study was an ex-ante cost-utility analysis of deemed consent legislation for deceased organ donation in Nova Scotia, a province in Canada. The legislation became effective in January 2021. The study’s objective was to assess the conditions necessary for the legislation change’s cost-effectiveness compared to expressed consent, focusing on kidney transplantation (KT).
Method
We performed a cost-utility analysis using a Markov model with a lifetime horizon. The study was from a Canadian payer perspective. The target population was patients with end-stage kidney disease (ESKD) in Atlantic Canada waitlisted for KT. The intervention was the deemed consent and accompanying health system transformations. Expressed consent (before the change) was the comparator. We simulated the minimum required increase in deceased donor KT per year for the cost-effectiveness of the deemed consent. We also evaluated how changes in dialysis and maintenance immunosuppressant drug costs and living donor KT per year impacted cost-effectiveness in sensitivity analyses.
Results
The expected lifetime cost of an ESKD patient ranged from $177,663 to $553,897. In the deemed consent environment, the expected lifetime cost per patient depended on the percentage increases in the proportion of ESKD patients on the waitlist getting a KT in a year. The incremental cost-utility ratio (ICUR) increased with deceased donor KT per year. Cost-effectiveness of deemed consent compared to expressed consent required a minimum of a 1% increase in deceased donor KT per year. A 1% increase was associated with an ICUR of $32,629 per QALY (95% CI: − $64,279, $232,488) with a 81% probability of being cost-effective if the willingness-to-pay (WTP) was $61,466. Increases in dialysis and post-KT maintenance immunosuppressant drug costs above a threshold impacted value for money. The threshold for immunosuppressant drug costs also depended on the percent increases in deceased donor KT probability and the WTP threshold.
Conclusions
The deemed consent legislation in NS for deceased organ donation and the accompanying health system transformations are cost-effective to the extent that they are anticipated to contribute to more deceased donor KTs than before, and even a small increase in the proportion of waitlist patients receiving a deceased donor KT than before the change represents value for money.

The Current Practice and Medico Legal Aspects of Informed Consent in Obstetrics and Gynaecology in a Teritary Care Hospital, Can We Improve?: An Interventional Study
Shreen R., Kagne R.N., Jayasree M
Indian Journal of Forensic Medicine and Toxicology, October-December 2022; 16(4)
Open Access
Abstract
The Informed Consent plays major role in both Patients and the Doctors to carry out various aspects in the surgical procedures. This paper was an interventional study it was conducted in the Department of Forensic Medicine and Toxicology, Sri Manakula Vinayaga Medical College and Hospital, Madagadipet, Puducherry to audit and to improve it was conducted in the Department of Obstetrics and Gynaecology. The deficiencies were identified and it was analysed. The results of both pre-interventional and post-interventional were recorded, which showed the significant improvement in the consent form of the major and minor procedures. This study results will give importance on documenting the Informed Consent day to day life practice.

Informed Decision-Making and Capabilities in Population-based Cancer Screening
Ineke L L E Bolt, Maartje H N Schermer, Hanna Bomhof-Roordink, Danielle R M Timmermans
Public Health Ethics, 3 October 2022
Abstract
Informed decision-making (IDM) is considered an important ethical and legal requirement for population-based screening. Governments offering such screening have a duty to enable invitees to make informed decisions regarding participation. Various views exist on how to define and measure IDM in different screening programmes. In this paper we first address the question which components should be part of IDM in the context of cancer screening. Departing from two diverging interpretations of the value of autonomy—as a right and as an ideal—we describe how this value is operationalized in the practice of informed consent in medicine and translate this to IDM in population-based cancer screening. Next, we specify components of IDM, which is voluntariness and the requirements of disclosure and understanding. We argue that whereas disclosure should contain all information considered relevant in order to enable authentic IDM, understanding of basic information is sufficient for a valid IDM. In the second part of the paper we apply the capability approach in order to argue for the responsibility of the government to warrant equal and real opportunities for invitees for IDM. We argue that additional conditions beyond mere provision of information are needed in order to do so.

Towards a technologically assisted consent in the upcoming new EU data laws?
Andrés Chomczyk Penedo
Privacy in Germany, 2 September 2022
Abstract
The European Commission (Commission) put forward an ambitious proposal package of new legislation for the digital economy, including the Digital Markets Act, the Digital Services Act, or the Data Governance Act. Despite their different scopes, they all share a recurring topic: the relevance of (personal) data in enabling a data-intensive economic model around data sharing and the role of data subjects in granting permission to do so. As such, the purpose of this article is to explore how the Commission and other EU institutions intended to strengthen consent in these novel data regulations through technological tools but also novel assistance duties, but also the potential shortcoming around this approach.