Kidney procurement policies in the Eurotransplant region. 'Opting in' versus 'opting out'.

A shortage of kidneys has been part of kidney transplantation ever since it evolved from its experimental stage and became a therapeutic possibility. However, at present this shortage is more acute than ever before. Post mortem kidney procurement policies can be distinguished into 'opting in' and 'opting out' systems. In the five countries cooperating in Eurotransplant, systems of both kind have been implemented. In this paper the relation between these procurement policies and kidney availability in the Eurotransplant region is examined. The opting out system turns out to be more favourable to kidney procurement than the opting in system. The approach of the next of kin with the donation question happens to be an important barrier for kidney procurement in the opting in system, but fails to appear under opting out. In the epilogue some remarks are made on the possibilities of introduction of the opting out system in countries now applying opting in.