Background
Significant numbers of patients in the USA and UK die while waiting for solid organ transplant. Only 1–2% of deaths are eligible as donors with a fraction of the deceased donating organs. The form of consent to donation may affect the organs available. Forms of consent include: opt‐in, mandated choice, opt‐out, and organ conscription. Opt‐in and opt‐out are commonly practiced. A systematic review was conducted to determine the effect of opt‐in versus opt‐out consent on the deceased donation rate (DDR) and deceased transplantation rate (DTR).
Methods
Literature searches of PubMed and EMBASE between 2006 and 2016 were performed. Research studies were selected based on certain inclusion criteria which include USA, UK, and Spain; compare opt‐in versus opt‐out; primary data analysis; and reported DDR or DTR. Modeled effect on US transplant activity was conducted using public data from Organ Procurement and Transplantation Network and Centers for Disease Control WONDER from 2006 to 2015.
Results
A total of 2400 studies were screened and six studies were included. Four studies reported opt‐out consent increases DDR by 21–76% over 5–14 years. These studies compared 13–25 opt‐out countries versus 9–23 opt‐in countries. Three studies reported opt‐out consent increases DTR by 38–83% over 11–13 years. These studies compared 22–25 opt‐out versus 22–28 opt‐in countries. Modeled opt‐out activity on the USA resulted in 4753–17,201 additional transplants annually.
Conclusion
Opt‐out consent increases DDR and DTR and may be useful in decreasing deaths on the waiting list in the USA and other countries.
Registration number
PROSPERO CRD42019098759.
Think tanks are non‐profit policy research organisations that provide analysis and expertise to influence policy makers. Since the early twentieth century, US think tanks have played a major role in framing policy issues and providing analysis, but in the last thirty years, there has been a veritable think tank proliferation. This paper chronicles and analyses the development of think tanks; classification, organization, staffing and funding; marketing, public relations and public engagement, current trends. Finally an attempt has been made to measure the influence of think tanks on the American policy process.
Neoadjuvant treatment strategies for resectable proximal gastric, gastroesophageal junction (GEJ), and distal esophageal cancer have evolved over several decades. Treatment recommendations differ based on histologic type—squamous cell carcinoma (SCC) versus adenocarcinoma (AC)—as well as the exact location of the tumor. Recent and older clinical trials in this area were critically reviewed. Neoadjuvant chemoradiation with concurrent taxane- or fluoropyrimidine-based chemotherapy has an established role for both AC and SCC of the distal esophagus and GEJ. The use of perioperative chemotherapy for gastric AC is based on the FLOT4 and MAGIC trials; however, the utility of neoadjuvant chemoradiation in this setting requires further evaluation. Additional clinical trials evaluating chemotherapy, targeted therapy, immunotherapy, and radiation that are currently in process are highlighted, given the need for further disease control.
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