Organ Donation: Debate over Opt-In vs. Opt-Out Approaches

Organ donation policies around the globe differ significantly, leading to question: should it be mandatory for individuals to opt in or opt out? A team of UK researchers set out to explore this, analyzing the organ donation protocols of 48 countries to determine the superior approach.

In opt-in systems, people must actively register to donate organs post-mortem. Conversely, opt-out systems lead to automatic donation unless a specific request is made before death to refrain. Professor Eamonn Ferguson, the study's lead author from the University of Nottingham, highlighted concerns related to inaction in opt-in systems:

“People may not take action for various reasons, such as fear of loss, lack of effort, or the belief that policy makers have made the correct decision.”

Inaction in opt-in systems can result in intended donors failing to donate (false negatives). However, inaction in opt-out systems may lead to individuals who don't wish to donate becoming donors (false positives).

The United States currently employs an opt-in system. Despite more than 28,000 transplants last year, thanks to organ donors, approximately 18 people still die daily due to a shortage of donated organs.

The research analyzed the organ donation systems of 48 countries over a period of 13 years, with 23 using opt-in systems and 25 opting for opt-out. The study considered overall donor numbers, the number of transplants per organ, and the total number of kidneys and livers transplanted from both deceased and living donors.

The authors discovered that countries with opt-out organ donation systems experienced higher total numbers of kidney donations. Opt-out systems also revealed a greater overall number of organ transplants. However, opt-in systems had a higher rate of kidney donations from living donors, a trend that had not been previously reported, according to Professor Ferguson.

The study acknowledged its limitations, such as not differentiating between varying degrees of opt-out legislation and overlooking factors possibly influencing organ donation.

The researchers suggest that their findings could guide future policy decisions regarding consent types. To further strengthen these results, they propose the regular collection and public availability of international organ donation information, including consent type, procurement procedures, and hospital bed availability.

Professor Ferguson also suggests that future studies could delve into the perspectives of individuals making the decision to opt in or opt out, combining survey and experimental methods for a more comprehensive understanding of the influence of consent legislation on organ donation rates.

The authors emphasize that countries with opt-out consent still face organ donor shortages. A complete system change is unlikely to solve this issue, and they suggest that modifications to consent legislation or the adoption of aspects of the "Spanish Model" may improve donor rates.

Spain boasts the highest organ donation rate globally, thanks to its opt-out consent system and robust transplant coordination network. Experts believe that improvements in the quality of public information regarding organ donation have also contributed to Spain's success.

Recently, Medical News Today featured a spotlight on the question: should animal organs be farmed for human transplants? Could this resolve the organ shortage, or is it a matter better addressed through changes to organ donation policy?

In opt-out systems, individuals may inadvertently become organ donors if they do not explicitly opt out, a situation known as a false positive, according to the study.
Conversely, people considering themselves intended donors might fail to donate in opt-in systems due to factors such as fear or lack of action, leading to false negatives, as highlighted by Professor Eamonn Ferguson.
The study discovered that countries with opt-out organ donation systems tended to have higher total numbers of kidney donations and a greater overall number of organ transplants, compared to opt-in systems.
Despite the advantages of opt-out systems, countries still face organ donor shortages, prompting the authors to suggest that modifications to consent legislation or the adoption of aspects of the "Spanish Model," which combines opt-out consent with a robust transplant coordination network, may improve donor rates.