Debate over Organ Donation Registration Methods: Opt-In vs. Opt-Out Approaches Compared
Organ donation policies worldwide are as different as the nations themselves, leaving us to ponder if an opt-in or opt-out system is the superior choice. To find answers, a team of researchers from the UK delved into the organ donation protocols of 48 countries, scrutinizing the pros and cons of each approach.
In opt-in systems, people must actively sign up to donate their organs after death, while opt-out systems automatically donate organs unless a specific request is made to the contrary. Prof. Eamonn Ferguson, the study's lead author from the University of Nottingham, acknowledges that the reliance on an individual's decision can lead to drawbacks:
"Individuals may not act for several reasons, such as loss aversion, lack of effort, or trusting that policy makers have made the 'right' decision."
Inaction in an opt-in system could result in individuals who would wish to donate not doing so (a false negative). On the other hand, in an opt-out system, inaction could lead to an individual who does not wish to donate accidentally becoming a donor (a false positive).
The US employs an opt-in system, with the U.S. Department of Health & Human Services reporting that 28,000 transplants were made possible last year thanks to organ donors. Regrettably, approximately 18 people die daily due to a scarcity of donated organs.
In or out?
The researchers from the University of Nottingham, the University of Stirling, and Northumbria University analyzed the organ donation systems of 48 countries over a 13-year period, discovering some interesting findings. They found that countries employing opt-out systems had a higher total number of kidneys donated, the organ most in demand for transplants. Opt-out systems also had a greater overall number of organ transplants.
However, opt-in systems yielded a higher rate of kidney donations from living donors. This previously undetected influence that policy had on living donation rates is worth noting, according to Prof. Ferguson. The researchers' study had some limitations, like not distinguishing between different degrees of opt-out legislation and not assessing other factors that may influence organ donation.
Moving forward
The researchers' results, published in BMC Medicine, suggest that "opt-out consent may lead to an increase in deceased donation but a reduction in living donation rates. Opt-out consent is also associated with an increase in the total number of livers and kidneys transplanted." They propose that these findings could be used to inform future policy decisions, but they could be bolstered further through the routine collection and public disclosure of international organ donation information.
Prof. Ferguson suggests that future studies could explore the beliefs, wishes, and attitudes of those making the decision to opt in or opt out:
"Further research outside of this country-level epidemiological approach would be to examine issues from the perspective of the individual."
"By combining these different research methods, researchers can develop a greater understanding of the influence of consent legislation on organ donation and transplantation rates," he says.
The researchers note that even countries using opt-out consent still experience organ donor shortages. A complete change in the system of consent is unlikely to solve such a problem, but modifying the consent legislation or adopting aspects of the "Spanish Model" could help boost donor rates.
Spain boasts the highest organ donation rate in the world, employing opt-out consent. Experts attribute their success to a transplant coordination network that operates on both a local and national level, as well as improved public information about organ donation.
Recently, Medical News Today ran a feature on whether farming animal organs for human transplants could be a solution to the organ shortage, or if this should be addressed through changes to organ donation policy.
- In the United Kingdom, researchers from Nottingham, Stirling, and Northumbria Universities investigated organ donation policies in 48 countries over a 13-year period, discovering that opt-out systems led to a higher total number of kidneys and overall organ transplants.
- However, the study found that opt-in systems resulted in a higher rate of kidney donations from living donors, a subtle yet significant influence on living donation rates.
- In the context of medical-health conditions, the US, with an opt-in system, reported 28,000 transplants last year, yet regrettably, approximately 18 people still die daily due to a lack of donated organs.
- To address these issues, the researchers suggest that future studies could explore the beliefs, wishes, and attitudes of individuals regarding organ donation to gain a deeper understanding of the factors influencing their decisions.
- Globally, opt-out systems have been associated with an increase in the total number of livers and kidneys transplanted, but the researchers warn that even countries with opt-out consent still experience organ donor shortages.
- The highest organ donation rate in the world is found in Spain, which employs opt-out consent, aided by a transplant coordination network and improved public information about organ donation.
