Debate over Organ Donation Registration: Which Approach - Opt-In or Opt-Out - Offers a More Effective System?
Organ donation policies across the globe present a diverse landscape, leading to ongoing debates about what works best: opt-in or opt-out systems. To explore this question, researchers from the UK examined the organ donation practices of 48 countries over a 13-year period.
In an opt-in system, people actively choose to sign up as organ donors after their demise. In contrast, an opt-out system sets organ donation as the default, but individuals can explicitly refuse if they wish.
Prof. Eamonn Ferguson from the University of Nottingham acknowledges that these systems rely on individuals making an active decision, which can sometimes lead to drawbacks. People might not act for reasons such as loss aversion, effort, or believing that policy makers have already made the right decision.
Inaction in an opt-in system could potentially result in individuals who would have wished to donate not doing so (a false negative). Meanwhile, inaction in an opt-out system could potentially lead to individuals who do not wish to donate being donors (a false positive).
The US currently uses an opt-in system. Despite efforts, approximately 18 people still die daily due to a shortage of donated organs. Last year saw 28,000 transplants made possible, with around 79 people receiving organ transplants every day.
Researchers from the University of Nottingham, University of Stirling, and Northumbria University analyzed the organ donation systems of 48 countries and found that countries using opt-out systems had higher total numbers of kidneys donated, an organ highly sought after by those on transplant lists. They also had a greater overall number of organ transplants.
Opt-in systems, however, had a higher rate of kidney donations from living donors. This influence on living donation rates has not been reported before, according to Prof. Ferguson.
The study, published in BMC Medicine, indicates that opt-out consent may result in increased deceased donations but reduced living donation rates. Opt-out consent is also associated with an increase in the total number of livers and kidneys transplanted.
The researchers suggest that their findings could inform future policy decisions but could be strengthened further by the collection and publication of international organ donation information, such as consent type, procurement procedures, and hospital bed availability.
Prof. Ferguson suggests that future studies should examine the beliefs, wishes, and attitudes of individuals directly, using survey and experimental methods, to develop a deeper understanding of the influence of consent legislation on organ donation and transplantation rates.
Countries using opt-out consent still experience organ donor shortages, suggesting that completely changing the system may not be the solution. Instead, they propose that consent legislation or adopting aspects of the "Spanish Model" could improve donor rates.
Spain has the highest organ donation rate in the world. While their success is credited to measures such as a transplant coordination network, the quality of public information available about organ donation also plays a crucial role in encouraging donation.
Recently, discussions have arisen about the possibility of using animal organs for human transplants as a potential solution to the organ shortage. This is a complex issue that may require a multidisciplinary approach to address.
In summary, international research suggests that while opt-out systems tend to increase organ donation rates by reducing barriers and changing defaults, the actual impact is heavily dependent on family involvement and preferences, indicating that policy design is not the sole determinant of success.
References:[1]https://onlinelibrary.wiley.com/doi/abs/10.1111/joco.13299[3]https://onlinelibrary.wiley.com/doi/abs/10.1111/joco.12757[5]https://onlinelibrary.wiley.com/doi/abs/10.1111/joco.12914
- The study, published in BMC Medicine, reveals that opt-out consent could lead to increased numbers of deceased organ donations but potentially lower rates of living organ donations.
- Research has shown that countries using opt-out systems have more kidneys and overall organ transplants compared to countries with opt-in systems, although they still experience organ donor shortages.
- To further understand the influence of consent legislation on organ donation and transplantation rates, researchers propose examining individuals' beliefs, wishes, and attitudes through survey and experimental methods.
- Spain, known for its high organ donation rate, emphasizes the importance of a transplant coordination network and quality public information about organ donation in encouraging donation, suggesting potential strategies for improving donor rates in other countries.
