Debating Organ Donation: Opt-In versus Opt-Out Approaches Compared
Organ donation policies have a worldwide range, leaving the question: should it be an opt-in or opt-out process? A group of researchers from the UK have examined the organ donation protocols of 48 countries to determine which method performs best.
In an opt-in system, people must actively register to donate their organs posthumously. Alternatively, opt-out systems involve automatic organ donation unless a specific request is made before death for organs to not be taken.
Prof. Eamonn Ferguson, the lead author from the University of Nottingham, UK, acknowledges the potential drawbacks of both systems:
- People may not act for several reasons, such as loss aversion, laziness, and trust in government decisions.
However, in an opt-in system, failing to act can lead to individuals who would want to donate not doing so (a false negative). In contrast, inaction in an opt-out system can potentially result in someone who doesn't want to donate becoming a donor (a false positive).
The United States employs an opt-in system, with last year's transplants facilitated by 28,000 organ donors. Approximately 79 people receive organ transplants daily, but sadly, around 18 people die daily due to a shortage of donated organs.
Researchers from the University of Nottingham, University of Stirling, and Northumbria University in the UK analyzed the organ donation systems of 48 countries for a 13-year period. The study authors investigated overall donor numbers, transplants per organ, and total kidney and liver transplants from both deceased and living donors.
They found that countries with opt-out organ donation systems had a higher total number of kidneys donated. Opt-out systems also produced a greater overall number of organ transplants.
Nonetheless, opt-in systems demonstrated a higher rate of kidney donations from living donors. This influence of policy on living donation rates is a novel finding, as reported by Prof. Ferguson.
The researchers acknowledge their study's limitations, including not accounting for the various degrees of opt-out legislation and non-assessment of other factors affecting organ donation.
Due to their findings, published in BMC Medicine, the researchers conclude 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 suggest that while their findings could inform future policy decisions, they could be reinforced further through the regular collection and public availability of international organ donation data, such as consent type, procurement procedures, and hospital bed availability.
Prof. Ferguson suggests that upcoming studies should investigate individual perspectives on the decision to opt in or opt out:
- Exploring beliefs, preferences, and attitudes via survey and experimental methods would provide a deeper understanding of the impact of consent legislation on organ donation and transplantation rates.
Countries using opt-out consent still experience organ donor shortages. Completely altering the system of consent is unlikely to solve such a problem, but the authors propose that consent legislation or adopting aspects of the "Spanish Model" could help improve donor rates.
Spain boasts the highest organ donation rate globally. The Spanish utilize opt-out consent, but their success is attributed to measures like a transplant coordination network that operates both locally and nationally and improvements in the quality of public information about organ donation.
Recent discussions have centered around the potential of using farm-raised animal organs for human transplants – a possible solution to the organ shortage or an issue to be addressed through changes to organ donation policy?
- The science behind organ donation has been studied extensively, with a group of researchers examining the organ donation protocols of 48 countries to determine which method performs best.
- In a study published in BMC Medicine, the researchers found that countries with opt-out organ donation systems had a higher total number of kidneys donated and a greater overall number of organ transplants.
- However, opt-in systems demonstrated a higher rate of kidney donations from living donors, a novel finding reported by Prof. Eamonn Ferguson.
- As the debate about organ donation policies continues, discussions have also centered around the potential of retargeting farm-raised animal organs for human transplants, potentially addressing the issue of organ shortage or requiring changes to existing organ donation policies.
