Debating Organ Donation: Which System – Opt-In or Opt-Out – Is More Effective?
Wonders of Organ Donation Policies: Opt In vs Opt Out
Every corner of the globe approaches organ donation differently, but the age-old question remains: Is it better to require consent or leave it optional? A clever bunch of researchers from the UK aimed to answer this, analyzing the organ donation procedures of 48 diverse nations to determine which system gets the job done best.
In opt-in systems, individuals have a responsibility to sign up to a registry to donate their organs post-mortem. Opt-out systems, on the other hand, assume consent for organ donation unless a specific refusal is mentioned prior to death.
Professor Eamonn Ferguson, Southampton's leading brain behind the study from the University of Nottingham, admits that such systems, which rely on an active decision from individuals, can have pitfalls:
"People may avoid action for a multitude of reasons, such as loss aversion, exercising minimal effort or blind trust in the government's decision."
In fact, the lack of action in an opt-in system could lead to individuals who would wish to donate missing out (false negatives). Conversely, inaction in an opt-out system could result in individuals who do not wish to donate inadvertently becoming donors (false positives).
The United States utilizes an opt-in system. According to the US Department of Health & Human Services, organ donors made 28,000 transplants possible last year. Yet, an unfortunate 18 people died daily due to a dearth of donated organs.
The Buzz: Opt In or Opt Out?
Researchers from the University of Nottingham, the University of Stirling, and Northumbria University took a deep dive into the organ donation practices of 48 nations for a span of 13 years. They categorized 23 countries as opt-in and 25 as opt-out.
They meticulously measured donor numbers, transplants per organ, the number of kidneys and livers transplanted from deceased and living donors. Their findings revealed that countries employing opt-out systems enjoyed significantly higher total numbers of kidneys donated—an essential organ for the vast majority of individuals on organ transplant lists. Opt-out systems also saw a higher total count of organ transplants.
Though opt-in systems demonstrated a higher rate of kidney donations from living donors, the influence of policy on such rates seemed to have gone unnoticed before, according to Prof. Ferguson.
The study's authors, however, acknowledged their research was limited, not classifying different degrees of opt-out legislation and overlooking several other factors that may impact organ donation.
Stepping Forward
The researchers argue that their results, published in BMC Medicine, suggest "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 while their findings could be applied to future policy decisions, they could be strengthened further through the systematic collection and public availability of international organ donation information. This data should include consent type, procurement procedures, and hospital bed availability.
Prof. Ferguson suggests future studies should focus on the opinions and beliefs of those making the decision to opt in or opt out:
"Researchers can explore this issue from the individual's perspective, examining beliefs, wishes, and attitudes using a blend of surveys and experimental methods."
The authors concluded that even countries employing opt-out consent still encounter organ donor shortages. A complete revamp of the system is unlikely to solve this issue. Instead, they propose that consent legislation or adopting components of the "Spanish Model"—a system that includes a comprehensive transplant coordination network and improved public information on organ donation—could help boost donor rates.
Recently, Medical News Today put animal organs in the spotlight as a potential solution to organ shortages. But is this the answer, or is it a problem that should be addressed by changing organ donation policy? Your thoughts?
Article written by James McIntosh.
- In their study, researchers from three universities examined organ donation practices in 48 nations for 13 years, finding that opt-out systems yielded significantly more kidneys donated, as well as more total organ transplants.
- While opt-in systems showed higher rates of kidney donations from living donors, the impact of policy on such rates seemed to have gone unnoticed before, according to the study's lead author, Professor Eamonn Ferguson.
- The researchers suggested that, based on their findings, opt-out consent may lead to an increase in deceased donation but a reduction in living donation rates, and they proposed that future studies could explore the individual's perspective, examining beliefs, wishes, and attitudes about organ donation using surveys and experimental methods.
- The authors of the study also proposed that adopting components of the "Spanish Model" could help boost donor rates, such as a comprehensive transplant coordination network and improved public information on organ donation, as a more effective solution to addressorgan donor shortages than a complete system overhaul.
