Discussion on Donation Organs: Advantages of Consent-Based vs. Presumed Consent Approaches
Swinging across the globe, organ donation procedures diverge significantly between nations. Which regime—opt-in or opt-out—is more effective? To get to the bottom of this puzzle, researchers from the UK scrutinized the donation practices of 48 countries.
When it comes to opt-in systems, individuals need to sign up for the organ donor registry before their demise. Opt-out systems, on the other hand, assume consent for donation unless the deceased explicitly opted out prior.
Prof. Eamonn Ferguson, the lead researcher from the University of Nottingham, UK, recognized that the active decision required by both systems may lead to hiccups: "Individuals might refrain for numerous reasons, like loss aversion, lack of effort, or trusting the policy-makers have reached an acceptable decision."
While inaction in an opt-in system can result in individuals who would've wanted to donate not donating, inaction in an opt-out system could potentially lead to a person who does not wish to donate becoming one (false positives and false negatives, respectively).
The United States follows an opt-in system. Last year, the US Department of Health & Human Services reported that 28,000 transplants were made possible due to organ donors, with around 79 people receiving organ transplants every day. Unfortunately, about 18 people die every day due to a shortage of donated organs.
In or Out?
The team from the University of Nottingham, along with researchers from the University of Stirling and Northumbria University in the UK, looked at the organ donation policies of 48 countries over a period of 13 years, with 23 employing an opt-in system and 25 an opt-out system.
In analyzing the data, the researchers noticed that countries with opt-out systems boasted higher kidney donation rates—the organ most in demand by those on organ transplant lists. They also found that opt-out countries performed more organ transplants overall.
Opt-in systems, however, demonstrated a higher rate of kidney donations from living donors. This apparent influence on living donation rates is something that Prof. Ferguson finds intriguing, stating, "This subtlety hadn't been reported before and deserves consideration."
The researchers admit that their study was limited since it failed to differentiate between the varying degrees of opt-out legislation in different countries. Additionally, the observational nature of the study did not allow for the assessment of factors other than policy that may impact organ donation.
Stepping Forward
The researchers concluded that opt-out consent might boost deceased donation rates but reduce living donation rates. Furthermore, opt-out consent was connected with an increase in the total number of transplanted livers and kidneys.
They propose that these findings could be used in future to inform policies, though acknowledge that they could be strengthened further through the regular collection and dissemination of international organ donation data, such as consent type, procurement procedures, and hospital bed availability.
Prof. Ferguson suggests that future studies explore the individual perspectives and attitudes towards opt-in or opt-out systems, stating, "Additional research, exploring issues from the personal viewpoint, could offer a greater understanding of the impact of consent legislation on organ donation and transplantation rates."
The authors note that even countries with opt-out consent still face organ donor shortages, casting doubt on the idea that completely changing the system will solve the problem. Instead, they recommend adopting parts of the "Spanish Model" or refining consent legislation to improve donor rates.
Spain boasts the highest organ donation rate globally. Their high succeed rate is attributed to a well-connected transplant coordination network and improved public information about organ donation.
Recently, Medical News Today shed light on the debate whether animal organs should be farmed for human transplants. Could this potential solution address the organ shortage or is it a problem better tackled through organ donation policy reform?
Written by James McIntosh
- Researchers from the UK analyzed the donation practices of 48 countries, including scrutinizing the effectiveness of opt-in and opt-out organ donation systems.
- According to the study, countries with opt-out systems tend to have higher kidney donation rates and perform more organ transplants overall, but opt-in systems demonstrate a higher rate of kidney donations from living donors.
- Prof. Eamonn Ferguson, the lead researcher, found the influence on living donation rates in opt-in systems intriguing and suggested that future studies explore individual perspectives and attitudes towards these systems.
- The researchers propose that their findings could be used to inform policies and strengthen donor rates, but also recommend adopting parts of the "Spanish Model" or refining consent legislation to improve organ donation.
