Is it more effective to have an organ donation system based on explicit consent or presumed consent?
Across the globe, the policies regarding organ donation vary significantly, with the debate persisting over whether an opt-in or opt-out system is more effective. To address this question, a team of researchers from the United Kingdom has examined the organ donation protocols of 48 countries over a 13-year period.
In the opt-in system, individuals must actively register to donate their organs post-mortem. Conversely, in opt-out systems, organ donation occurs automatically unless an explicit request is made to prevent organ donation before death.
Professor Eamonn Ferguson, the lead author from the University of Nottingham, acknowledges potential drawbacks associated with both systems.
"Individuals may fail to act for various reasons, such as loss aversion, lack of effort, or the belief that policy makers have already made an informed decision," he said.
Lack of action in an opt-in system may lead to individuals who wish to donate not being included (known as a false negative). On the other hand, inaction in an opt-out system could result in an individual who does not wish to donate unwittingly becoming a donor (a false positive).
The United States employs an opt-in system, facilitating approximately 28,000 transplants annually. Despite this, around 18 people still die each day due to a shortage of donated organs.
Researchers from the University of Nottingham, University of Stirling, and Northumbria University analyzed the organ donation systems of 48 countries, discovering that countries with opt-out systems donated more kidneys - the organ most in demand for transplant recpients. Opt-out systems also exhibited higher overall organ transplant numbers.
Nevertheless, opt-in systems demonstrated a higher rate of kidney donations from living donors. Professor Ferguson notes that this outcome has not been observed previously.
While the study's scope included analyzing various degrees of opt-out legislation, it did not assess all factors affecting organ donation rates, including differences in healthcare infrastructure and public trust.
The researchers suggest that their findings can contribute to future policy decisions but recommend improving the collection and public availability of international data on organ donation policies, procedures, and hospital bed availability.
Professor Ferguson advocates for additional research focusing on the perspectives and belief systems of individuals who must decide between opting in or opting out.
Despite the higher organ donation rates seen in opt-out systems, even these countries still experience donor shortages. The researchers propose that legislative changes or adopting elements of the Spanish Model could help improve donor rates.
Spain boasts the highest organ donation rate worldwide, a result attributed to its opt-out system, efficient transplant coordination network, and high-quality public information about organ donation. In the near future, it may be worth exploring alternative solutions such as farming animal organs for human transplants to alleviate the ongoing organ shortage.
- In opt-out systems, organ donation takes place automatically unless an explicit request is made to prevent it, contrary to the opt-in system where individuals must actively register.
- The study by the researchers from the UK found that countries with opt-out systems donate more kidneys and have higher overall organ transplant numbers.
- Interestingly, opt-in systems demonstrated a higher rate of kidney donations from living donors, a finding not observed previously.
- The researchers suggest that their findings can contribute to future policy decisions, but acknowledge there are other factors impacting organ donation rates, such as differences in healthcare infrastructure and public trust.
- Given the ongoing donor shortages, the researchers propose legislative changes or adopting elements of the Spanish Model to improve donor rates, while also exploring alternative solutions like farming animal organs for human transplants.
