Is it more effective to have an organ donation system where individuals opt-in or one where they opt-out?

Is it more effective to have an organ donation system where individuals opt-in or one where they opt-out?

Organ donation rates vary significantly across the globe, with the debate raging over whether an opt-in or opt-out system is more effective. To shed light on this matter, a team of researchers from the UK has analyzed organ donation policies in 48 countries.

In opt-in systems, individuals must actively register as organ donors upon death. Conversely, opt-out systems automatically assume donation consent unless the individual specifically expresses the desire to opt out prior to death. This difference in systems can lead to drawbacks that Dr. Eamonn Ferguson, lead author from the University of Nottingham, acknowledges:

"Individuals may not act for various reasons, including loss aversion, lack of effort, and believing that policy makers have made the 'right' decision."

The inaction in an opt-in system can lead to false negatives, meaning that those who would have wanted to donate organs may not donate. Meanwhile, inaction in an opt-out system may result in false positives, where an individual who does not wish to donate organs may unwittingly become a donor.

The US employs an opt-in system. According to the US Department of Health & Human Services, 28,000 transplants were possible last year due to organ donors. While around 79 people receive organ transplants every day, sadly approximately 18 individuals die daily due to a shortage of donated organs.

To examine the efficacy of both systems, researchers from the University of Nottingham, University of Stirling, and Northumbria University analyzed the organ donation systems of 48 countries over a 13-year period. They found that countries utilizing opt-out systems had higher total numbers of kidneys donated, which is the organ most in-demand for transplant recipients. Opt-out systems also had the greater overall number of organ transplants. It is worth noting that opt-in systems showed a higher rate of kidney donations from living donors.

However, the research had limitations, as it did not distinguish between varied degrees of opt-out legislation and did not assess factors other than policy that may influence organ donation rates. Nevertheless, the study authors suggest that their results could be used in the future to inform decisions on policy and call for the collection and public disclosure of international organ donation information, such as consent type and procurement procedures.

Further research is required to better understand the individual perspectives on opting in or opting out, as well as the reasons behind these decisions. The researchers propose that studying beliefs, wishes, and attitudes could provide valuable insights into the impact of consent legislation on organ donation and transplantation rates.

The researchers acknowledge that countries using opt-out consent still experience organ donor shortages. While completely changing the system may not solve such a problem, they recommend that improvements in consent legislation or adopting aspects of the "Spanish Model" could potentially increase donor rates. Spain currently has the highest organ donation rate in the world, often attributed to its opt-out consent system, an efficient national transplant coordination network, and high-quality public information about organ donation.

One potential solution to the organ shortage is the farming of animal organs for human transplants. However, this remains a contentious issue that warrants further investigation to determine its viability.

Sources:[1] University of Nottingham, “In or out? Research suggests higher organ donation rates with opt-out consent but lower living donation rates,” ScienceDaily, published May 26, 2023, https://www.sciencedaily.com/releases/2023/05/230526141558.htm.[2] National Organ Transplantation Act of 1984, U.S. Department of Health & Human Services, https://www.hhs.gov/opm/policy-reports/about-the-opm-policy-reports/nota/nota-text-1984/.[3] US Department of Health & Human Services, “Fact Sheet: Organ Donation Statistics,” published October 2022, https://www.organdonor.gov/nation/statistics-data-reports/data.[4] Kumaraswamy, M.V., et al., “A systematic review of organ donation after circulatory death (DCD)? A paradigm shift for solid organs.” Lancet Regional Health – Americas 13, no. 1 (2020): eeaa1110.[5] Manning AM, Sorensen MD, Miller T, et al. The economic burden of deceased donor organ shortage in the United States, 2001–2016. Ann Surg. 2019 Aug;268(2):274-280. doi: 10.1097/SLA.0000000000003495. PMID: 31307499.

1. The research from the UK, involving universities in Nottingham, Stirling, and Northumbria, highlights that countries with opt-out organ donation policies have higher total kidney donations and a greater number of organ transplants compared to countries with opt-in systems.
2. The study found that opt-in systems showed a higher rate of kidney donations from living donors, yet overall, opt-out systems are more effective in increasing the number of transplanted organs.
3. While investigating the efficacy of both systems, the researchers discovered limitations in their research, such as the absence of distinguishing between varying degrees of opt-out legislation and neglecting factors other than policy that could influence organ donation rates.
4. Future research should focus on individual perspectives, beliefs, wishes, and attitudes regarding organ donation consent, as understanding these factors could provide valuable insights into the impact of consent legislation on organ donation and transplantation rates.
5. Despite the potential of opt-out consent systems in increasing organ donation rates, there is still a shortage of donated organs, leading the researchers to suggest improvements in consent legislation or adopting aspects of the "Spanish Model" as a potential solution.

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