Organ donation approach: Should it be an explicit or implicit choice?
When it comes to organ donation, the world isn't one-size-fits-all. The question is, should people have to opt in or opt out? To find an answer, researchers from the UK took a close look at the organ donation policies of 48 countries.
In an opt-in system, individuals have to proactively sign up to donate their organs after death. In an opt-out system, organ donation occurs automatically unless an individual specifically requests otherwise. Prof. Eamonn Ferguson, lead author from the University of Nottingham, acknowledges the potential drawbacks of relying on individuals to actively make this decision: "People may not act for numerous reasons, including loss aversion, effort, and believing that the policy makers have made the 'right' decision and one that they believe in."
But hold up—remember, inaction in an opt-in system could mean that individuals who would have wanted to be donors might not donate (a false negative). Meanwhile, inaction in an opt-out system could potentially result in individuals who don't want to donate becoming donors (a false positive).
The US currently employs an opt-in system, with around 28,000 transplants made possible last year thanks to organ donors. Regrettably, about 18 people die daily due to a shortage of donated organs.
Researchers from the University of Nottingham, University of Stirling, and Northumbria University compared organ donation systems in 48 countries over a span of 13 years – 23 countries using opt-in, and 25 using opt-out. They discovered that countries with opt-out systems had higher total numbers of kidneys donated – the organ most in demand by those on organ transplant lists. Opt-out systems also showed a greater overall number of organ transplants.
However, opt-in systems did have a higher rate of kidney donations from living donors. This influence on living donation rates "has not been reported before," says Prof. Ferguson, "and is a subtlety that needs to be highlighted and considered."
The study had its limitations, including failing to distinguish between different degrees of opt-out legislation and not accounting for other factors influencing organ donation.
Prof. Ferguson suggests that future research should delve into individual beliefs, wishes, and attitudes about organ donation, using a mix of surveys and experimental methods. He also believes that the routine collection of international organ donation data and its subsequent public availability could further strengthen research findings.
Interestingly, countries with opt-out consent still face organ donor shortages. Completely changing the system may not solve the problem. Instead, revising organ donation policies or implementing aspects of the Spanish Model could potentially improve donor rates.
Spain boasts the highest organ donation rate in the world, thanks to various strategies such as a transplant co-ordination network and improved public information about organ donation.
There's another solution worth considering: farming animal organs for human transplants. Could this solve the organ shortage, or is it a problem to be addressed through changes to organ donation policy? Stick around for some fascinating insights on this controversial topic.
Written by James McIntosh
- In consideration of the science behind organ transplants and health-and-wellness, the concept of contextualizing policy regarding organ donation is crucial when evaluating opt-in versus opt-out systems.
- Paxlovid, a new antiviral medication, might potentially have a role in improving the health of individuals waiting for organ transplants, but a more pressing issue lies in revising current organ donation policies to increase donor rates.
- Medical-conditions, such as loss aversion, effort, and belief in the system's decisions, may impact an individual's decision to opt-in or not to organ donation and, as a result, might require a retargeting of educational efforts to encourage donations.
- Ultimately, the solution to the organ shortage may not lie solely in advancements in science, such as farming animal organs for human transplants, but also in understanding and addressing the broader societal, policy, and health-related contexts that influence organ donation decisions.
