Organ Donation: Should It Be an Opt-In or Opt-Out Process?
Organ donation policies vary worldwide, sparking the question: is it better to have an opt-in or opt-out system? A team from the UK, composed of researchers from the University of Nottingham, University of Stirling, and Northumbria University, investigated this question by analyzing organ donation protocols in 48 countries over a 13-year period.
In an opt-in system, people must actively sign up to donate their organs after death. Meanwhile, opt-out systems allow organ donation to occur automatically unless a specific request is made prior to death to opt-out.
Prof. Eamonn Ferguson, the lead author from the University of Nottingham, acknowledges that these systems are dependent on individual decisions, which can lead to drawbacks: "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."
In an opt-in system, inaction can lead to individuals who would want to be a donor not donating (a false negative). On the other hand, inaction in an opt-out system can potentially lead to an individual who does not want to donate becoming a donor (a false positive).
The United States currently employs an opt-in system, with approximately 28,000 transplants made possible last year thanks to organ donors. Unfortunately, around 18 people still die each day due to a shortage of donated organs.
After assessing donor numbers, transplants per organ, and total kidneys and livers transplanted from both deceased and living donors, the researchers found 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 had a greater overall number of organ transplants.
Opt-in systems did, however, have a higher rate of kidney donations from living donors. Ferguson believes this is a subtlety that needs to be highlighted and considered, as it hasn't been reported before.
The authors acknowledged that their study was limited by not distinguishing between different degrees of opt-out legislation and not assessing factors that may influence organ donation. They suggested that future studies could analyze the opinions of those who must decide to opt-in or opt-out, using survey and experimental methods.
The researchers' results, published in BMC Medicine, suggest that opt-out consent may lead to an increase in deceased donation but a reduction in living donation rates. They also found that opt-out consent is associated with an increase in the total number of livers and kidneys transplanted.
However, they note that countries using opt-out consent still face organ donor shortages. They further suggest that changes to organ donation policy or adopting aspects of the "Spanish Model" could help improve donor rates.
Spain currently has the highest organ donation rate in the world. The Spanish utilize opt-out consent, but experts attribute their success to a transplant coordination network that operates locally and nationally, as well as improved public information about organ donation.
Recent discussions have included the possibility of farming animal organs for human transplants as a potential solution to the organ shortage. However, researchers suggest that this issue might be better addressed through changes to organ donation policy.
References:[1] Khan, A.R. & Savulescu, J. (2010). Individual freedom and the presumption of consent for organ donation. Journal of Medical Ethics.[4] Cummings, P.P., Torrance, G.W., & Squires, P.S. (2011). Opt-out organ donation: a review of evidence and case law. British Medical Journal.[5] Naik, M.C. et al. (2017). Organ donation registries: lessons for registration from other countries. Current Opinion in Organ Transplantation.
- The research team from the UK, including members from the University of Nottingham, University of Stirling, and Northumbria University, investigated the question of opt-in versus opt-out organ donation systems by analyzing donation protocols in 48 countries over a 13-year period.
- In an opt-in system, individuals must actively sign up to donate their organs after death, while opt-out systems allow for organ donation to occur automatically unless a specific request is made prior to death to opt-out.
- Professor Eamonn Ferguson, the lead author from the University of Nottingham, acknowledges that these systems are dependent on individual decisions, which can lead to drawbacks such as inaction resulting in false negatives for organ donation in an opt-in system.
- In an opt-out system, potential false positives can occur if an individual who does not want to donate becomes a donor due to inaction.
- The United States currently employs an opt-in system, making approximately 28,000 transplants possible last year, but still sees around 18 people die each day due to a shortage of donated organs.
- Countries with opt-out systems had higher total numbers of kidneys donated, the organ most in demand by those on organ transplant lists, as well as a greater overall number of organ transplants.
- Opt-in systems did, however, have a higher rate of kidney donations from living donors, a subtlety that needs to be considered according to Ferguson.
- Future studies could analyze the opinions of those who must decide to opt-in or opt-out, using survey and experimental methods, as suggested by the authors of the research published in BMC Medicine, to address limitations in their study such as not distinguishing between degrees of opt-out legislation and not assessing factors influencing organ donation.
