Organ Donation: Which Opt-In or Opt-Out Approach Yields More Donations?
Unpacking Organ Donation Systems: Opt-in vs Opt-out
The globe's organ donation policies show a wide-ranging diversity. Should it be a mandate to register, or should it be assumed that you've agreed to donate? A squad of researchers from the UK has delved into the organ donation protocols of 48 countries to shed some light on the most effective approach.
With an opt-in system, individuals are required to actively sign up to a register, signifying their agreement to donate organs post-mortem. In contrast, an opt-out system presumes consent for organ donation, and specific requests for the contrary are necessary before death.
Prof. Eamonn Ferguson, the lead author from the University of Nottingham, UK, admits that both strategies are reliant on an individual's active decision, which could lead to limitations:
"People may forgo action for a multitude of reasons, including loss aversion, lack of effort, and the belief that policy makers have made the 'right' decision."
In an opt-in system, failure to act can result in individuals who wish to donate not doing so (a false negative). Conversely, in an opt-out system, inaction could lead to an individual who does not wish to donate becoming a donor (a false positive).
The United States currently employs an opt-in system. Last year, over 28,000 transplants were facilitated due to organ donors, with around 79 people receiving organ transplants daily. Sadly, approximately 18 individuals die every day due to a scarcity of donated organs.
Weighing the Options
The researchers from the University of Nottingham, University of Stirling, and Northumbria University in the UK scrutinized the organ donation protocols of 48 countries over a period of 13 years - 23 employing an opt-in system and 25 using an opt-out system.
The study authors evaluated overall donor numbers, transplants per organ, and the total number of kidneys and livers transplanted from both deceased and living donors.
They discovered that countries utilizing opt-out systems experienced higher overall numbers of kidneys donated - the organ most sought after by those on organ transplant lists. Opt-out systems also had more overall organ transplants.
Opt-in systems, however, boasted a higher rate of kidney donations from living donors. This apparent 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 authors acknowledge that their study was limited by not distinguishing between varying degrees of opt-out legislation, with some countries mandating permission from next-of-kin for organs to be donated. Additionally, other factors influencing organ donation remained unassessed due to the study's observational nature.
The Path Forward
The researchers state that their results, published in BMC Medicine, indicate that "opt-out consent may lead to an increase in deceased donation but a reduction in living donation rates. Opt-out consent is also associated with an increase in the total number of livers and kidneys transplanted."
They suggest that their findings could be used to inform future policy decisions but could be further strengthened through the regular collection and public availability of international organ donation information - consent type, procurement procedures, and hospital bed availability, for instance.
Prof. Ferguson proposes that future studies should examine individual beliefs, wishes, and attitudes through a combination of survey and experimental methods:
"By combining these different research methods, researchers can develop a more comprehensive understanding of the influence of consent legislation on organ donation and transplantation rates."
The authors note that countries using opt-out consent still encounter organ donor shortages. A complete overhaul of the system is unlikely to alleviate this issue. Instead, they suggest that consent legislation or adopting aspects of the "Spanish Model" could help boost donor rates.
Spain currently boasts the highest organ donation rate globally. The Spanish utilize opt-out consent but credit their success to measures such as a transplant co-ordination network that functions both locally and nationally, and enhancing the quality of public information on organ donation.
Recently, Medical News Today spotlighted the debate surrounding using farm-raised animal organs for human transplants. Could this be a solution to the organ shortage, or is it a problem better addressed through changes to organ donation policy?
Written by James McIntosh
- In the study analyzing organ donation protocols of 48 countries, it was found that opt-out systems, which presume consent for organ donation, resulted in higher overall numbers of kidneys donated and more overall organ transplants.
- The research team, comprising professors from the University of Nottingham, University of Stirling, and Northumbria University in the UK, also discovered that countries employing an opt-out system had a higher total number of livers and kidneys transplanted from both deceased and living donors.
- Interestingly, opt-in systems, where individuals are required to actively sign up to a register, showed a higher rate of kidney donations from living donors, a finding that has not been reported before according to Prof. Eamonn Ferguson.
- The authors of the study, published in BMC Medicine, suggest that their findings could be instrumental in informing future policy decisions regarding organ donation, but they acknowledge limitations such as the absence of variations in opt-out legislation and unassessed factors influencing organ donation.
- As discussions surrounding alternative solutions to the organ shortage continue, recent news highlights the debate about using farm-raised animal organs for human transplants, questioning whether it is a viable solution or if changes to organ donation policy deserves more attention.
