Organ Transplantation: Should the Donation Process be Consent-Based or Presumed Consent?
Cupping the global organ donation landscape, there's an ongoing debate about whether an opt-in or opt-out system is more effective. Researchers at the University of Nottingham, UK, stirred this pot by examining the organ donation policies of 48 countries.
With an opt-in system, individuals need to actively sign up to donate their organs postmortem. In the opt-out system, organ donation happens automatically, unless an explicit request to opt-out is made.
Prof. Eamonn Ferguson, leading the charge from the University of Nottingham, acknowledges that the reliance on an individual's decision can lead to drawbacks: "People can be inactive for various reasons, like loss aversion, lack of effort, or belief that the authorities made the right decision."
Inactivity can lead to missed opportunities in an opt-in system, keeping potential donors away from those in need. Meanwhile, in an opt-out system, inactivity could potentially result in someone who doesn't wish to donate becoming a donor unknowingly (a false positive).
The US employs an opt-in system, with over 28,000 transplants made possible last year thanks to organ donors. Sadly, approximately 18 people die every day due to a lack of donated organs.
To dig deeper, a team of researchers from the University of Nottingham, University of Stirling, and Northumbria University analyzed the organ donation systems of 48 countries over a period of 13 years. They found that countries using an opt-out system had higher total numbers of kidneys donated—the organ most sought after by those on organ transplant lists. Opt-out systems also boasted a higher overall number of organ transplants.
However, opt-in systems did demonstrate a higher rate of kidney donations from living donors. Prof. Ferguson points out that this influence of policy on living donation rates hasn’t been reported before.
The study's limitations include not distinguishing between varying degrees of opt-out legislation in different countries and untested factors influencing organ donation.
Published in BMC Medicine, the researchers advocate for the use of their results to shape future policy decisions. They also suggest strengthening these findings through the collection and publication of international organ donation information such as consent type, procurement procedures, and hospital bed availability.
Prof. Ferguson suggests that future studies could delve into the opinions of those making the decision to opt-in or opt-out through surveys and experimental methods, gaining a greater understanding of individual beliefs, wishes, and attitudes.
In an ideal world, opt-out consent would lead to an increase in deceased donations but a reduction in living donor rates. However, countries using opt-out consent still struggle with organ donor shortages. Enacting complete changes in consent systems isn't the be-all, end-all solution to this issue. Instead, consent legislation or adopting aspects of the "Spanish Model" could be potential routes to improving donor rates.
Spain boasts the highest organ donation rate globally. The Spanish utilize opt-out consent, but their success is attributed to other factors such as a transplant coordination network operating both locally and nationally, and improving the quality of public information available about organ donation.
Should we consider animal organs for farming to address the organ shortage, or is this a problem to be tackled through changes to organ donation policy? This question is up for debate and warrants further discussion.
- The study published in BMC Medicine suggests that countries using opt-out systems for organ donation have higher total numbers of kidneys donated and a higher overall number of organ transplants compared to opt-in systems.
- Inactivity can lead to missed opportunities in an opt-in system, preventing potential donors from helping those in need, while in an opt-out system, inactivity could potentially result in someone who doesn't wish to donate becoming a donor unknowingly.
- The US employs an opt-in system, with over 28,000 transplants possible last year due to organ donors, but sadly, approximately 18 people die every day due to a lack of donated organs.
- Prof. Ferguson suggests that future studies could delve into the opinions of those making the decision to opt-in or opt-out through surveys and experimental methods, gaining a greater understanding of individual beliefs, wishes, and attitudes.
- The ongoing debate regarding global organ donation involves not only the type of consent system (opt-in or opt-out) but also policy recommendations, the collection and publication of international organ donation information, and potentially, considering animal organs for farming to address the organ shortage.
