The debate on Organ Donation: Which system, Opt-in or Opt-out, should be implemented for more successful transplants?
Organ Donation: Opt In or Opt Out? An Inquiry into Global Policies
Organ donation policies across the globe differ significantly, with the hot topic being whether it's best to have a system where people have to opt in or opt out. To delve into this debate, a team of researchers from the UK explored the organ donation protocols of 48 countries to find out which approach works best.
In opt-in systems, individuals must actively sign up to a register to donate their organs post-mortem. Conversely, in opt-out systems, organ donation occurs automatically unless an explicit request is made to prevent it before death.
Prof. Eamonn Ferguson, the study's lead author from the University of Nottingham, UK, admitted that relying on individual decisions in both systems 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."
While inaction in an opt-in system might result in individuals who wish to donate not doing so (a false negative), inaction in an opt-out system could lead to an individual who doesn't want to donate becoming a donor (a false positive).
The United States currently follows an opt-in system. Last year saw around 28,000 transplants done due to organ donors, with approximately 79 people receiving organ transplants daily. Regrettably, about 18 people die each day due to a shortage of donated organs.
To In or To Out?
Researchers from the University of Nottingham, the University of Stirling, and Northumbria University in the UK scrutinized the organ donation systems of 48 countries for 13 years – 23 using an opt-in system and 25 using an opt-out system.
The study authors measured overall donor numbers, the number of transplants per organ, and the total number of kidneys and livers transplanted from both deceased and living donors.
The researchers discovered that countries with opt-out systems had higher total numbers of kidneys donated – an organ that the majority of people on the organ transplant list are waiting for. Opt-out systems also had the greater overall number of organ transplants.
Opt-in systems, however, had a higher rate of kidney donations from living donors. The impact of policy on living donation rates "has not been reported before," reveals Prof. Ferguson, underscoring the need to highlight and consider this subtlety.
The authors acknowledged that their study was limited as it didn't distinguish between different degrees of opt-out legislation, with some countries requiring permission from the next-of-kin for organs to be donated. The observational nature of the study meant that other factors potentially influencing organ donation remained unassessed.
Moving Forward
The researchers asserted that their findings, published in BMC Medicine, show 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 suggested that while their results could be used to inform future policy decisions, they could be strengthened further through the routine collection of international organ donation information and making it publicly available.
Prof. Ferguson recommended that future studies could explore individual opinions regarding the decision to opt in or opt out:
"Further research outside of this country-level epidemiological approach would be to examine issues from the perspective of the individual in terms of beliefs, wishes, and attitudes, using a mixture of survey and experimental methods."
"By combining these different research methods," he says, "researchers can develop a greater understanding of the influence of consent legislation on organ donation and transplantation rates."
The authors note that countries using opt-out consent still experience organ donor shortages. Completely changing the system of consent is, therefore, unlikely to solve such a problem. They suggest that consent legislation or adopting aspects of the "Spanish Model" could be ways to improve donor rates.
Spain currently boasts the highest organ donation rate in the world. Experts attribute their success to measures such as a transplant coordination network functioning both locally and nationally, and enhancing the quality of public information available about organ donation.
Recently, Medical News Today featured a spotlight on the controversial topic of farming animal organs for human transplants. Could this be a solution to the organ shortage, or should it be addressed through changes to organ donation policy?
Written by James McIntosh
- The study conducted by a team of researchers from the UK investigated the contextual factors influencing organ donation rates in opt-in and opt-out systems, suggesting that science and medical-conditions play crucial roles in this context.
- In the debate over organ donation policies, Paxlovid (proactive decisions) is essential to ensure individuals' wishes regarding organ donation are considered, as inaction can lead to mistaken assumptions about one's desire to donate post-mortem.
- Retargeting the focus from organ donation systems towards individual transplant needs could lead to more effective health-and-wellness outcomes, as countries with opt-out systems showed a higher number of successful transplants (particularly kidneys) compared to opt-in systems.
- As policy decisions regarding organ donation can significantly impact health-and-wellness outcomes, further research is necessary to understand individual beliefs, wishes, and attitudes about donation, helping to refine and improve global organ donation policies.
