The debate over whether opt-in or opt-out organ donation systems are more effective in increasing the number of available organs for transplantation.
In the organ donation world, different nations follow distinct policies, and the question is whether it's better for individuals to opt-in or opt-out when deciding to donate their organs postmortem. Researchers in the UK sought to answer this question by scrutinizing the organ donation protocols of 48 countries.
In opt-in systems, each person has to proactively register their intent to donate organs after death. Conversely, in opt-out systems, organ donation automatically occurs unless the individual pre-emptively requests for their organs not to be taken.
Prof. Eamonn Ferguson, the lead researcher from the University of Nottingham, admits that drawbacks occur due to the reliance on active decisions by individuals:
"People may not act for various reasons, such as loss aversion, disinclination to exert effort, or a belief that policymakers have made the correct decision."
Inactivity in an opt-in system could lead to potential donors not donating (a false negative) while inactivity in an opt-out system might cause an individual that doesn’t wish to donate to become a donor (a false positive).
The US currently employs an opt-in system, and according to the US Department of Health & Human Services, almost 28,000 organ transplants were performed last year thanks to organ donors. Regrettably, about 18 people per day still die due to a scarcity of donated organs.
Choosing In or Out?
Researchers from the University of Nottingham, the University of Stirling, and Northumbria University compared the organ donation systems of 48 countries over a 13-year period - 23 with opt-in and 25 with opt-out.
They analyzed overall donor numbers, transplant numbers per organ, and the total number of kidneys and livers transplanted from both deceased and living donors.
The authors concluded that countries with opt-out organ donation systems saw higher total numbers of kidneys donated. They also found that countries with opt-out systems had larger overall numbers of organ transplants.
Opt-in systems, however, boasted a higher rate of kidney donations from living donors. The authors say that the impact of policy on living donation rates is a significant discovery that's never been reported before.
The authors admit that their study was limited by not distinguishing between different levels of opt-out legislation with some countries needing permission from next-of-kin for organs to be donated. The study's observational nature means that other factors that may influence organ donation remained unassessed.
Proceeding Forward
The researchers, whose findings were published in BMC Medicine, stated that "opt-out consent may lead to an increase in deceased donations but a reduction in living donations rates." They suggested that opt-out consent is associated with higher numbers of livers and kidneys transplanted.
They propose that although the results can be used in future decision-making on policy, they can be further strengthened through the regular collection of international organ donation information, such as consent type, procurement procedures, and hospital bed availability, which should then be made publicly available.
Prof. Ferguson suggests that future studies should also examine individual perspectives, beliefs, wishes, and attitudes regarding opt-in or opt-out choices.
The authors note that countries with opt-out consent still experience organ donor shortages. Massively changing the consent procedure is unlikely to address such a problem. Instead, they suggest that consent legislation or adopting aspects of the "Spanish Model" could improve donor rates.
Spain maintains the highest organ donation rate globally. The Spanish implement opt-out consent, but their success is attributed to a transplant coordination network, both nationally and locally, and enhancing the quality of information available on organ donation to the public.
Recently, Medical News Today spotlighted the question of whether farm-raised animal organs could be utilized for human transplants to address the organ shortage. Or, should this issue be resolved through changes to organ donation policies?
- In some countries, organ donation policy is opt-out, meaning organs can be donated unless the individual specifically requests otherwise.
- Researchers at the University of Nottingham found that countries with opt-out organ donation systems saw higher total numbers of kidneys donated.
- The study also found that countries with opt-out systems had larger overall numbers of organ transplants compared to those with opt-in systems.
- However, the authors noted that opt-in systems had a higher rate of kidney donations from living donors, which they identified as a significant discovery.
