Organ donation: Is an opt-out or consent-based system more effective?
Worldwide, organ donation policies show remarkable diversity. A team of researchers from the University of Nottingham, UK, has examined the organ donation protocols of 48 countries to determine which strategy is most effective.
In opt-in systems, individuals must actively register their intent to donate their organs posthumously. In contrast, opt-out systems assume consent and proceed with organ donation unless the deceased expressed a wish not to donate.
Professor Eamonn Ferguson, the lead author from the University of Nottingham, acknowledges potential drawbacks of the systems' reliance on individual action:
"Individuals may not act for various reasons such as loss aversion, lack of effort, and trust in the decision made by policy makers."
Notably, an opt-in system could result in potential donors inaction (a false negative). Conversely, an opt-out system might lead to individuals who do not wish to donate becoming donors (a false positive).
The United States employs an opt-in system, with 28,000 transplants facilitated last year due to organ donors. Regrettably, approximately 18 people continue to die daily due to a scarcity of donated organs.
The researchers analyzed the organ donation systems of 48 countries for a 13-year period, with 23 utilizing opt-in systems and 25 opt-out.
The study found that countries using an opt-out system had significantly higher totals of kidneys donated, the organ most in demand by those on the organ transplant waiting list. Additionally, opt-out systems had a 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 is reported as a new discovery by the authors.
The researchers recognize the study's limitations, as it did not distinguish between the levels of opt-out legislation in various countries, and some nations required familial consent for organ donation. Moreover, factors influencing organ donation beyond consent remained unassessed owing to the study's observational nature.
The researchers publish their findings in BMC Medicine, noting that opt-out consent may increase deceased donations while decreasing living donation rates. Furthermore, opt-out consent leads to a rise in the total number of livers and kidneys transplanted.
They suggest that future decisions on policy could be informed by their findings, providing they are further strengthened by the routine collection and public availability of international organ donation data, such as consent type, procurement procedures, and hospital bed availability.
Professor Ferguson proposes future research exploring the perspectives of individuals making the opt-in or opt-out decision, investigating factors such as beliefs, wishes, and attitudes through survey and experimental methods to provide a more comprehensive understanding of the impact of consent legislation on organ donation and transplantation rates.
Countries with opt-out consent still face organ donor shortages, suggesting that completely changing the system may not fully address the issue. However, the authors suggest possible solutions such as adjusting consent legislation or adopting aspects of the "Spanish Model," known for having the highest organ donation rate globally.
Spain's success is attributed to strong transplant coordination, high public trust, and quality public information regarding organ donation. The Spanish Model could potentially serve as a model for other countries seeking to improve their organ donation rates.
Recently, the question of whether animal organs should be used for human transplants has been considered as a potential solution to the organ shortage. This issue may be addressed through adjustments to organ donation policy or explored by further investigation into the feasibility and ethical implications of animal organ donation.
- The researchers' study, published in BMC Medicine, has discovered that opt-in systems have a higher rate of kidney donations from living donors compared to opt-out systems.
- Opt-out systems, which assume consent and proceed with organ donation unless the deceased expressed a wish not to donate, had significantly higher totals of kidneys donated, the organ most in demand by those on the organ transplant waiting list.
- Countries using an opt-out system, such as Spain with its high organ donation rate, have achieved success through strong transplant coordination, high public trust, and quality public information regarding organ donation.
- In light of ongoing organ donor shortages, the authors suggest possible solutions like adjusting consent legislation or adopting aspects of the Spanish Model, known for its high success rate, to improve organ donation rates in other countries.
