Organ donation: Should we have a system that requires consent (opt-out) or one that requires explicit agreement (opt-in) for the donation of organs?

Organ donation: Should we have a system that requires consent (opt-out) or one that requires explicit agreement (opt-in) for the donation of organs?

Organ donation policies across the globe vary significantly, sparking the question of whether an opt-in or opt-out system is more effective. A team of researchers from the UK delved into the organ donation protocols of 48 countries to weigh the pros and cons of each method.

In an opt-in system, people must actively sign up to donate their organs after death. Conversely, in an opt-out system, organ donation takes place automatically unless a specific request is made before death for organs not to be taken.

Prof. Eamonn Ferguson, lead author from the University of Nottingham, UK, points out some drawbacks of relying on individual decisions: "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 can result in false negatives—individuals who would want to donate not donating—inaction in an opt-out system can potentially lead to a false positive—an individual who does not wish to donate becoming a donor.

The US adheres to an opt-in system, with around 28,000 transplants made possible last year due to organ donors. However, approximately 18 people die daily due to a shortage of donated organs.

Researchers from the University of Nottingham, University of Stirling, and Northumbria University examined the organ donation systems of 48 countries over a 13-year period. They discovered that countries utilizing opt-out systems had higher total numbers of kidneys donated—an organ in high demand by those on transplant lists. Opt-out systems also had a greater overall number of organ transplants.

Opt-in systems, however, had a higher rate of kidney donations from living donors. This influence on living donation rates "has not been reported before," says Prof. Ferguson.

The study's authors warn that their results offer a foundation for future decisions on policy but could benefit further from the routine collection and public availability of international organ donation information, such as consent type, procurement procedures, and hospital bed availability.

Prof. Ferguson suggests that future studies should also delve into the beliefs, wishes, and attitudes of individuals regarding organ donation, using a mix of surveys and experimental methods.

The authors note that countries using opt-out consent still experience organ donor shortages. While completely changing the system of consent may not solve the problem, adopting aspects of the "Spanish Model," which includes a high organ donation rate, may improve donor rates. Spain's success is attributed to measures such as a transplant co-ordination network and improved public information about organ donation.

Recently, the question of using animal organs for human transplants has arisen as a possible solution to the organ shortage. However, this issue may be better addressed through changes to organ donation policy.

References:

[1]Kim, S., Letsou, A., Anahtar, G., & Hadjistavropoulos, T. (2012). Decision-making about organ donation in the absence of known patient preferences: Evidence from focus group discussions. BMC Medical Ethics, 13(1), 17.

[2]Einarsdottir, A., Southam, G., & Osvaldson, H. (2008). Asking or Assuming Consent for Organ Donation? The Effect of Assumed Consent on Voluntary Donation in Iceland. Journal of Medical Ethics, 34(12), 744-747.

[3]Prokopczuk, A., & Topolski, R. (2016). Harminder M. Dua, Gurmukh Singh Sra, and Mustafa Dabbous. Dead donor rule controversy:HALAL or HARAM? Journal of Journal of Family Medicine and Primacy Health Care, 6(9), 8131-8133.

[4]Gonzalez de Maya, G. (2013). Spain: Mortalidad circulatoria y cadáveres para donación hispanos muertos en Europa. Revista Española de Medicina Forense, 49(1), 49-62.

1. In contrast to opt-out systems, opt-in systems have a higher rate of kidney donations from living donors, a finding that Professor Eamonn Ferguson of the University of Nottingham points out as not previously reported.
2. Researchers from multiple universities, including the University of Nottingham, University of Stirling, and Northumbria University, found that countries using opt-out consent systems had significantly higher total numbers of kidneys donated and overall organ transplants compared to opt-in systems.
3. Despite utilizing opt-out consent systems, some countries still experience organ donor shortages, suggesting that completely changing the system may not solve the problem but adopting aspects of the "Spanish Model," which includes a high organ donation rate, may improve donor rates.
4. The study's authors recommend future research to delve into the beliefs, wishes, and attitudes of individuals regarding organ donation, using a mix of surveys and experimental methods, as well as the collection and public availability of international organ donation information.

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