Organ Donation: Which System - Opt-In or Opt-Out - Is More Effective?
Going In or Out? Deciphering the Optimal Organ Donation System
Across the globe, organ donation policies see a significant variation, leaving us pondering: is it best to opt in or opt out? A team of researchers from the UK have delved into the organ donation protocols of 48 nations to discern which approach delivers the best results.
With an opt-in policy, individuals must actively register to donate their organs post mortem. In contrast, opt-out systems automatically authorize organ donation unless a specific request is made prior to death opposing the donation.
Prof. Eamonn Ferguson, the lead author from the University of Nottingham, UK, acknowledges that relying on individual decisions could lead to drawbacks:
"Folks might not take action for all sorts of reasons, ranging from loss aversion, laziness, and a belief that policymakers made the 'right' decision."
Inaction in an opt-in system might result in individuals who'd wish to donate missing the opportunity (a false negative). Conversely, inaction in an opt-out system could potentially lead to an individual who does not wish to donate becoming a donor (a false positive).
The US, for example, employs an opt-in system. According to the US Department of Health & Human Services, 28,000 transplants were facilitated last year, thanks to organ donors. While around 79 people receive organ transplants daily, around 18 people still die every day due to a scarcity of donated organs.
Research and Realities
Researchers from the University of Nottingham, University of Stirling, and Northumbria University in the UK scrutinized the organ donation systems of 48 nations over a 13-year period - 23 using an opt-in system and 25 employing an opt-out system.
The study's authors measured total donor numbers, transplant numbers per organ, and the overall number of kidneys and livers transplanted from both deceased and living donors.
Despite an opt-in system's higher living donor kidney donation rate, countries utilizing opt-out donation systems reported higher total numbers of kidneys donated - an organ that the majority of people on organ transplant lists are waiting for. Opt-out systems also outperformed opt-in systems in terms of overall organ transplant numbers.
A Matter of Life and Death
The authors point out that their study had limitations, such as not distinguishing between varying degrees of opt-out legislation (with some countries requiring permission from next-of-kin for organs to be donated) and not considering other factors that could affect organ donation rates. Nonetheless, their study published in BMC Medicine reveals that "opt-out consent may increase deceased donation but potentially decrease living donation rates."
Opt-out consent was also associated with an increase in the overall number of livers and kidneys transplanted. While their findings could inform policy decisions, they could be further strengthened through the collection and public availability of international organ donation data, such as consent type, procurement procedures, and hospital bed availability.
Prof. Ferguson suggests that future studies could also delve into the beliefs, wishes, and attitudes of individuals faced with the decision to opt in or opt out:
"By combining survey and experimental research methods, we can gain a deeper understanding of how consent legislation influences organ donation and transplantation rates."
Countries with opt-out consent still grapple with organ donor shortages, suggesting that completely changing the system may not be the solution. Instead, the authors propose that consent legislation or embracing aspects of the "Spanish Model" could be viable approaches to enhancing donor rates.
Spain boasts the highest organ donation rate globally. The Spanish success is attributed to factors such as a transplant coordination network encompassing both local and national operations, as well as improved public information regarding organ donation.
In recent years, the question of animal organs being farmed for human transplants has arisen, serving as a potential solution to the organ shortage or a problem to be addressed through changes to organ donation policy.
- The study, published in BMC Medicine, revealed that "opt-out consent may increase deceased donation but potentially decrease living donation rates."
- The researchers found that opt-out systems reported higher total numbers of kidneys donated, an organ that the majority of people on organ transplant lists are waiting for.
- By combining survey and experimental research methods, future studies could gain a deeper understanding of how consent legislation influences organ donation and transplantation rates.
- The question of animal organs being farmed for human transplants has arisen, serving as a potential solution to the organ shortage or a problem to be addressed through changes to organ donation policy.
