Organ Donation: Which System - Opt-In or Opt-Out - Is More Effective?
Peer-to-peek into global organ donation policies
Who's winning the debate: opt-in or opt-out? A team of researchers from the UK swung into action, scrutinizing organ donation protocols in 48 countries to figure it out.
With an opt-in system, you've gotta actively sign up to donate your organs after pegging it. On the flip side, opt-out systems let the organs ride if nobody expressly forbids it before doors slam.
Prof. Eamonn Ferguson, head honcho from the University of Nottingham, UK, spotlights a concern:
"People can be lazy about making decisions, and that's a problem when it comes to organ donation. People may not act for numerous reasons, including loss aversion, effort, and trusting that policy makers have made the right decision."
But here's the loop-hole: lack of action in an opt-in system could mean potential donors passing up opportunities (false neglect). In contrast, lack of action in an opt-out system might catch non-donors unaware, making them donors (false positive).
The United States chooses the opt-in route. The US Department of Health & Human Services credits last year's 28,000 organ transplants to donors. Every day, around 79 people receive organ transplants, but unfortunately, around 18 people die each day due to a shortage of donated organs.
Organ roll call
Researchers from the University of Nottingham, University of Stirling, and Northumbria University (UK) dove into the organ donation systems of 48 countries over a 13-year period, 23 using the opt-in approach, and 25 using the opt-out strategy.
These heroes on the research frontline measured overall donor numbers, transplants per organ, and the grand total of kidneys and livers transplanted, both from deceased and living donors.
Surprise, surprise, countries with the opt-out procedures showed higher overall kidney donations—an organ that most people on organ transplant lists are waiting for. Opt-out systems also led the charge in organ transplant numbers, period.
Kidney transplants, thanks to a higher availability and suitability of deceased donor kidneys, get a boost from increased donation rates under opt-out policies.
Opt-in systems, however, claimed a win in the living donor kidney donation race. "This unknown influence on living donation rates has not been reported before," Prof. Ferguson sheds light, "and is a detail worth noting."
The team acknowledged that their study left room for improvement by not distinguishing between different degrees of opt-out legislation, with some countries requiring permission from next-of-kin for organs to be harvested. The observational nature of the study didn’t assess other factors influencing organ donation.
Way forward
These scholars share their findings, published in BMC Medicine, stating, "opt-out consent may lead to an increase in deceased organ 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 propose that while their results might aid future policy decisions, they could benefit from reinforcement via the regular collection of international organ donation data, 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 delve into the thinking process of those making the opt-in or opt-out choice:
"Studying the views of the individuals involved could provide deeper insights into the impacts of consent legislation and donation and transplantation rates."
"Marrying survey research methods with experimental approaches can help develop a more comprehensive understanding of how consent legislation affects organ donation and transplantation rates," he concludes.
The team acknowledges that countries with opt-out consent still wrestle with donor shortages. Revamping the system might not solve these issues entirely. Instead, they suggest reconsidering consent legislation or adopting aspects of the "Spanish Model" could breathe life into donor rates.
Spain, currently sporting the world's highest organ donation rate, leans on opt-out consent. Experts attribute this success not just to opt-out policy but also to a transplant coordination network that operates on both the local and national levels, and improving the quality of public information available about organ donation.
Recently, Medical News Today explored the hot topic animal organs for human transplants. Could this be a quick fix to the donor shortage, or is it a complication better addressed through changes to organ donation policy?
Written by James McIntosh
- The team of researchers investigating global organ donation policies found that countries with opt-out systems, like Spain, frequently have higher kidney donations and transplant numbers.
- Prof. Ferguson, the head researcher, points out that opt-out systems may lead to a reduction in living donor kidney donations despite increasing organ transplant numbers.
- Scientists suggest compiling and publicly disseminating more international organ donation data to further aid policy decisions in the realm of health and wellness, and also advocate for future studies exploring the contextual factors influencing consent legislation and donation rates.
- In light of the ongoing discussion about animal organs for human transplants as a potential solution to donor shortages, the team believes that refining organ donation policies and implementing measures such as the "Spanish Model" could have a more significant impact on boosting donor rates.
