Organ Transplantation: Debating the Merits of Consent-Based or Presumed Consent Approaches
In the realm of organ donation, the choice between opt-in and opt-out systems sparks heated debates worldwide. The UK researchers have taken a deep dive to analyze the effectiveness of both approaches in 48 different countries.
With opt-in systems, individuals must actively enroll in an organ donor registry. Conversely, opt-out systems have organ donation set as the default, and one must explicitly request to opt-out. It's not rocket science that the active decision-making process can lead to drawbacks, as people may not act due to loss aversion, lack of effort, or trust in the system's decision-making.
However, in an opt-in system, people who want to donate may not end up doing so (a false negative). In contrast, an opt-out system might result in someone unwilling to donate becoming a donor (a false positive).
The U.S, for instance, adheres to an opt-in system, with 28,000 transplants made possible last year due to organ donors. Regrettably, around 18 people die daily due to a scarcity of donated organs.
Researchers from the University of Nottingham, University of Stirling, and Northumbria University scrutinized the organ donation protocols of 48 countries for 13 years, comparing 23 opt-in and 25 opt-out countries. Their findings reveal that countries with opt-out systems had a higher total number of kidneys donated—the organ most in demand for transplants. There were also more overall organ transplants in opt-out systems.
Though opt-in systems boasted a higher rate of kidney donations from living donors, it's essential to highlight this influence on living donation rates is a novel finding. The study authors presented their findings in BMC Medicine, emphasizing that opt-out systems increase the total number of livers and kidneys transplanted, but they lower the living donation rates.
The study's limitations included not differentiating between varying degrees of opt-out legislation and neglecting to account for factors that may have impacted organ donation rates other than the consent type. They highlighted the need for information on consent type, procurement procedures, and hospital bed availability to be routinely collected and made public.
To gather a more nuanced understanding of the influence of consent legislation on organ donation and transplantation rates, they recommended future studies to explore the beliefs, wishes, and attitudes of individuals facing the choice to opt-in or opt-out using a blend of surveys and experimental methods.
Countries that have embraced opt-out systems still battle organ donor shortages. Therefore, an absolute change in the consent system may not be sufficient to solve the problem. Instead, adjustments to the consent legislation or adopting elements of the Spanish Model might help boost donor rates.
Spain currently boasts the highest organ donation rate worldwide. Their success is attributed to a transplant coordination network that operates both locally and nationally, in addition to improving the quality of public information available about organ donation.
Recent discussions revolve around whether animal organs could be farmed for human transplants. This potential solution to the organ shortage or approach to address it through changes in organ donation policy is worth pondering.
Sources:1. Transplant Tracker. (2020). Organ donation statistics. https://optn.transplant.hrsa.gov/data/statistics/usage.asp2. Australian Government Department of Health. (2021). Organ and tissue donation data collection series: Annual report 2020. https://www1.health.gov.au/publications/report/organ-and-tissue-donation-data-collection-series-annual-report-20203. The Hamilton Project. (2010). Increasing the number of living kidney donors: A cost-benefit analysis. https://www.brookings.edu/wp-content/uploads/2016/07/1002_ferguson-longmuir_report_.pdf4. She argued for the Reciprocal System in the University of Pennsylvania Journal of Constitutional Law, rebutting other scholars who thought presumed consent was the best system. Her article was titled “Creating a Reciprocal System of Organ Donation.”5. Deutschlander, S. (2018). The organ donation shortage in the EU: The EU’ role and potential in solving the organ donation crisis. https://www.ahaaps.org/wp-content/uploads/2019/01/AHAA_BonnReport_Pdf.pdf
- Given the debate on opt-in versus opt-out organ donation systems, researchers examined the effectiveness of these approaches in 48 countries, finding that opt-out systems led to a higher total number of kidneys donated, but lower living donation rates.
- Though opt-out systems have proven more successful in terms of overall organ transplants, there is a need to address challenges such as organ donor shortages, which remain even in countries adhering to this approach.
- In a search for new solutions, recent discussions center around the potential of farming animal organs for human transplants as a possible approach to alleviating the organ shortage.
- To gain a more comprehensive understanding of factors influencing organ donation rates, future studies are recommended to explore the beliefs, wishes, and attitudes of individuals facing the choice to opt-in or opt-out, using both surveys and experimental methods.
