Debate on Organ Donation: Which System – Opt-In or Opt-Out – is More Effective?
International Organ Donation Policies Assessed: Opt-In vs. Opt-Out Systems
Organ donation policies worldwide exhibit substantial variations. Investigating this disparity, a team of researchers from the UK has analyzed organ donation protocols in 48 countries to discern which strategy is most effective.
The two systems under scrutiny are opt-in, where individuals must actively register to donate organs after death, and opt-out, where organ donation automatically occurs unless a specific request is made to preclude donation.
Prof. Eamonn Ferguson, the lead author from the University of Nottingham, UK, concedes that both systems rely on individuals' proactive decisions, which can potentially yield drawbacks.
"Individuals may not act for numerous reasons, such as loss aversion, effort, and the belief that policy makers have made the right decision and one that they agree with," Ferguson explains.
In an opt-in system, inaction can lead to false negatives, where individuals who would have wanted to donate fail to do so. In contrast, inaction in an opt-out system may result in false positives, with individuals who do not wish to donate becoming donors.
Currently, the US employs an opt-in system. Last year, 28,000 transplants were facilitated due to organ donors, with approximately 79 individuals receiving organ transplants each day. Regrettably, around 18 people die daily due to an insufficient number of donated organs.
Researchers from the University of Nottingham, University of Stirling, and Northumbria University analyzed the organ donation systems in 48 countries over a span of 13 years. Of these, 23 countries utilized an opt-in system, while 25 followed an opt-out system.
The study authors measured key indicators such as the total number of donors, transplants per organ, and the number of kidneys and livers transplanted from deceased and living donors.
They discovered that countries with opt-out systems had higher total numbers of kidneys donated, an organ in high demand among those on the organ transplant list. Furthermore, opt-out systems exhibited the greater overall number of organ transplants.
Opt-in systems, however, demonstrated a higher rate of kidney donations from living donors. This influence that policy has on living donation rates was noted as "unprecedented" by Ferguson.
The researchers acknowledge the limitations of their study, including the lack of distinction between different degrees of opt-out legislation and other unassessed factors that may influence organ donation.
They argue that the results, published in BMC Medicine, demonstrate that "opt-out consent may lead to an increase in deceased 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 these findings could serve as a basis for future policy decisions, they could be bolstered further through the collection and public disclosure of international organ donation data.
Future research, according to Ferguson, should focus on the perspectives of individuals making the decision to opt-in or opt-out, which could provide insights into beliefs, wishes, and attitudes pertaining to organ donation.
The authors note that countries using opt-out consent still experience organ donor shortages. Therefore, completely altering the system of consent is unlikely to address such a problem. Instead, they suggest that consent legislation or adopting aspects of the "Spanish Model" could improve donor rates.
Spain, with the highest organ donation rate in the world, employs opt-out consent. Their success is attributed to a transplant coordination network operating both locally and nationally, as well as improved public information about organ donation.
Recent discussions have surfaced regarding the possibility of farming animal organs for human transplants as a potential solution to the organ shortage. However, this topic remains a matter of ongoing debate.
- In some countries, organ donation automatically occurs unless a specific request is made to preclude donation, a system known as opt-out.
- The study authors found that countries with opt-out systems exhibit higher total numbers of kidneys donated, an organ in high demand.
- The US employs an opt-in system, and while approximately 79 individuals received organ transplants each day last year, around 18 people die daily due to an insufficient number of donated organs.
- The researchers suggest that complete alteration of the system of consent might not solve organ donor shortages, and instead propose focusing on improving consent legislation or adopting aspects of the "Spanish Model" to enhance donor rates.
