Debate over Organ Donation: Should It Be an Opt-In or Opt-Out System?
Organ Donation: To Opt-In or Opt-Out?
Across the globe, the methods of organ donation vary largely, and it's a puzzle if the best pick is an opt-in or opt-out system. To shed light on this quandary, researchers from the UK scrutinized the organ donation strategies of 48 nations, analyzing which approach proves most successful.
An opt-in system empowers individuals to proactively register their desire to donate organs post-mortem. Meanwhile, in opt-out systems, organ donation takes place automatically, unless a specific refusal is stated prior to death for specific organs.
Prof. Eamonn Ferguson, the lead author from the University of Nottingham, UK, acknowledges the potential pitfalls of these systems, as they rely on individual choices:
"People might abstain from acting for myriad reasons, such as loss aversion, effort, and believing policymakers have made the 'right' decision."
However, inaction in an opt-in system could lead to individuals who would wish to donate not doing so (a false negative). Conversely, inaction in an opt-out system could potentially result in an individual who does not want to donate becoming a donor (a false positive).
The US adheres to an opt-in system. Last year, approximately 28,000 transplants were achieved due to organ donors. On average, around 79 individuals receive organ transplants daily. Unfortunately, roughly 18 individuals die daily due to a scarcity of donated organs.
## In or Out?
Researchers from the University of Nottingham, the University of Stirling, and Northumbria University, UK, dove into the organ donation systems of 48 countries over a 13-year span—23 utilizing an opt-in system and 25 employing an opt-out system.
The researchers assessed overall donor numbers, transplants per organ, and the total number of kidneys and livers transplanted from both deceased and living donors.
Interestingly, countries that opted for opt-out systems had a higher total count of kidneys donated—the organ most sought-after in organ transplant lists. Furthermore, these nations also saw greater overall numbers of organ transplants.
Opt-in systems, however, boasted a higher rate of kidney donations from living donors. The fact that policy significantly impacted living donation rates "has never been reported before," claims Prof. Ferguson, calling attention to this subtle observation.
The authors concede that their study had constraints, notably not distinguishing between varying degrees of opt-out legislation, with some countries requiring permission from next-of-kin for organs to be donated. The observational nature of the study meant other influencing factors in organ donation were left unassessed.
## Moving Forward
The researchers declare that their findings, published in BMC Medicine, indicate "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 their findings could guide future decisions on policy, their relevance could be amplified if international organ donation information—consent type, procurement procedures, and hospital bed availability, for instance—were consistently collected and made publicly available.
Prof. Ferguson encourages future studies to delve into individual perspectives:
"Further research should examine beliefs, wishes, and attitudes from an individual perspective using a combination of survey and experimental methods."
"By developing a deeper comprehension of the influence of consent legislation on organ donation and transplantation rates," he says.
The authors note that countries adopting opt-out consent still face organ donor shortages. A complete system change may not eradicate such a problem. Instead, they suggest that consent legislation or embracing elements of the "Spanish Model" could bolster donor rates.
Spain boasts the highest organ donation rate worldwide. The Spanish utilize opt-out consent but attribute their success to a robust transplant coordination network encompassing both local and national efforts, as well as enhanced quality public information regarding organ donation.
Recently, Medical News Today examined whether farming animal organs for human transplants is a viable solution to the organ shortage or another round of challenges to be tackled through improvements to organ donation policy.
- The study, published in BMC Medicine, contextualizes the science behind organ donation systems, highlighting that opt-out consent might lead to an increase in deceased donation but a reduction in living donation rates.
- In the analysis of 48 countries over a 13-year span, researchers found that countries adopting opt-out consent had a higher total count of kidneys donated, and greater overall numbers of organ transplants.
- However, the researchers also observed that opt-in systems had a higher rate of kidney donations from living donors, a finding that has not been reported before according to Prof. Ferguson.
- In the realm of health-and-wellness and medical-conditions, the authors propose that to address the organ shortage, further research should be conducted to retarget policies that may influence individual attitudes and beliefs towards organ donation.
