Organ donation: Should it be based on consent or presumed consent?
Worldwide, the approach to organ donation varies significantly among countries, prompting a team of researchers from the United Kingdom to investigate whether an opt-in or opt-out policy is more effective.
In an opt-in system, individuals must proactively sign up to a donor registry to allow organ donation after death. Conversely, in an opt-out system, organs are automatically donated unless an individual expresses contrary wishes before their demise.
Professor Eamonn Ferguson, lead author from the University of Nottingham, recognizes potential limitations of both systems: "Individual inaction can lead to individuals who wish to donate not doing so (a false negative) in the opt-in system. On the other hand, inaction in the opt-out system could result in an individual who does not wish to donate becoming a donor (a false positive)."
The United States employs an opt-in system, with 28,000 transplants made possible last year through organ donors. Despite this, around 18 people still die daily due to a scarcity of available organs, unable to undergo surgery.
Researchers from the universities of Nottingham, Stirling, and Northumbria analyzed the organ donation protocols of 48 countries for a span of 13 years: 23 with opt-in systems and 25 with opt-out systems. The study showed that countries utilizing opt-out systems had significantly higher total numbers of donated kidneys, the organ most frequently sought by those on organ transplant lists. Moreover, these countries also demonstrated a greater overall number of organ transplants.
Although opt-in systems recorded a higher rate of kidney donations from living donors, the researchers noted a novel finding — the influence of policy on living donation rates "has not been reported before."
The authors stressed limitations in their study, such as the lack of assessment of varying degrees of opt-out legislation and the uninspected influence of other factors on organ donation. They suggest that enhancing the collection and public disclosure of international organ donation data would fortify their findings.
Professor Ferguson recommended future research to understand donors' beliefs, attitudes, and wishes from an individual perspective, saying, "Combining different research methods can help us understand the impact of consent legislation on organ donation and transplantation rates." While opt-out systems can increase the total donated organs, they acknowledge that countries employing such systems still face organ donor shortages. They propose that changes in consent legislation or adopting aspects of the "Spanish Model" could potentially improve donor rates.
Spain currently boasts the highest global organ donation rate, credited to measures such as a nationwide transplant coordination network and improved public information about organ donation. Whether animal organs should be farmed for human transplants has recently been discussed as a solution to organ shortages, but experts argue that addressing organ donation policies could be a more practical approach.
[1] National Foundation for Transplants (2016) "Understanding Organ Donation in the United States vs. Spain." Retrieved from https://sharinghopelegacy.org/sites/default/files/nh_to_es_comparison.pdf
[2] National Health Service Blood and Transplant (2019) "Organ Donation and Transplantation Statistics." Retrieved from https://www.organdonation.nhs.uk/statistics-and-reports/statistics/transplant-activity-and-waiting-lists/details-of-organ-donation-and-transplantation-activity-in-england
- A team of researchers from the United Kingdom is investigating whether an opt-in or opt-out policy for organ donation is more effective, given that worldwide approaches vary significantly.
- The study analyzed organ donation protocols of 48 countries for 13 years, revealing that countries utilizing opt-out systems had significantly higher total numbers of donated kidneys.
- While opt-out systems can increase the total donated organs, they acknowledge that countries employing such systems still face organ donor shortages.
- Experts argue that addressing organ donation policies could be a more practical approach to addressing organ shortages, such as the discussion of farming animal organs for human transplants.
- Future research is recommended to understand donors' beliefs, attitudes, and wishes from an individual perspective, allowing for an in-depth understanding of the impact of consent legislation on organ donation and transplantation rates. [Reference1, Reference2]
