Organ Donation: Should the System Be Based on Consent or Automatic Assumption?
Worldwide organ donation policies show significant variation, leading to questions about the most effective approach: opt-in or opt-out. A team of researchers from the University of Nottingham, UK, has investigated organ donation protocols in 48 countries to determine which strategy yields the best results.
In an opt-in system, individuals must actively register to donate their organs posthumously. Conversely, opt-out systems automatically assume organ donation unless a specific request is made to prevent it before death.
Professor Eamonn Ferguson, the study's lead author from the University of Nottingham, recognizes the potential drawbacks of both systems relying on individual decisions:
"Individuals may fail to act for numerous reasons, including loss aversion, lack of effort, and the belief that policymakers have made the correct decision and one that they support."
A key concern with opt-in systems is that inaction can lead to individuals who would have wanted to donate not doing so (a false negative). On the other hand, inaction in opt-out systems could result in an individual who does not wish to donate unwittingly becoming a donor (a false positive).
Currently, the US employs an opt-in system. Last year, 28,000 transplants were made possible due to organ donors, but unfortunately, around 18 people die each day due to a shortage of donated organs.
The researchers compared organ donation systems in 48 countries, 23 of which use opt-in systems and 25 opt-out systems, over a 13-year period. They found that countries with opt-out organ donation systems had higher total numbers of kidneys donated—the organ most in demand for transplants. Opt-out systems also boasted the greater total number of organ transplants.
However, opt-in systems had a higher rate of kidney donations from living donors. This influence on living donation rates, according to Professor Ferguson, has not been reported before and necessitates further consideration.
The study's limitations include not distinguishing between varying degrees of opt-out legislation in different countries and not assessing other potentially influential factors.
The researchers concluded that opt-out consent may lead to increased deceased donations but decreased living donation rates, as well as an increase in the total number of livers and kidneys transplanted. They suggest using their findings to inform future policy decisions and advocating for the collection and public release of international organ donation data.
Professor Ferguson also suggests conducting future studies focusing on the individual's perspective regarding beliefs, wishes, and attitudes about organ donation. By blending these research methods, researchers can better understand the impact of consent legislation on organ donation and transplantation rates.
Countries utilizing opt-out consent still face organ donor shortages, suggesting that a complete policy change is unlikely to solve the issue. Instead, consent legislation, or adopting aspects of the "Spanish Model," could be employed to boost donor rates. Spain has the world's highest organ donation rate, with its success attributed to a presumed consent system, strong transplant coordination, and improved public information about organ donation.
Recently, Medical News Today published a feature discussing whether animal organs should be farmed for human transplants as a potential solution to the organ shortage or an issue to be addressed through changes to organ donation policy.
- In an opt-out system, unlike opt-in, the assumption of organ donation is made unless a specific request is made to prevent it before death.
- The research on organ donation protocols in 48 countries revealed that countries with opt-out organ donation systems had higher total numbers of kidneys donated and a greater total number of organ transplants compared to those with opt-in systems.
- While opt-out systems may lead to increased deceased donations, they were found to have lower rates of kidney donations from living donors.
- To better understand the impact of consent legislation on organ donation and transplantation rates, future studies should focus on individuals' beliefs, wishes, and attitudes about organ donation, as suggested by Professor Ferguson.
