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Organ Donation: Which System – Opt-In or Opt-Out – is More Effective?

Organ Donation: Debate on Informed Consent vs Automatic Enrollment Approach

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3 min read
Every 10 minutes, a new patient is enrolled in the organ transplant queue within the United States.
Every 10 minutes, a new patient is enrolled in the organ transplant queue within the United States.

Organ Donation: Which System – Opt-In or Opt-Out – is More Effective?

In the world of organ donation, policy approaches differ significantly across nations, leaving the question: is it better to have an opt-in or an opt-out system in place? A team of UK researchers delved into the donation protocols of 48 countries to figure this out.

Under an opt-in system, individuals need to actively sign up to a register to donate their organs post mortem. Opt-out systems, on the other hand, assume consent for donation unless a specific request is made before death for organs not to be harvested.

Prof. Eamonn Ferguson, lead researcher from the University of Nottingham, acknowledges potential drawbacks of such a system due to its reliance on an informed decision from individuals:

"People may choose to remain indifferent for numerous reasons, including loss aversion, effort, or trusting the authorities to make the 'right' decision they believe in."

Inactivity in an opt-in system might cause individuals who would want to be donors to miss the opportunity (a false negative). In contrast, inactivity in an opt-out system could potentially lead to an individual who does not wish to donate becoming one (a false positive).

The US sticks to an opt-in system. According to the US Department of Health & Human Services, around 28,000 transplants were made possible last year due to organ donors. Sadly, around 18 people die daily due to organ shortages.

Researchers from the Universities of Nottingham, Stirling, and Northumbria analyzed the organ donation systems of 48 countries over a 13-year period—23 using an opt-in system and 25 using an opt-out system.

The researchers found that countries adapting opt-out systems had higher total numbers of kidneys donated — the primary organ most people on organ transplant lists are waiting for. Opt-out systems also boasted the highest overall number of organ transplants.

Opt-in systems, however, exhibited a higher rate of kidney donations from living donors. The tremendous impact policy had on living donation rates, as noted by Prof. Ferguson, is a finding yet to be reported before.

The authors admit that their study faced limitations, such as not accounting for different extents of opt-out legislation and not assessing other factors that may contribute to organ donation.

The researchers state that their findings, 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 the results can guide future policy decisions, they could be strengthened further through the regular collection and public availability of international organ donation information, including consent type, procurement procedures, and hospital bed availability.

Prof. Ferguson suggests that future studies should also investigate the viewpoints of those who have to make the opt-in or opt-out decision:

"Further research outside of this country-level epidemiological approach would be to examine issues from the perspective of the individual in terms of beliefs, wishes, and attitudes, using a mix of survey and experimental methods."

The authors note that even countries operating under opt-out consent struggle with organ donor shortages. A complete system change is thus unlikely to solve the problem. Instead, they suggest changes to organ donation policies or adopting aspects of the "Spanish Model" could improve donor rates.

Spain boasts the highest organ donation rate in the world. The Spanish employ opt-out consent but are credited for their success to measures such as a transplant coordination network that operates both locally and nationally, as well as improving the quality of public information about organ donation.

Further debate arises over the possibility of using animal organs for human transplants as a potential solution to the organ shortage or a problem to be resolved through changes to organ donation policy.

  1. In the study published in BMC Medicine, a team of researchers from the Universities of Nottingham, Stirling, and Northumbria explored the effect of opt-in and opt-out organ donation systems across 48 countries over a 13-year period.
  2. The findings showed that countries adopting opt-out systems had significantly higher total numbers of kidneys donated, the primary organ most people are waiting for on organ transplant lists.
  3. Opt-in systems, however, had a higher rate of kidney donations from living donors, a finding not reported extensively before, according to lead researcher Prof. Eamonn Ferguson.
  4. The authors of the study suggest that future research should focus on the individual's perspective, including beliefs, wishes, and attitudes, using a mix of surveys and experimental methods.
  5. The debate over organ donation systems is not limited to the question of opt-in or opt-out, as some argue that using animal organs for human transplants could potentially solve the organ shortage, while others view it as a problem that may be resolved through changes to organ donation policy and legislation.

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