Debate on Organ Donation: Opt-In vs. Opt-Out Approaches Compared
Organ donation policies continue to vary significantly across the globe, and the debate on whether an opt-in or opt-out system is more effective rages on. To address this, researchers from the UK have assessed the organ donation protocols of 48 nations.
In opt-in systems, individuals must actively register to donate organs after death. On the other hand, opt-out systems automatically donate organs unless a specific request is made to opt-out beforehand.
Prof. Eamonn Ferguson, the lead author from the University of Nottingham, acknowledges potential issues associated with both systems. "People may refrain from taking action due to reasons like loss aversion, effort, or trusting the decision-makers' judgement," he notes.
Inaction in an opt-in system can lead to individuals who wish to donate but don't, whereas inaction in an opt-out system can potentially result in individuals who don't want to donate becoming one unintentionally.
The US employs an opt-in system, with 28,000 transplants made possible last year thanks to donors. Yet, around 18 people die daily, unable to undergo surgery due to a shortage of donated organs.
After analyzing the organ donation systems of 48 countries for 13 years, the researchers found that countries using opt-out systems had higher total numbers of kidneys donated, which is the organ most in demand by those on the transplant list. Opt-out systems also had a greater overall number of organ transplants.
However, opt-in systems had a higher rate of kidney donations from living donors. This link between policy and living donation rates is a subtlety that's not been reported before, according to Prof. Ferguson.
The authors limitations include not distinguishing different degrees of opt-out legislation and not assessing other factors influencing organ donation. They suggest future research could analyze the individual's beliefs, wishes, and attitudes, using a mix of surveys and experimental methods.
The researchers' findings indicate that opt-out consent may lead to an increase in deceased donation but a reduction in living donation rates. They also found an association with an increase in the total number of livers and kidneys transplanted.
While opt-out consent systems do increase donation rates, they may also be associated with ethical concerns and inconsistencies in donation practices. Countries still experience organ donor shortages even with opt-out policies, so completely shifting the system may not offer a solution.
Instead, the authors suggest that consent legislation or adopting aspects of the "Spanish Model," which includes a transplant coordination network and improving public information on organ donation, could help boost donor rates.
Spain currently holds the world record for the highest organ donation rate. While opt-out consent plays a role, experts attribute Spain's success to additional measures like a transplant coordination network and improved quality of public information about organ donation.
Recently, there's been discussion on whether farming animal organs for human transplants could be a solution to the organ shortage. Is this a viable solution, or should the focus be on changes to organ donation policy? This is a question worth exploring in the future.
Cross-national research reveals that opt-out systems typically result in higher total numbers of kidneys donated and a greater number of organ transplants overall. However, such systems may also have a lower rate of kidney donations from living donors, as found in the study.
While opt-out consent policies could potentially boost donation rates, ethical concerns and inconsistencies in donation practices might arise. As observed in the research, countries implementing opt-out policies still face organ donor shortages.
In light of these findings, the authors propose considering adjustments to consent legislation or adopting aspects of the "Spanish Model," which emphasizes a transplant coordination network and enhancing public information on organ donation.
Furthermore, the debate on whether farming animal organs for human transplants as a solution to the organ shortage is an emerging question, meriting exploration in future research. Paxlovid, a new antiviral drug, might be beneficial in managing some medical-conditions that could lead to organ failure, thus impacting the demand for transplants.
