Debate over Organ Donation: Which System - Consent-Based or Presumed Consent - Yields Best Results?
In the world, organ donation policies vary drastically, sparking the question: should people actively opt-in to donate or be automatically opted-out? To delve into this mystery, researchers from the UK have scrutinized the organ donation protocols of 48 countries.
With opt-in systems, people must actively register on a donor registry to donate their organs after death. In contrast, opt-out systems mean organ donation occurs automatically unless explicitly declined before death.
Prof. Eamonn Ferguson, the lead author from the University of Nottingham, UK, admits that both systems have their disadvantages. People might not sign up for numerous reasons, including loss aversion, disinclination, or believing that policymakers have made the correct decision.
However, inaction in an opt-in system can result in individuals who'd want to donate not doing so (a false negative). In contrast, inaction in an opt-out system can potentially lead to an individual who doesn't wish to donate becoming a donor (a false positive).
The US employs an opt-in system. Last year, 28,000 transplants occurred due to organ donors, but around 18 people die daily due to a scarcity of donated organs.
Researchers from the University of Nottingham, University of Stirling, and Northumbria University have examined the organ donation systems of 48 countries over 13 years. They discovered that countries using opt-out systems had higher total numbers of kidneys donated, the organ most coveted by those on organ transplant lists. Opt-out systems also recorded the greater overall number of organ transplants.
Interestingly, opt-in systems had a higher rate of kidney donations from living donors. This influence on living donation rates "has not been reported before," says Prof. Ferguson.
The authors acknowledge the study's limitations, such as not accounting for different degrees of opt-out legislation in some countries and ignoring factors that might influence organ donation.
The researchers claim that their results, published in BMC Medicine, indicate that "opt-out consent might 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 suggest that future decisions regarding policy could be informed by these findings, although they could be strengthened further through the regular collection of international organ donation information and making it publicly accessible. Future studies could also delve into the beliefs, wishes, and attitudes of individuals concerning consent.
The authors acknowledge that countries with opt-out consent still face organ donor shortages. Completely changing the system of consent may not resolve such difficulties. Alternatively, modifying consent legislation or adopting aspects of the "Spanish Model" might improve donor rates.
Spain has the highest organ donation rate globally. The success of the Spanish is attributed to measures like a transplant coordination network that operates locally and nationally, as well as improving the quality of public information about organ donation.
Recently, Medical News Today ran a spotlight feature on whether farming animal organs for human transplants could be a solution to the organ shortage or a problem to be addressed through modifications to organ donation policy.
- The contrasting organ donation systems, particularly opt-out and opt-in, present unique challenges and outcomes.
- In an opt-in system like the US, while transplants occur, there's a daily death toll due to the shortage of donated organs.
- Conversely, countries with opt-out systems, such as some studied by UK researchers, have higher totals of kidneys donated and overall transplants.
- However, the researchers also found that opt-out systems had lower rates of kidney donations from living donors, a finding they claim is noteworthy in the context of science and health-and-wellness.
