Organ Donation: Should the Donation Process Be Opt-In or Opt-Out?
Throwdown on Transplants: Opt-in vs. Opt-out Organ Donation - A Real-Life Showdown
Whether to opt 'in' or 'out' when it comes to organ donation can make a world of difference. A team of researchers from the UK took a deep dive into the organ donation protocols of 48 nations to put these two systems face-to-face and see which one comes out on top.
On one side, we've got the opt-in system, where people need to actively sign up to a register to donate their organs post mortem. In the opt-out camp, organ donation happens automatically unless a specific request is made before death to prevent the taking of organs.
Professor Eamonn Ferguson, the study's lead author from the University of Nottingham, UK, admits that the two systems' reliance on an active decision from individuals can lead to obstacles:
"People may not act for a variety of reasons, such as loss aversion, laziness, or trusting that policy makers have made the right decision and one they believe in."
However, inaction in an opt-in system can lead to individuals who would want to be donors not donating (a false negative). On the flip side, inaction in an opt-out system can potentially lead to an individual that doesn't want to donate becoming a donor (a false positive).
The United States currently uses an opt-in system. According to the US Department of Health & Human Services, 28,000 transplants were made possible last year thanks to organ donors. Around 79 people receive organ transplants every day. Sadly, around 18 people die every day due to a shortage of donated organs.
So, In or Out?
Researchers from the University of Nottingham, University of Stirling, and Northumbria University in the UK analyzed the organ donation systems of 48 countries for a period of 13 years - 23 using an opt-in system and 25 using an opt-out system.
The study authors measured overall donor numbers, numbers of transplants per organ, and the total number of kidneys and livers transplanted from both deceased and living donors.
They found that countries using opt-out systems of organ donation had higher total numbers of kidneys donated - the organ that the majority of people on organ transplant lists are waiting for. Opt-out systems also had the greater overall number of organ transplants.
Opt-in systems did, however, have a higher rate of kidney donations from living donors. The apparent influence that policy had on living donation rates "has not been reported before," says Prof. Ferguson, "and is a subtlety that needs to be highlighted and considered."
The authors acknowledge that their study was limited by not distinguishing between different degrees of opt-out legislation, with some countries requiring permission from next-of-kin for organs to be donated. The observational nature of the study means that other factors that may influence organ donation remained unassessed.
Moving Forward
The researchers state that their results, published in BMC Medicine, show 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 suggest that although the results could be used in the future to inform decisions on policy, they could be strengthened further through the routine collection of international organ donation information - consent type, procurement procedures, and hospital bed availability, for example - which should then be made publicly available.
Prof. Ferguson suggests that future studies could also analyze the opinions of those who have to make the decision to opt in or opt out:
"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 mixture of survey and experimental methods."
"By combining these different research methods researchers can develop a greater understanding of the influence of consent legislation on organ donation and transplantation rates," he says.
The authors note that countries using opt-out consent still experience organ donor shortages. Completely changing the system of consent is, therefore, unlikely to solve such a problem. They suggest that consent legislation or adopting aspects of the 'Spanish Model' could be ways to improve donor rates.
Spain currently has the highest organ donation rate in the world. The Spanish utilize opt-out consent, but their success is credited by experts to measures such as a transplant coordination network that works both locally and nationally, and improving the quality of public information available about organ donation.
Recently, Medical News Today ran a spotlight feature on whether animal organs should be farmed for human transplants. Could this be a solution to the organ shortage, or is this a problem to be addressed through changes to organ donation policy?
Written by James McIntosh
Enrichment Data:
The Organ Donation Showdown: Opt-in vs. Opt-out
The debate between opt-in and opt-out organ donation systems is crucial in boosting organ donor rates and ensuring that individuals waiting for transplants have a chance to receive them. Here's a detailed comparison of the two systems:
Impact on Organ Donation Numbers
- Opt-in System: In this voluntary system, individuals must actively enroll as organ donors. This approach leads to lower donation rates because it requires proactive registration by potential donors.[1][2]
- Opt-out System: In an opt-out system, people are presumed to be donors unless they explicitly opt-out. Countries following this system tend to see higher organ donation rates compared to those implementing the opt-in system.[5]
Kidney Donation and Overall Organ Transplants
- Kidney Donation: Studies suggest that opt-out systems contribute to an increase in the number of kidneys available for transplantation. This is due to the larger donor pool created by automatically considering more individuals as donors.[5]
- Overall Organ Transplants: Opt-out systems often result in higher overall organ transplant numbers. This is largely because of the increased donor pool size, as more individuals are presumed to be donors unless they opt-out.[5]
Living Donor Numbers
- Living Donors: The differences between opt-in and opt-out systems are less pronounced in terms of living donors. Living donation is generally influenced by personal relationships and family decisions rather than the specific legal framework of organ donation.[2]
Nevertheless, the environment surrounding organ donation can affect the willingness of individuals to become living donors, as increased awareness and societal support for organ donation can encourage more people to consider living donation.[5]
In summary, opt-out systems often result in higher total numbers of kidneys donated and overall organ transplant numbers due to the larger donor pool they create. However, the impact on living donor numbers is less clear and may be influenced by broader societal factors rather than the specific legal framework.
- The study authors found that countries using opt-out systems of organ donation had higher total numbers of kidneys donated, the organ that the majority of people on organ transplant lists are waiting for.
- In the United States, which uses an opt-in system, around 18 people die every day due to a shortage of donated organs, despite 28,000 transplants being made possible last year thanks to organ donors.
- Researchers suggest that future studies could analyze the opinions of those who have to make the decision to opt in or opt out, using a mixture of survey and experimental methods.
- Spain, which has the highest organ donation rate in the world, utilizes an opt-out consent system but is credited by experts for measures such as a transplant coordination network and improving the quality of public information available about organ donation.
