Organ Donation: Should We Adopt an Opt-In or Opt-Out Approach?
Organ donation policies across the globe show a noticeable variance. Is it better to have a system where donation is optional or mandatory? To find an answer, a group of researchers from the UK conducted a study on organ donation procedures in 48 countries to determine which method is working most effectively.
In opt-in systems, individuals must actively register to donate their organs posthumously. On the other hand, opt-out systems imply organ donation will occur automatically unless a specific request is made before death, opting out of donation.
Prof. Eamonn Ferguson, the lead author from the University of Nottingham, UK, acknowledges that since both systems rely on an active decision from individuals, it can lead to certain drawbacks:
"People may not act for numerous reasons, including loss aversion, effort, and believing that the policy makers have made the 'right' decision and one that they believe in."
However, inaction in an opt-in system can result in individuals who would want to donate but don't, leading to false negatives. In contrast, inaction in an opt-out system can potentially lead to an individual who does not want to donate becoming a donor, which is known as a false positive.
The US currently operates on an opt-in system, with the US Department of Health & Human Services reporting that over 28,000 transplants were conducted last year due to organ donors. Regrettably, around 18 people die every day due to a scarcity of donated organs.
Weighing the Options
The researchers from the University of Nottingham, University of Stirling, and Northumbria University in the UK 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 study examined overall donor numbers, transplants per organ, and the total number of kidneys and livers transplanted, both from deceased and living donors.
The authors discovered that countries using an opt-out system for organ donation had a higher total number of kidneys donated - the organ that a majority of people on the organ transplant waiting list are waiting for. Opt-out systems also had a greater overall number of organ transplants.
Opt-in systems, however, had 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 researchers acknowledge limitations in their study, as it didn't distinguish between different levels of opt-out legislation, with some countries requiring permission from next-of-kin for organs to be donated. Furthermore, the observational nature of the study meant that other factors that might impact organ donation remained unassessed.
A Path Forward
The researchers state that their results, published in BMC Medicine, suggest 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 while the results could be used in the future to inform decisions on policy, they could be strengthened further through the regular 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 recommends that future studies also investigate the opinions of individuals who have to make a 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," he says, "researchers can develop a greater understanding of the influence of consent legislation on organ donation and transplantation rates."
The authors note that countries using an opt-out system for consent still experience organ donor shortages. Changing the system entirely is, thus, unlikely to address this issue. Instead, they suggest that consent legislation or adopting aspects of the "Spanish Model" could be ways to enhance donor rates.
Spain currently boasts the highest organ donation rate in the world. The Spanish employ an opt-out system, but their success is attributed to measures such as a transplant coordination network operating locally and nationally, as well as the improvement of public information on organ donation.
Recently, a feature on Medical News Today discussed the idea of farming animal organs for human transplants as a solution to the organ shortage. This approach raises questions about whether it represents a viable solution or if solution lies in changing organ donation policy.
Written by James McIntosh
- In opt-in systems, individuals actively register to donate their organs posthumously, whereas opt-out systems imply automatic organ donation unless a specific request is made before death.
- Prof. Eamonn Ferguson, a researcher from the University of Nottingham, UK, pointed out that both systems rely on individuals' active decisions, leading to potential drawbacks like loss aversion, effort, and trust in policy makers.
- The study, conducted by researchers from Nottingham, Stirling, and Northumbria universities in the UK, analyzed organ donation systems in 48 countries over a 13-year period, finding that opt-out systems had a higher total number of kidneys and overall organ transplants.
- Opt-in systems, however, had a higher rate of kidney donations from living donors, and this influence on living donation rates is a "subtlety" not previously reported, according to Prof. Ferguson.
- The researchers acknowledge limitations in their study, such as the absence of distinction between different levels of opt-out legislation and unassessed factors affecting organ donation.
- Looking forward, the researchers suggest that their findings could inform future policy decisions and recommend regular collection of international organ donation information, such as consent type, procurement procedures, and hospital bed availability, for public access. They also suggest investigating individuals' beliefs, wishes, and attitudes to gain a better understanding of how consent legislation impacts organ donation and transplantation rates. Additionally, they question the viability of farming animal organs for human transplants and whether changing organ donation policy is a more effective solution.
