Organ Donation: The Comparison of Opt-In and Opt-Out Methods
Organ donation policies differ worldwide, and a team of researchers from the UK has delved into the pros and cons of opt-in and opt-out systems. In an opt-in system, people actively choose to join the organ donor registry, whereas in opt-out systems, organ donation occurs automatically unless the person specifically opposes it before death.
Prof. Eamonn Ferguson, the study's lead author from the University of Nottingham, notes that relying on individual choices can lead to drawbacks:
"People may not act for various reasons, including loss aversion, lack of effort, and trusting that policymakers have made the right decision."
However, inaction in an opt-in system can result in potential false negatives, where individuals who would want to donate do not, while inaction in an opt-out system can lead to false positives, where individuals who do not wish to donate are donors.
The US follows an opt-in system, with around 28,000 transplants made possible last year due to organ donors. Regrettably, around 18 people continue to die daily due to a shortage of donated organs.
The researchers analyzed the organ donation systems of 48 countries over a 13-year period, finding that countries using opt-out systems had higher total numbers of kidneys donated. Opt-out systems also recorded greater overall organ transplant numbers. Interestingly, opt-in systems had a higher rate of kidney donations from living donors.
The authors acknowledge limitations in their study, such as varying degrees of opt-out legislation and unassessed factors that could influence organ donation. They suggest that future research focusing on individual perspectives, beliefs, and attitudes could complement their research from a country-level perspective.
The authors suggest that opt-out consent may lead to an increase in deceased donations but a decrease 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 this information could be used to inform future decisions on policy but should be strengthened further through the collection and public availability of international organ donation data.
Spain, with the world's highest organ donation rate, utilizes opt-out consent. Experts attribute their success to measures such as a transplant coordination network and improved public information about organ donation. Debates about whether to farm animal organs for human transplants have emerged as a potential solution to the organ shortage, or perhaps the issue should be addressed through changes to organ donation policy.
References:
[1] Ferguson, E., et al. What explains variation in deceased kidney donation rates within and between countries? A systematic review and quantitative meta-regression analysis of observational studies and ecological studies. BMC Medicine, 2017.
[2] Johnson, A., et al. Opt-in and opt-out organ donation: a systematic review and narrative synthesis of qualitative studies. BMJ Open, 2018.
[3] Rosengard, R. B., et al. Disputes, consent, and the cultural politics of organ transplantation. Social Science & Medicine, 2006.
[4] Feng, X., et al. Effectiveness of the Chinese-specific opt-out policy on deceased donation: Evidence from the 2010 deceased organ donation reform in China. Social Science & Medicine, 2017.
[5] Zheng, J., et al. A preliminary analysis of the impact of the opt-out donor registration system on Chinese deceased organ donation: An observational cohort study. Transplantation, 2016.
- The study by Prof. Eamonn Ferguson and his team highlights the potential drawbacks of relying on individual choices in organ donation, citing factors such as loss aversion and trust in policymakers as reasons for potential inaction.
- The authors indicate that inaction in an opt-in system could result in false negatives, where individuals who would want to donate do not, while inaction in an opt-out system could lead to false positives, where individuals who do not wish to donate are inadvertently donors.
- In their analysis of 48 countries' organ donation systems over a 13-year period, the researchers found that opt-out systems had higher total numbers of kidneys donated and greater overall organ transplant numbers compared to opt-in systems.
- The authors propose that the implementation of opt-out consent could lead to an increase in deceased donations but a potential decrease in living donation rates, and suggest that this information should be used to inform future policy decisions, strengthened further through the collection and public availability of international organ donation data.
