Organ Transplantation: Choosing Between an Opt-In or Opt-Out Approach
In a global comparison, organ donation policies differ greatly between nations. The burning question: opt-in or opt-out? To gather insights, a team of researchers from the United Kingdom delved into the organ donation protocols of 48 countries to check which approach works best.
In an opt-in system, individuals must actively sign up to a donor register after death. On the other hand, an opt-out system means that organ donation takes place automatically unless specifically requested to hold off on taking organs before death.
Prof. Eamonn Ferguson, the lead author from the University of Nottingham, acknowledges the challenges that come with both systems:
"People may not act due to numerous reasons, such as loss aversion, a lack of effort, and because they believe the policy makers have made the right decision and one they trust."
Inaction in an opt-in system might lead to individuals who would want to be donors not donating (a false negative). Conversely, inaction in an opt-out system might result in individuals who do not wish to donate becoming donors (a false positive).
The US currently boasts an opt-in system. According to the US Department of Health & Human Services, 28,000 transplants were made possible last year due to organ donors. Each day, around 79 people receive organ transplants, while unfortunately, around 18 people die without receiving the surgery due to a shortage of donated organs.
In or Out?
This study involved the organ donation systems of 48 countries, analyzed by researchers from the University of Nottingham, University of Stirling, and Northumbria University in the UK over a period of 13 years - 23 countries using an opt-in system, and 25 using an opt-out system.
The researchers looked at overall donor numbers, numbers of transplant per organ, and the total number of kidneys and livers transplanted from both deceased and living donors. They found that countries using an opt-out system had higher total numbers of kidneys donated - the organ that the majority of people waiting for organ transplants 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. This point, as Prof. Ferguson points out, "has not been reported before," emphasizing its significance.
The authors admit that their study had limitations, such as not distinguishing between different degrees of opt-out legislation and not evaluating other factors influencing organ donation.
Moving Forward
The researchers conclude 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 their findings could be used in the future to guide policy decisions but could be strengthened further through the collection of international organ donation information and its public availability.
Prof. Ferguson recommends future studies that delve into individual beliefs, wishes, and attitudes towards organ donation, in addition to the country-level epidemiological approach.
Despite increased donation rates in opt-out countries, they still face organ donor shortages. Completely changing the system may not solve the issue. They propose 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 secret to their success lies in a well-oiled transplant coordination network, both local and national, as well as the high quality of available public information about organ donation.
Recently, we discussed whether farmed animal organs should be considered for human transplants as a potential solution to the organ shortage, or whether addressing this issue lies in tweaking the organ donation policy itself.
Sources:[1] Lgu states perspective : The role of family law in managing tissue and organ donation for transplantation. (2020, April 20).[2] Organ donation overview (2022, February 8).
- The research conducted by a team from the University of Nottingham, University of Stirling, and Northumbria University analyzed organ donation policies in 48 countries and found that opt-out systems led to higher total numbers of kidneys donated.
- In contrast, opt-in systems had a higher rate of kidney donations from living donors, a point that has not been reported before, as noted by Prof. Eamonn Ferguson.
- Despite the higher donation rates in opt-out countries, they still face organ donor shortages, suggesting the need to consider other strategies, such as revising consent legislation or adopting aspects of the "Spanish Model" to enhance donor rates.
- Spain, which has the highest organ donation rate in the world, achieved this success through a well-functioning transplant coordination network and high-quality public information about organ donation.
- Recently, the topic of using farmed animal organs for human transplants has been brought up as a potential solution to the organ shortage, but some argue that addressing this issue might lie in making adjustments to the organ donation policy itself.
- Researchers suggest that future studies should delve into individual beliefs, wishes, and attitudes towards organ donation, beyond a country-level epidemiological approach, to better understand the complexities surrounding organ donation and help guide policy decisions.
