Discussing Organ Donation: Which Approach – Consent-Based or Presumed Consent – Is More Effective?
Worldwide organ donation policies exhibit considerable variation, with the question persisting: Is it more effective to have an opt-in or opt-out system? To address this, a team of researchers from the UK explored the organ donation protocols of 48 countries to determine which approach is the most successful.
In an opt-in system, individuals must actively register to donate their organs post-mortem. Conversely, opt-out systems allow for automatic organ donation unless an explicit request is made before death to preclude organ retrieval.
Professor Eamonn Ferguson, principal researcher from the University of Nottingham, acknowledges potential drawbacks associated with both systems due to reliance on individuals' active decisions:
"People may refrain from taking action for various reasons, such as loss aversion, lack of effort, and the belief that policymakers have made the right decision and one that they support."
Inaction under an opt-in system may result in individuals who wish to donate inadvertently not doing so (a false negative). In contrast, inaction under an opt-out system could potentially lead to individuals who do not wish to donate unintentionally becoming donors (a false positive).
The United States adheres to an opt-in system. According to the US Department of Health & Human Services, over 28,000 transplants were made possible last year due to organ donors. Around 79 people receive organ transplants every day, but an unfortunate 18 die daily due to a shortage of donated organs.
University of Nottingham, University of Stirling, and Northumbria University researchers analyzed the organ donation protocols of 48 countries for a 13-year period, investigating 23 opt-in and 25 opt-out systems.
The study authors assessed overall donor numbers, transplants per organ, and the total number of kidneys and livers transplanted from both deceased and living donors. They found that countries utilizing opt-out systems had substantially higher total kidney donations, the organ most sought after by those on organ transplant lists. Opt-out systems also recorded a greater overall number of organ transplants.
Opt-in systems, however, boasted a higher rate of kidney donations from living donors. Prof. Ferguson notes that this relationship between policy and living donation rates "has not been reported before" and calls for further consideration.
The researchers acknowledge their study limitations, such as not accounting for varying degrees of opt-out legislation and unassessed factors impacting organ donation.
They conclude that their findings, published in BMC Medicine, show "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 these results could inform future policy decisions and recommend the regular compilation of international organ donation information for public availability.
Prof. Ferguson suggests that further studies should focus on the beliefs, wishes, and attitudes of individuals faced with the decision to opt in or opt out, employing a blend of surveys and experimental methods. He believes that these approaches can help researchers better understand the impact of consent legislation on organ donation and transplantation rates.
The authors note that countries using opt-out consent still experience organ donor shortages. Changing the system of consent may not significantly address such issues. Instead, they propose that consent legislation or implementing aspects of the "Spanish Model" (a successful combination of opt-out consent and comprehensive organ donation facilitation) could potentially enhance donor rates.
Spain currently boasts the highest organ donation rate globally due to its use of opt-out consent, supported by measures such as a transplant coordination network operating at both local and national levels, as well as the enhancement of public information on organ donation.
In addressing the organ shortage, some experts have suggested exploring the farming of animal organs for human transplants. However, this raises ethical and practical concerns that require careful consideration.
- Contextually, the study published in BMC Medicine analyzed organ donation protocols in 48 countries, comparing both opt-in and opt-out systems.
- The study found that countries with opt-out systems had significantly higher total kidney donations and an overall greater number of organ transplants.
- In contrast, opt-in systems demonstrated a higher rate of kidney donations from living donors, a relationship previously unreported.
- Despite the increase in organ transplants in opt-out countries, Prof. Ferguson suggests that further studies should investigate individuals' beliefs, wishes, and attitudes towards organ donation to better understand the impact of consent legislation on donation and transplantation rates.
