Organ Donation: Should Donation be Opt-In or Opt-Out as Default?
Organ Donation: Opt-In vs Opt-Out - Which Way Forward?
Our global organ donation policies dance like a kaleidoscope, with different nations favoring either opt-in or opt-out systems. A team of researchers from the UK aimed to shed light on which approach reigns supreme by delving into the organ donation protocols of 48 countries.
In opt-in systems, individuals have to sign up actively for the organ donor registry post mortem. On the other hand, opt-out systems allow organ donation to occur automatically unless a specific request is made before death to opt out of donation.
Prof. Eamonn Ferguson, the lead author from the University of Nottingham, UK, acknowledges that relying on individual decisions can have its pitfalls:
"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 lead to false negatives - individuals who'd want to be donors not donating. Oppositely, inaction in an opt-out system can potentially result in false positives - individuals not wishing to donate becoming donors.
The United States stands with an opt-in system, as reported by the U.S. Department of Health & Human Services, with 28,000 transplants made possible last year due to organ donors. Although it's a significant number, around 18 people per day die due to a scarcity of donated organs.
In or Out?
Researchers from the University of Nottingham, University of Stirling, and Northumbria University delved into the organ donation systems of 48 countries over 13 years, with 23 using an opt-in system and 25 opting for an opt-out system.
They measured overall donor numbers, transplants per organ, and the total number of kidneys and livers transplanted from both deceased and living donors. Their findings? Countries using opt-out systems had higher total numbers of kidneys donated - the organ most in demand by those on organ transplant lists. Opt-out systems also boasted greater overall numbers of organ transplants.
Opt-in systems, however, held a higher rate of kidney donations from living donors. This apparent influence on living donation rates, according to Prof. Ferguson, is a novel insight that needs highlighting:
"The influence that policy had on living donation rates 'has not been reported before,' says Prof. Ferguson. 'This is a subtlety that needs to be addressed and considered.'"
The authors recognized that their study fell short by not distinguishing between varying degrees of opt-out legislation, with some countries requiring permission from next-of-kin for organs to be donated. Moreover, the observational nature of the study meant that other factors that could influence organ donation remained unassessed.
Charting the Course Ahead
The researchers published their results in BMC Medicine, stating 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 suggested that although their results could inform future policy decisions, they could be strengthened further through the routine collection and public availability of international organ donation data - consent type, procurement procedures, and hospital bed availability, to name a few.
Prof. Ferguson suggested that future studies could also delve into the beliefs, wishes, and attitudes of individuals faced with 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 noted that countries employing opt-out consent still experience organ donor shortages. As such, a complete change in the system of consent is unlikely to remedy such a predicament. Instead, they suggest that consent legislation or adopting aspects of the "Spanish Model" could be ways to enhance donor rates.
Spain presently boasts the highest organ donation rate globally. Their success is attributed to measures such as a transplant coordination network that operates on both local and national levels, and augmenting the quality of public information available about organ donation.
Recently, Medical News Today ran a spotlight feature on the topic of farmed animal organs for human transplants. Could this be the solution to the organ shortage, or is it an issue better handled through modifications to organ donation policy?
Written by James McIntosh
- In opt-out systems, which allows organ donation to occur automatically unless a specific request is made before death to opt out, countries have higher total numbers of kidneys donated, the organ most in demand by those on organ transplant lists.
- Opt-in systems, on the other hand, though they have a higher rate of kidney donations from living donors, can lead to false negatives - individuals who'd want to be donors not donating.
- Contextual research suggests that the science of health-and-wellness could potentially benefit from retargeting approaches, focusing on individuals who've shown interest in organ transplantation, medical-conditions, or health-and-wellness to increase awareness about organ donation and its implications.
- As organ donor shortages persist even in countries with opt-out consent, exploration of alternative solutions like farmed animal organs for human transplants becomes an intriguing consideration within the health-and-wellness and medical-conditions discourse, though policy modifications might offer ways to enhance donor rates as well.
