Organ donation: Should the system be based on presumed consent or individual choice?
Organ donation policies worldwide vary significantly, with the big question being: should people be required to opt-in or opt-out for donation? To tackle this mystery, a team of researchers from the UK investigated organ donation procedures in 48 countries to determine which method leads to the best outcomes.
In an opt-in system, individuals must actively sign up to a register to donate their organs after death. Conversely, an opt-out system automatically assumes organ donation unless a specific request is made before death to prevent it.
Prof. Eamonn Ferguson, leading the study from the University of Nottingham, UK, acknowledges potential drawbacks due to the active decision required for both systems:
"People may not act for numerous reasons, including loss aversion, effort, and believing that the policy makers have made the 'right' decision and one they believe in."
Inaction in an opt-in system could lead to individuals who would want to be a donor not donating (a false negative). In contrast, inaction in an opt-out system could potentially lead to an individual that does not want to donate becoming a donor (a false positive).
The US adheres to an opt-in system, with approximately 28,000 transplants facilitated last year due to organ donors. Despite this, around 18 people continue to die daily due to a shortage of donated organs.
Researchers from the University of Nottingham, University of Stirling, and Northumbria University analyzed the organ donation systems of 48 countries for a period of 13 years, finding that countries using opt-out systems of organ donation had higher total kidney donations - the organ most in demand by those on organ transplant lists. Opt-out systems also had the greater overall number of organ transplants.
Opt-in systems, however, had a higher rate of kidney donations from living donors, a subtlety yet to be reported before by experts. The authors admitted their study was limited, as it did not account for varying degrees of opt-out legislation or other factors affecting organ donation.
Future studies might involve analyzing individual opinions on the decision to opt-in or opt-out, and the authors suggest that legislation changes or adopting aspects of the "Spanish Model" could potentially improve donor rates. Spain boasts the highest organ donation rate globally due to their opt-out system, coupled with a transplant coordination network and improved public information about donation.
Controversial discussions have arisen regarding the farming of animal organs for human transplants as a potential solution to the donor shortage. But, perhaps, this issue might be resolved through changes to organ donation policies rather than a drastic shift towards animal donations.
- In an opt-in system, individuals must actively sign up to donate their organs after death, unlike in opt-out systems where organ donation is assumed unless specifically requested otherwise.
- Inaction in an opt-out system could potentially lead to an individual that does not want to donate becoming a donor (a false positive), while inaction in an opt-in system could lead to individuals who would want to be a donor not donating (a false negative).
- Researchers found that opt-out systems had higher total kidney donations and a greater overall number of organ transplants, while opt-in systems had a higher rate of kidney donations from living donors.
- Future studies might involve analyzing individual opinions on the decision to opt-in or opt-out, and the authors suggest that legislation changes or adopting aspects of the "Spanish Model," which combines an opt-out system with a transplant coordination network and improved public information, could potentially improve donor rates.
