Organ Donation: Which System - Opt-In or Opt-Out - Is More Preferable?
Competing Organ Donation Policies Across the Globe: Opt-In or Opt-Out?
A casual, laid-back exploration of the benefits and downsides of opt-in vs. opt-out organ donation systems, based on current research and findings
So, the big question: is it better to have an organ donation system where people actively sign up or one where organ donation happens automatically unless you opt out? To shed light on this problem, a team of researchers from the UK took a close look at organ donation protocols in 48 countries. Let's dive into their findings and see where the benefits and drawbacks of each system lie.
With opt-in systems, people need to proactively enroll in a register to donate their organs after they kick the bucket. In contrast, opt-out systems make organ donation automatic unless a specific request is made before your demise for organs not to be taken.
Prof. Eamonn Ferguson, lead author from the University of Nottingham, acknowledges the challenges with both systems:
"People can choose to sit this one out for numerous reasons, like loss aversion, not wanting to put in the effort, or assuming that the Powers that Be have made the 'right' choice for them."
Here's the twist: inaction in an opt-in system can lead to individuals who would want to be a donor NOT donating (a false negative). On the flip side, inaction in an opt-out system can potentially lead to an individual who doesn't want to donate becoming a donor (a false positive).
The United States currently employs an opt-in system. Approximately 28,000 transplants were made possible last year due to organ donors, and around 79 people still receive organ transplants every day. Sadly, around 18 people die every day due to a shortage of donated organs.
To In, or Not To In?
Researchers from the University of Nottingham, University of Stirling, and Northumbria University in the UK analyzed the organ donation systems of 48 countries over a 13-year period, examining 23 countries using an opt-in system and 25 using an opt-out system.
The study authors measured overall donor numbers, transplant numbers per organ, and the total number of kidneys and livers transplanted from both deceased and living donors. They found that countries using opt-out systems had higher total numbers of kidneys donated, the organ that the majority of people on transplant lists are waiting for. These systems also had the greater overall number of organ transplants.
Opt-in systems did, however, have a higher rate of kidney donations from living donors. According to Prof. Ferguson, "the impact of policy on living donation rates is something that hasn't been reported before," and it's a subtlety that needs to be taken into consideration.
The authors acknowledge that their study had limitations, as it didn't distinguish between different degrees of opt-out legislation, with some countries requiring permission from next-of-kin for organs to be donated. The observational nature of the study means that other factors that might influence organ donation remained unassessed.
Stepping Up to the Elephant in the Room
The researchers state that their results, published in BMC Medicine, show 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 these results, while useful, could be strengthened further through the collection of international organ donation information, such as consent type, procurement procedures, and hospital bed availability, which should be made publicly accessible.
Moving forward, Prof. Ferguson recommends future studies that analyze the opinions of those who have to make the decision between opting in or opting 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 note that even countries using opt-out consent still struggle with organ donor shortages. A complete system overhaul is therefore unlikely to solve this problem. They suggest that changing the system of consent or adopting elements of the "Spanish Model" could be ways to boost donor rates.
Spain currently boasts the highest organ donation rate in the world. The Spanish utilize opt-out consent but are credited with their success due to measures like a transplant coordination network that functions on both a local and national scale, and improving the quality of public information available about organ donation.
Recently, Medical News Today ran a feature on whether farming animal organs for human transplants could be a solution to the organ donor shortage or another problem to address through changes in organ donation policy. Thoughts?
- In opt-in systems, individuals proactively enroll in a donor register, potentially leading to false negatives where those who would want to donate do not.
- Opt-out systems, on the other hand, make organ donation automatic, potentially resulting in false positives where individuals who did not wish to donate become donors.
- Researchers from Nottingham, Stirling, and Northumbria Universities analyzed the organ donation systems of 48 countries over a 13-year period, finding that opt-out systems had higher total numbers of kidneys donated and overall organ transplants.
- Opt-in systems, however, had a higher rate of kidney donations from living donors, a subtlety that the study authors noted.
- The authors suggest that their results could be strengthened through the collection of international organ donation information, such as consent type, procurement procedures, and hospital bed availability, to be made publicly accessible.
- Prof. Ferguson recommends future studies that examine individual beliefs, wishes, and attitudes towards organ donation, using a combination of surveys and experimental methods, to gain a better understanding of the influence of consent legislation on organ donation and transplantation rates.
