Debate over organ donation registration protocol: Which method - consent-based or presumed consent - is more effective?
In the realm of organ donation, policies deviate significantly across the globe. Is it better to have an opt-in or opt-out system? To dissect this dilemma, a team of researchers from the UK delved into the organ donation strategies of 48 countries, scrutinizing which approach is delivering the best results.
With opt-in systems, individuals must sign up to a registry to donate their organs post-mortem. Conversely, in opt-out setups, organ donation ensues automatically unless a specific request is made before death requesting organs not to be harvested.
Prof. Eamonn Ferguson, the lead author from the University of Nottingham, acknowledges that relying on individuals to make a choice can lead to drawbacks, such as:
"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."
Inaction in an opt-in system can result in individuals who wish to be donors not donating, thereby producing a false negative. Meanwhile, inaction in an opt-out system could potentially lead to an individual unwilling to donate becoming a donor, thus producing a false positive.
Currently, the US adheres to an opt-in system. Last year, around 28,000 transplants were facilitated by organ donors. Unfortunately, unfortunate circumstances lead to 18 people per day dying due to a lack of donated organs.
To in or out?
Researchers from the University of Nottingham, University of Stirling, and Northumbria University in the UK analyzed the organ donation systems of 48 countries across a 13-year span - 23 using opt-in systems and 25 adopting opt-out systems.
The researchers compared overall donor numbers, numbers of transplants per organ, and the total number of kidneys and livers transplanted from deceased and living donors.
The study authors observed that countries utilizing opt-out systems experienced higher totals of kidneys donated - the organ most in-demand among those on organ transplant waiting lists. Furthermore, these countries had a greater overall number of organ transplants.
Opt-in systems, however, yielded a higher rate of kidney donations from living donors. This influence on living donation rates, as reported by Prof. Ferguson, "has not been reported before," and necessitates further attention.
Despite the study's limitations - such as failing to distinguish between varying degrees of opt-out legislation and the absence of an assessment of other factors potentially influencing organ donation - the researchers stress that their findings, published in BMC Medicine, indicate 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."
Moving Forward
The researchers suggest that these results could assist in making future policy decisions, but they could be strengthened further through the routine collection and public dissemination of international organ donation information, such as consent type, procurement procedures, and hospital bed availability.
Future studies could also delve into the perspectives of individuals making the decision to opt-in or opt-out by employing a mix of surveys and experimental methods.
The authors acknowledge that countries implementing opt-out consent still experience organ donor shortages. A complete system overhaul may not solve such a problem, but changes to consent legislation or the adoption of elements from the "Spanish Model" could potentially improve donor rates.
Spain currently boasts the highest organ donation rate globally. The Spanish system adheres to opt-out consent, but experts attribute their success to a well-established transplant coordination network and the enhancement of public information regarding organ donation.
Recent discussions revolve around whether animal organs should be farmed for human transplants to tackle the organ shortage. Could this be the solution, or should the issue be addressed through policy changes in organ donation? Only time will tell.
- The study published in BMC Medicine revealed that countries using opt-out systems tend to have a higher number of kidneys donated, which is the organ most in-demand among organ transplant recipients.
- Researchers observed that these countries also had a greater overall number of organ transplants, although opt-in systems yielded a higher rate of kidney donations from living donors.
- In the context of medical-conditions and health-and-wellness, the researchers suggest that their findings could help guide future policy decisions regarding organ donation, but they encourage the routine collection and public dissemination of international organ donation data for a more comprehensive analysis.
- As the discussion continues about potential solutions to organ shortages, such as retargeting efforts towards animal organ farming for human transplants, researchers emphasize the importance of considering policy changes in organ donation as well, particularly adopting elements from the successful Spanish Model, which has led to the highest organ donation rate globally.
