Debate over Organ Donation: Which System – Opt-In or Opt-Out – Offers Greater Efficiency?
The Buzz on Organ Donation: Opt-In versus Opt-Out
Organ donation policies across the globe vary wildly, and the question remains: is it better to have an opt-in or opt-out system? A research team from the UK decided to investigate and examined the organ donation regulations of 48 nations to see which method is more effective.
In an opt-in system, people must actively sign up to a donor registry to give their organs posthumously. On the other hand, in an opt-out system, organ donation automatically occurs unless a specific request is made before death to not take the organs.
Prof. Eamonn Ferguson, the lead author from the University of Nottingham in the UK, acknowledges that the reliance on an active decision from individuals can lead to some drawbacks, such as:
- People may not act for various reasons, such as loss aversion, lack of effort, or the belief that policy makers have made the right decision and one that they trust.
The US currently operates under an opt-in system. According to the US Department of Health & Human Services, 28,000 transplants were made possible last year due to organ donors. On average, 79 individuals receive organ transplants per day. Sadly, around 18 people die every day due to a shortage of donated organs.
In or Out?
Researchers from the Universities of Nottingham, Stirling, and Northumbria in the UK analyzed the organ donation systems of 48 countries for a period of 13 years—23 with an opt-in system and 25 with an opt-out system.
The study authors measured various aspects, such as the total number of donors, the number of transplants per organ, and the total number of kidneys and livers transplanted from both deceased and living donors.
They found that countries with opt-out systems had a higher total number of kidneys donated, which is the organ that the majority of people on organ transplant lists are waiting for. Opt-out systems also had a greater overall number of organ transplants.
Opt-in systems did, however, have a higher rate of kidney donations from living donors. This influence on living donation rates "has not been reported before," says Prof. Ferguson, "and is a subtlety that needs to be highlighted and considered."
The authors admit that their study was limited by not accounting for varying degrees of opt-out legislation in different countries, with some requiring permission from the next of kin before organs can be donated. The study's observational nature means that other factors that may influence organ donation were not accounted for.
Moving Forward
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 their findings could be used in the future to inform policy decisions but could be strengthened further through the regular collection of international organ donation information, such as consent type, procurement procedures, and hospital bed availability, and making this data publicly available.
Prof. Ferguson suggests that future studies could also delve into the perspectives of individuals making 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," he says, "researchers can develop a greater understanding of the influence of consent legislation on organ donation and transplantation rates."
The authors note that even countries utilizing opt-out consent still face organ donor shortages. A complete overhaul of the system of consent is unlikely to resolve such a problem, they suggest. Instead, changes to consent legislation or adopting elements of the "Spanish Model" may help improve donor rates.
Spain currently boasts the highest organ donation rate in the world. The success in Spain is often credited to the Spanish's use of opt-out consent, as well as measures such as a transplant coordination network that operates on both regional and national levels, and the availability of high-quality public information about organ donation.
Recently, Medical News Today ran a feature exploring whether animal organs should be farmed for human transplants. Could this potentially be a solution to the organ shortage, or should the problem be addressed through changes to donation policy?
Written by James McIntosh
- The study from the Universities of Nottingham, Stirling, and Northumbria analyzed organ donation systems of 48 countries for 13 years, finding that countries with opt-out systems had more kidney donations and overall organ transplants.
- In the US, which uses an opt-in system, 28,000 transplants were made possible last year, but around 18 people still die daily due to a shortage of donated organs.
- The research team suggests that their findings could be used to inform future policy decisions, but they also call for the regular collection of international organ donation data and its public availability.
- Researchers propose that future studies should examine individuals' beliefs, wishes, and attitudes towards organ donation, using both survey and experimental methods, to better understand the influence of consent legislation on organ donation and transplantation rates.
- Spain, which has an opt-out system and a transplant coordination network that operates on both regional and national levels, boasts the highest organ donation rate in the world. However, even Spain faces organ donor shortages.
- In a recent feature, Medical News Today explored the idea of farming animal organs for human transplants as a potential solution to the organ shortage, or if changes to donation policy should be the focus instead.
