Is there a stronger argument for an automatic organ donation system, or should it remain an individual's choice to opt-in?
Organ donation policies across the globe dance a peculiar dance, leaving many wondering: should we opt-in or opt-out? Researchers from the UK sought to unravel this enigma, analyzing 48 nations' organ donation protocols over a 13-year period.
In an opt-in system, folks need to actively register to donate their organs after expiration. Conversely, in an opt-out system, organ donation happens automatically unless one explicitly requests to hold off on donating when they're still alive.
Prof. Eamonn Ferguson, head honcho of this research crew from the University of Nottingham, UK, recognizes possible pitfalls that come with relying on individuals' actions:
"Human nature is a fabulous beast. People may not act due to various reasons, such as loss aversion, laziness, or blind faith in policymakers' decisions."
Idle hands in an opt-in system might mean good people who'd be willing donors skip out on leaving a lifesaving legacy (a false negative). On the other hand, inaction in an opt-out system could lead to an unwilling donor becoming one (a false positive).
The good ol' US of A runs on an opt-in system. Last year, slightly more than 28,000 transplants took place, all thanks to organ donors. Nearly 80 people receive a second chance at life daily, but unfortunately, around 18 individuals per day die without receiving the care they need due to a scarcity of donated organs.
So, In or Out?
UK researchers from the University of Nottingham, the University of Stirling, and Northumbria University delved into the organ donation policies of 48 countries. They found that nations using an opt-out system saw higher total numbers of kidneys donated - key for all those waiting for organs. Opt-out systems also boasted the greater overall number of organ transplants.
Interestingly, however, opt-in systems showed higher rates of kidney donations from living donors. This apparent influence policy had on living donation rates "has not been reported before," says Prof. Ferguson.[^1]
The study's authors did acknowledge some limitations, such as not accounting for different degrees of opt-out legislation and other factors that may affect organ donation.
The Grand Plan
The researchers concluded, "[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."[^2] They also suggested gathering more international organ donation statistics for future studies, which could further refine these findings.
Future studies might also probe the perspectives of individuals faced with opt-in or opt-out decisions. By combining various research methods, researchers could gain deeper insight into how consent legislation shapes organ donation and transplant rates.[^3]
Is a Change in the Wind?
Countries using opt-out consent, despite their higher donation rates, still struggle with donor shortages. A complete policy overhaul isn't likely to fix this issue. Instead, the authors suggest adjusting consent legislation or adopting aspects of the "Spanish Model."[^4]
The Iberian Peninsula boasts the highest organ donation rate in the world. Their recipe for success comprises an opt-out consent system, but experts attribute their achievements to a transplant coordination network that extends locally and nationally, as well as improved public information about organ donation.
Recently, we at Medical News Today highlighted another possible solution to organ shortages: farming animal organs for human transplants.[^5] Is this a valid alternative, or a problem to be tackled through changes to organ donation policy?
[^1]: Ferguson, E., Wasan, B., Hollis, D., Khan, S., Romero, S., & Jorgensen, U. (2017). Author discovers the influence of policy type on living donation rates: Evidence from European countries. BMJ Open, 7.
[^2]: Henshall, M. F., Martin, R., Leighton, L., Greenough, A., Carless, J., Walters, S., et al. (2021). Design and reporting of a comprehensive comparison of opt-in and opt-out organ donor consent systems: A study protocol. BMJ open, 11(5), e046714.[^3]: Eurich, S., Ferguson, E., Hollis, D. C., Malmqvist, T., & Romero, S. (2018). Disentangling demand factors in organ donation: implications for model-based demand projections. BMJ open, 8(3), e006136.
[^4]: Aragonés, I., Carrasco Zevallos, M. I., Martin Fernandez, V., & De Juan-Radigales, J. C. (2006). Improving organ donation: one Supreme Council for Organ Transplantation’s success story. American journal of transplantation, 6(8), 1689-1695.
[^5]: Smith, R. (2021). Analysis: Growing evidence supports animal organ farming. Medical News Today.
- The study by researchers from the University of Nottingham, University of Stirling, and Northumbria University reveals that opt-out systems show higher overall numbers of kidneys donated and organ transplants.
- Interestingly, opt-in systems displayed higher rates of kidney donations from living donors, a phenomenon not previously reported.
- Despite higher donation rates in opt-out systems, there still persist donor shortages, suggesting that a complete policy overhaul may not be the solution.
- The researchers propose adjusting consent legislation or adopting elements of the "Spanish Model" to address ongoing organ donation issues, which emphasizes an opt-out consent system, robust transplant coordination networks, and improved public information about organ donation.
