Opt-in or Opt-out Organ Donation: Which Approach Offers More Efficient Results?
Organ donation policies across the globe exhibit significant disparities, sparking debate over whether an opt-in or opt-out approach is more effective. A team of researchers from the UK, including Prof. Eamonn Ferguson from the University of Nottingham, have examined the organ donation protocols of 48 countries to determine the optimal system.
In opt-in systems, individuals must actively register to donate their organs post-mortem, whereas in opt-out systems, donation occurs by default unless specifically requested otherwise before death. The researchers acknowledge that both systems may encounter drawbacks due to reliance on individual decisions:
"People may not act for numerous reasons, including loss aversion, effort, and trusting that policy makers have made the right decision," says Prof. Ferguson.
In an opt-in system, a lack of action may prevent those who would potentially want to donate from doing so (a false negative). Conversely, inaction under opt-out systems may lead to individuals who do not wish to donate becoming donors (a false positive).
The US adopts an opt-in system, with 28,000 transplants made possible last year through organ donors. However, around 18 people still die daily due to a shortage of donated organs, reflecting the ongoing need for more donors.
Researchers from the University of Nottingham, University of Stirling, and Northumbria University investigated the impact of organ donation policies in 48 countries over a 13-year period. They found that countries using opt-out systems had higher total numbers of kidneys donated, the organ most in demand for transplants. Opt-out systems also recorded a greater total number of overall organ transplants.
Despite this, opt-in systems demonstrated a higher rate of kidney donations from living donors. The impact of policy on living donation rates is a novel finding, as noted by Prof. Ferguson. However, the study had limitations, such as not accounting for variations in opt-out legislation and assessing other factors influencing organ donation.
The researchers suggest that their findings could inform future decisions on policy, but could be strengthened further through the collection and public availability of international organ donation data, such as consent type, procurement procedures, and hospital bed availability. They also propose examining the opinions of those who make the decision to opt in or opt out, using a combination of surveys and experimental methods.
Countries using opt-out consent still face organ donor shortages. The researchers suggest that revising consent legislation or adopting aspects of the "Spanish Model" could help improve donor rates. Spain boasts the world's highest organ donation rate, attributed to factors including a transplant coordination network and the quality of public information about organ donation.
The study provides insights into the complex interplay between organ donation policies and donation rates. While the direct impact of switching between opt-in and opt-out systems may be limited, the evidence supports the notion that opt-out systems generally lead to higher consent rates compared to opt-in systems.
[1] Organ donation policies and consent legislation: A systematic review and meta-analysis.
[2] The effect of organ donation consent policies on donation rates: An empirical analysis based on US data.
- In the study "Organ donation policies and consent legislation: A systematic review and meta-analysis," researchers from various UK universities, including the University of Nottingham, examined the impact of organ donation policies in 48 countries over a 13-year period.
- The study found that countries using opt-out systems had higher total numbers of kidneys donated, the organ most in demand for transplants. Opt-out systems also recorded a greater total number of overall organ transplants.
- However, opt-in systems demonstrated a higher rate of kidney donations from living donors, the researchers noted. This apparent contradiction suggests that policy plays a significant role in living donation rates, a novel finding in the context of organ donation research.
- In an effort to address organ donor shortages, the researchers propose investigating the opinions of those who make the decision to opt in or opt out, and suggest revising consent legislation or adopting aspects of the "Spanish Model," credited with the world's highest organ donation rate.
