Organ Donation: Choosing Between Opt-In and Opt-Out Approach for Donations
In the organ donation debate, the question on the table is whether an opt-in or opt-out system is more effective. Researchers from the UK have delved into this issue by examining organ donation protocols of 48 countries.
In an opt-in system, people must actively sign up to donate their organs posthumously. On the other hand, in an opt-out system, organ donation occurs automatically unless an individual specifically requests otherwise before death.
Professor Eamonn Ferguson, the lead author from the University of Nottingham, acknowledges that the reliance on individual action can lead to drawbacks in both systems. He explains, "People may not act for numerous reasons, including loss aversion, effort, and believing that policy makers have made the 'right' decision."
The United States currently follows an opt-in system. Last year, 28,000 transplants were made possible due to organ donors. However, around 18 people die every day due to a shortage of donated organs.
Researchers from the University of Nottingham, University of Stirling, and Northumbria University analyzed the organ donation systems of 48 countries for a period of 13 years. They found that countries using opt-out systems had higher total numbers of kidneys donated. Opt-out systems also boasted a greater overall number of organ transplants.
However, opt-in systems fared better when it came to kidney donations from living donors. This apparent influence on living donation rates, according to Prof. Ferguson, is a subtlety that needs to be highlighted and considered.
The researchers recommend that their results could be used in the future to inform policies. They suggest the routine collection of international organ donation information, including consent type, procurement procedures, and hospital bed availability, which should then be made publicly available.
Prof. Ferguson also suggests that future studies could examine issues from the perspective of the individual, including their beliefs, wishes, and attitudes, using a mixture of survey and experimental methods.
The authors point out that countries using opt-out consent still experience organ donor shortages. They suggest that while changing the system of consent might be a way to improve donor rates, it is unlikely to solve the problem entirely. They propose that countries might consider adopting aspects of the "Spanish Model," which has resulted in Spain having the highest organ donation rate in the world.
Spain's success is attributed to a transplant co-ordination network that works nationally and locally, and the provision of high-quality public information about organ donation.
The debate over organ donation policies is not solely about the system itself, but also about the cultural, legal, and social factors that influence outcomes. While opt-out systems seem to result in higher organ donation rates, their success is highly dependent on cultural context and practical implementation, including respect for individual and family wishes.
- The researchers' findings suggest that opt-out systems, such as the one in Spain, generally lead to higher numbers of total kidneys donated and overall organ transplants, compared to opt-in systems.
- Interestingly, opt-in systems performed better in terms of kidney donations from living donors, a subtlety that needs to be taken into account when considering policy changes.
- The researchers advocate for the regular collection of international organ donation data, including consent types, procurement procedures, and hospital bed availability, for public dissemination, to inform future policies.
- Recognizing the limits of system changes, the authors also propose that countries might benefit from adopting aspects of the "Spanish Model," which incorporates a strong transplant coordination network and comprehensive public information about organ donation, to address ongoing organ donor shortages.
