Organ donation: Should it be based on explicit consent or automatically assumed?
Title: Organ Donation: Opt-in or Opt-out - What's Better?
In the realm of organ donation, policies around the globe differ significantly. But is it more effective to have a system where people need to actively opt-in or one where they auto-opt-out? To answer this question, researchers from the UK examined the organ donation rules of 48 countries.
With an opt-in system, folks have to proactively sign up to the donor registry, meaning their organs will be donated after death. In contrast, an opt-out system assumes organ donation unless a specific request is made not to donate before death.
Prof. Eamonn Ferguson, head researcher from the University of Nottingham, recognizes the potential drawbacks of both approaches:
"People might not sign up for various reasons, including loss aversion, putting in effort, and trusting that the authorities have made the 'right' decision."
Now, here's the kicker - inaction in an opt-in system means some individuals who'd want to donate may not actually donate (a false negative). On the flip side, inaction in an opt-out system might result in someone who doesn't wish to donate becoming one unintentionally (a false positive).
The United States employs an opt-in system. Last year, over 28,000 transplants occurred due to organ donors, with approximately 79 people receiving transplants daily. Regrettably, around 18 people die daily due to a lack of donated organs.
To In or To Out?
Researchers from the University of Nottingham, University of Stirling, and Northumbria University analyzed the organ donation policies of 48 countries for 13 years, featuring 23 opt-in-based and 25 opt-out systems.
The study authors assessed overall donor numbers, organ transplants per organ, and total kidney and liver transplants from both deceased and living donors.
They discovered that countries employing opt-out systems had more kidneys donated, the organ most often sought by individuals on the organ transplant waiting list. Opt-out systems also boasted higher overall organ transplant numbers.
Opt-in systems did, however, exceed opt-out systems in kidney donations from living donors. This finding, according to Prof. Ferguson, "has not been reported before" and is "a subtlety that needs to be highlighted."
The researchers admit that their study was restricted by not distinguishing various degrees of opt-out legislation among countries and not accounting for factors influencing organ donation other than policy.
Moving Ahead
The researchers conclude that their findings, published in BMC Medicine, indicate "opt-out consent may increase deceased donation but reduce living donation rates. Opt-out consent is also associated with an increase in the total number of livers and kidneys transplanted."
They suggest utilizing these findings to inform future policies but acknowledge that they could be strengthened further through the consistent gathering of international organ donation information, such as consent type, procurement procedures, and hospital bed availability, to be made publicly available.
Prof. Ferguson proposes that future studies might delve into the personal perspectives on opting in or opting out:
"Further research could examine issues from the individual's viewpoint in terms of beliefs, desires, and sentiments, using a mixture of surveys and experiments."
"By blending these different research methods, researchers can develop a more profound understanding of the influence of consent legislation on organ donation and transplantation rates," he says.
The authors add that countries with opt-out consent also experience donor shortages. Completely changing the consent system is unlikely to solve this issue. They suggest that consent legislation or adopting aspects of the "Spanish Model" could be ways to enhance donor rates.
Spain currently boasts the highest organ donation rate globally. Experts attribute their success to measures such as a transplant coordination network that operates both locally and nationally, and improving the quality of public information about organ donation.
Recent discussions on Medical News Today have centered around whether animal organs should be farmed for human transplants - a possible solution to the organ shortage or a problem to be tackled through changes to organ donation policy?
- The research conducted by the team from the University of Nottingham, University of Stirling, and Northumbria University compared organ donation policies in 48 countries, finding that opt-out systems resulted in more kidneys and overall organ transplants.
- Opt-out systems, where organ donation is assumed unless a specific request is made not to donate before death, had higher organ transplant numbers, particularly for kidneys, the organ most sought after.
- However, countries with opt-in systems showed higher rates of kidney donations from living donors, a finding deemed "subtle but significant" by Prof. Eamonn Ferguson.
- Researchers admit their study's limitations, including not considering various degrees of opt-out legislation among countries and not accounting for factors other than policy influencing organ donation.
- In light of their findings, researchers recommend using the data to inform future policies, proposing that public availability of international organ donation information could provide valuable insights.
- Prof. Ferguson suggests future research should focus on personal perspectives, examining beliefs, desires, and sentiments surrounding the choice between opt-in and opt-out organ donation systems to gain a deeper understanding of their impact on donation and transplantation rates.
