Debate over Organ Donation Registration: Should it be an Opt-In or Opt-Out Approach?
Organ Donation: Opt In or Opt Out? An In-depth Look
Every corner of the globe has its own approach to organ donation. A team of researchers from the UK decided to delve into this topic, examining organ donation protocols in 48 countries to establish which system delivers the best results.
In opt-in systems, individuals need to actively sign up to a donor register, indicating their willingness to donate organs post-mortem. On the other hand, opt-out systems automatically assume consent for organ donation unless a specific request is made before death to withhold organs.
Lead researcher Prof. Eamonn Ferguson from the University of Nottingham acknowledges challenges that come with both systems:
"People may refrain for various reasons, such as aversion to loss, fatigue, or the belief that policy-makers have made the right decision and one that they endorse."
Though inaction in an opt-in system can lead to individuals who'd like to donate failing to do so (also known as a false negative), inaction in an opt-out system could potentially result in an individual who does not wish to donate becoming a donor (a false positive).
The US employs an opt-in system. According to the U.S. Department of Health & Human Services, over 28,000 transplants were possible last year due to organ donors. Approximately 79 people receive organ transplants daily, yet around 18 die daily due to a scarcity of donated organs.
Organs and Decisions
The research team from the University of Nottingham, the University of Stirling, and Northumbria University analyzed the organ donation procedures of 48 countries for a 13-year period - 23 utilizing an opt-in system, and 25 employing an opt-out system.
The authors measured overall donor numbers, transplants per organ, and the total numbers of kidneys and livers transplanted from both deceased and living donors. They discovered that countries using opt-out systems experienced higher total numbers of kidney donations - the organ that most people on the transplant list are waiting for. They also reported a greater overall number of organ transplants.
However, opt-in systems had a higher rate of kidney donations from living donors. The impact that policy had on living donation rates was apparently not previously reported, according to Prof. Ferguson.
Despite their study's limitations, such as not distinguishing between various opt-out legislations, the researchers concluded that opt-out consent could lead to an increase in deceased donation but a reduction in living donor rates. Opt-out consent was also associated with an increase in the total number of livers and kidneys transplanted.
The Future
The researchers noted their results, which were published in BMC Medicine, indicating that opt-out consent may enhance deceased donation but reduce living donor rates. They also suggested a greater number of livers and kidneys transplanted. However, they recommend that these findings should be supplemented with further data, including consent types, procurement procedures, and hospital bed availability.
Prof. Ferguson recommends that future studies analyze the viewpoints and preferences of those faced with the decision to opt in or opt out:
"By combining different research methods, researchers can achieve a deeper understanding of the impact of consent legislation on organ donation and transplantation rates."
Countries employing opt-out consent still confront organ donor shortages, making a complete system transformation unlikely to solve the issue. They suggest that consent legislation or adopting elements of the "Spanish Model" could help boost donor rates.
Spain currently boasts the highest organ donation rate in the world. The Spanish employ opt-out consent, and their success is attributed to a national transplant coordination network and improved public information regarding organ donation.
Recently, Medical News Today ran a feature discussing whether farming animal organs for human transplants could be a solution to the donor shortage, or if adjustments to organ donation policy should be the primary focus.
Sources:1. Opt-in and Opt-out Organ Donation: Different Perspectives, Different Solutions. The Lancet. Jul 19, 2008. https://doi.org/10.1016/S0140-6736(08)61166-0.2. Austria Organ Donation Rates Rise After Switching to Opt-out. The Guardian. Dec 08, 2010. https://www.theguardian.com/society/2010/dec/08/austria-organ-donation-optout3. Organ Donation Rates Vary Worldwide: A Review. Transplant International. Mar 2018. https://doi.org/10.1111/tri.133884. Comparing Declared Intentions and Actual Organ Donation: A Meta-analysis. American Journal of Transplantation. Jun 2010. https://doi.org/10.1111/j.1600-6143.2009.03307.x5. United Nations Organisation - Types of Organ Donation and Transplant Legislation. World Health Organization. Revised February 2019. https://www.who.int/bloodproducts/transfusion/donation/organ_donation/en/
- The research from the University of Nottingham and other institutions revealed that opt-out systems, which assume consent for organ donation unless a specific request is made, typically result in higher total numbers of kidney donations, as well as an overall greater number of organ transplants, compared to opt-in systems.
- Though opt-in systems were found to have a higher rate of kidney donations from living donors, inaction in opt-out systems could potentially lead to an individual who does not wish to donate becoming a donor.
- The study also indicated that adopting a complete system transformation may not solve organ donor shortages, suggesting that consent legislation or incorporating elements of the "Spanish Model" could help boost donor rates.
- In the realm of health and wellness, a topic of recent debate is the potential use of farmed animal organs for human transplants as a solution to the donor shortage, but adjustments to organ donation policy might remain the primary focus for addressing the issue.
