Debate over organ donation: Should consent be implicit or explicit?
Organ donation policies differ worldwide, and the debate on whether an opt-in or opt-out system is more effective is ongoing. To shed some light on this, researchers from the UK analyzed the organ donation protocols of 48 countries, hoping to find the most efficient system.
With an opt-in approach, people are required to register to donate their organs post-mortem. In contrast, opt-out systems assume donation unless an individual explicitly requests otherwise before passing.
According to Prof. Eamonn Ferguson, lead author from the University of Nottingham, the reliance on individual decisions can lead to potential drawbacks:
"People may not act due to loss aversion, lack of effort, or believing that the right decision has already been made."
Inaction in opt-in systems may result in individuals who wish to donate not doing so (false negatives). On the other hand, inaction in opt-out systems could lead to individuals who don't wish to donate unwillingly donating (false positives).
The United States employs an opt-in system. Last year, over 28,000 transplants were made possible thanks to donors, but unfortunately, around 18 people still die daily due to organ shortages.
Researchers from the University of Nottingham, University of Stirling, and Northumbria University examined the organ donation systems of 48 countries for a period of 13 years. They found that opt-out systems led to higher total numbers of kidneys donated, which is the desired organ for most people on the transplant list. Opt-out also saw a greater overall number of organ transplants.
Opt-in systems, however, had a higher rate of kidney donations from living donors, a factor Prof. Ferguson notes has not been reported before. The study's limitations include not differentiating between varying degrees of opt-out legislation and unassessed factors affecting organ donation.
Moving forward, the researchers suggest that their findings could help shape future policies. They recommend collecting and publishing more international organ donation information for further research. Future studies might also delve into individual perspectives on opting in or out, shedding more light on the influence of consent legislation on donation rates.
Even with opt-out systems, organ donor shortages still persist. The authors suggest that changes to consent legislation or adopting aspects of the "Spanish Model," known for its high donation rates, could help improve the situation. The Spanish model of opt-out consent, combined with a robust transplant coordination network and quality public information, has been credited with their success in organ donation.
Recent discussions have also revolved around the possibility of farming animal organs for human transplants as a potential solution to ongoing shortages. However, more research is needed to determine if this is a viable option or if the problem should be addressed through adjustments to organ donation policy.
People might choose not to donate their organs in opt-in systems, leading to undesired false negatives. On the contrary, some individuals might unwillingly donate in opt-out systems, resulting in false positives. The United States, employing an opt-in system, managed over 28,000 transplants last year, yet still struggles with daily organ shortages. Despite opt-out systems leading to higher total kidney donations and overall organ transplants, they also had a higher rate of kidney donations from living donors in the study, a factor that hasn't been reported before. The researchers suggest collecting and publishing more international organ donation information, investigating individual perspectives onopt-in and opt-out, and considering changes to consent legislation or adopting aspects of the "Spanish Model" to help address organ donor shortages. Remarkably, discussions have emerged about farming animal organs for human transplants as a potential solution, but more science and research are needed to determine its viability.
