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Is it more effective for organ donation regulations to be based on explicit consent (opt-in) or presumed consent (opt-out)?

Organ donation: Should we rely on an individual's decision or assume consent for organ donation?

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3 min read
Every 10 minutes, a fresh patient is inserted onto the organ transplant waiting list in the United...
Every 10 minutes, a fresh patient is inserted onto the organ transplant waiting list in the United States.

In the globe, policies about organ donations vary wildly. A quandary remains: should donation systems require individuals to opt in or opt out? A crew of researchers from the United Kingdom sought to solve this dilemma by examining the organ donation protocols of 48 countries.

With opt-in systems, people must actively sign up to a registry to donate their organs post-mortem. In contrast, opt-out systems have organs donated automatically unless a specific request is made to prevent organ donation upon death.

Prof. Eamonn Ferguson, the study's lead author from the University of Nottingham, UK, admits that these systems rely on individuals to make a choice, leading to drawbacks:

"People may not act for myriad reasons, including loss aversion, effort, and believing that the policy-makers have made the 'right' decision and one they endorse."

Inaction in an opt-in system might result in individuals who'd want to be donors not donating (a false negative). Conversely, inaction in an opt-out system could potentially lead to an individual who doesn't wish to donate becoming a donor (a false positive).

The United States presently employs an opt-in system. According to the US Department of Health & Human Services, 28,000 transplants were made possible last year due to organ donors. Every day, around 79 people receive organ transplants, while an unfortunate 18 individuals perish daily due to a scarcity of donated organs.

Researchers from the University of Nottingham, University of Stirling, and Northumbria University compared the organ donation systems of 48 countries for 13 years, with 23 countries using an opt-in system and 25 utilizing an opt-out system.

The study's authors measured overall donor numbers, the number of transplants per organ, and the total number of kidneys and livers transplanted from both deceased and living donors. They uncovered that countries using opt-out systems had a higher total number of kidneys donated, the organ most sought after by those on the organ transplant lists. Furthermore, opt-out systems had a greater overall number of organ transplants.

Opt-in systems, however, had a higher rate of kidney donations from living donors. This apparent influence of policy on living donation rates "has not been reported before," says Prof. Ferguson. He notes that this subtlety needs to be accentuated.

The authors acknowledge their study's limitations – they didn't differentiate between varying degrees of opt-out legislation, as some countries required next-of-kin permission for organs to be donated. The observational nature of the study meant that other factors impacting organ donation remained unassessed.

They suggest that their findings, published in BMC Medicine, show that "opt-out consent may lead to an increase in deceased donation but a reduction in living donation rates. Opt-out consent is also associated with an increase in the total number of livers and kidneys transplanted."

They propose that these results could guide future policy decisions, but could be strengthened further through the systematic collection of international organ donation data, such as consent type, procurement procedures, and hospital bed availability – all of which should be made publicly accessible.

Prof. Ferguson suggests that future studies could delve into the feelings, beliefs, and attitudes of those making the decision to opt in or opt out: "Further research outside of this country-level epidemiological approach would be to examine issues from the perspective of the individual."

The authors note that countries using opt-out consent still experience organ donor shortages, and completely switching the system of consent is unlikely to solve such an issue. They suggest that changing the consent legislation or adopting aspects of the "Spanish Model" could be ways to boost donor rates.

Spain currently boasts the highest organ donation rate globally. Experts attribute their success to measures such as a transplant coordination network spanning both local and national levels, and an improvement in the caliber of public information about organ donation available.

Recently, Medical News Today covered the concept of farming animal organs for human transplants. Could this be the solution to the organ scarcity, or a matter to be addressed through alterations in organ donation policy?

  1. The study's authors discovered that countries using opt-out systems had a higher total number of kidneys donated, a finding that could guide future policy decisions in health-and-wellness.
  2. Opt-in systems, on the other hand, had a higher rate of kidney donations from living donors, a peculiarity that has not been reported before according to Prof. Eamonn Ferguson.
  3. Science and medical-conditions are often intertwined, as illustrated by the ongoing debate about opt-in versus opt-out organ donation systems. The contextual difference between these systems can significantly impact the number of transplants available, as seen in this medical-conditions research.
  4. In the context of organ donation, retargeting policy could potentially involve adopting elements from successful models such as Spain's, utilizing science to address the global shortage of organs for transplant.

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