Organ Donation: Should the approach be Consent or Assumption-based?
Rewritten Article:
Organ donation policies worldwide exhibit a broad range of approaches. Should we go for an opt-in or opt-out system? A team of researchers from the UK delved into the organ donation protocols of 48 countries to determine which strategy delivers the best results.
With an opt-in system, individuals must actively sign up to a register to donate their organs post-mortem. On the other hand, under opt-out systems, organ donation occurs automatically unless a specific opt-out request is made before death.
Prof. Eamonn Ferguson, the lead author from the University of Nottingham, UK, recognizes that the dependance on active decisions from individuals can lead to pitfalls, such as:
"People may not act due to numerous reasons, including loss aversion, effort, and the belief that policy makers have made the 'right' decision and one they trust."
However, inaction in an opt-in system can lead to individuals who wish to donate but don't follow through (a false negative). In contrast, inaction in an opt-out system can potentially result in someone who does not want to donate becoming a donor (a false positive).
The U.S. currently implements an opt-in system. According to the US Department of Health & Human Services, 28,000 transplants were facilitated last year due to organ donors. Approximately 79 people receive organ transplants every day, yet sadly around 18 people die daily due to a scarcity of donated organs.
To In or To Out?
University of Nottingham, University of Stirling, and Northumbria University researchers analyzed the organ donation systems of 48 countries over a period of 13 years, with 23 employing an opt-in system, while 25 utilized an opt-out system.
The study authors measured overall donor numbers, organ transplants per organ, and the total number of kidneys and livers transplanted from both deceased and living donors.
They discovered that countries with opt-out organ donation systems showed higher total numbers of kidneys donated, the organ that the majority of people on organ transplant lists are waiting for. In addition, countries employing opt-out systems boasted a greater overall number of organ transplants.
However, opt-in systems exhibited a higher rate of kidney donations from living donors. The apparent impact that policy had on living donation rates "has not been reported before," says Ferguson, "and is a subtlety that needs to be highlighted and considered."
The researchers acknowledged limitations in their study, such as not distinguishing between varying degrees of opt-out legislation and the observational nature of the study, which failed to assess other factors impacting organ donation.
Moving Forward
The researchers published their results in BMC Medicine, indicating 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 recommended that future decisions on policy could be informed by their findings, but they could be strengthened further through the routine collection of international organ donation information – such as consent type, procurement procedures, and hospital bed availability – which should be made publicly available.
Ferguson also suggested that future studies should focus on the opinions of individuals who must decide to opt in or opt out, using a combination of surveys and experimental methods:
"By combining these research methods, researchers can develop a greater understanding of the impact of consent legislation on organ donation and transplantation rates," he says.
The authors noted that countries using opt-out consent still encounter organ donor shortages. A complete shift in the system of consent is unlikely to solve this issue, and they suggest that consent legislation or adopting aspects of the "Spanish Model" could be ways to improve donor rates.
Spain currently holds the highest organ donation rate in the world. The Spanish utilize opt-out consent, but their success is credited to factors such as a transplant coordination network operating locally and nationally and improved public information about organ donation.
Recently, Medical News Today ran a feature on whether farm-raised animal organs could be a suitable solution for human transplants. Is this a feasible solution to the organ shortage, or should attempts be made to address the issue through changes to organ donation policy?
Written by James McIntosh
- The study in BMC Medicine revealed that countries with opt-out organ donation systems tend to have higher total kidney donations, a critical organ for those waiting for organ transplants.
- Researchers from the University of Nottingham and other universities found that opt-out systems also led to a greater overall number of organ transplants, but opt-in systems showed a higher rate of kidney donations from living donors.
- The researchers suggested that future decisions on organ donation policy could be informed by their findings, and that improving public information about organ donation, like Spain's approach, might help increase donor rates.
- In the context of persistent organ donor shortages, a discussion about Farm-raised animal organs as potential solutions for human transplants has arisen, but scientists are debating whether this is a viable solution or if efforts should focus on changes to organ donation policy.
