Organ Donation: Should We Opt-In or Opt-Out for Donation?
Organ donation policies across the globe exhibit notable variations, prompting discussions over whether an opt-in or opt-out system is more effective. A team of researchers from the UK sought to address this question by analyzing the organ donation practices of 48 countries.
In opt-in systems, individuals are required to actively register to donate their organs posthumously. On the other hand, opt-out systems automatically arrange for organ donation unless a specific request is made explicitly before death to forego the donation.
Professor Eamonn Ferguson, the lead author from the University of Nottingham, acknowledges that the reliance on individual decisions in both systems can lead to drawbacks: "People may refrain from acting for numerous reasons, such as loss aversion, lack of effort, or the belief that policy makers have made the 'right' decision."
Notably, inaction in an opt-in system may result in individuals who wish to donate failing to do so (a false negative). Conversely, inaction in an opt-out system could potentially lead to an individual who does not wish to donate becoming a donor (a false positive).
The US employs an opt-in system. According to the US Department of Health & Human Services, over 28,000 transplants were facilitated last year due to organ donors. Yet, around 18 people continue to die daily due to a scarcity of donated organs, unable to receive surgery.
The researchers, in collaboration with the University of Stirling and Northumbria University, studied the organ donation systems in 48 countries for a period of 13 years. They found that countries utilizing opt-out systems experienced higher total numbers of kidney donations compared to those using opt-in systems. Opt-out systems also recorded a greater overall number of organ transplants.
Opt-in systems, however, demonstrated a higher rate of kidney donations from living donors. The influence of policy on living donation rates has not been reported before, according to Ferguson.
The authors of the study acknowledge limitations, such as not differentiating between varying degrees of opt-out legislation in some countries and not assessing other factors that may influence organ donation.
The researchers conclude that opt-out consent may lead to an increase in deceased donations but a reduction in living donation rates. They also observe an increase in the total number of livers and kidneys transplanted in opt-out systems.
They propose that their findings could inform future policy decisions but could be further strengthened through the regular collection and public availability of international organ donation data. Future research, they suggest, should also examine individual attitudes and beliefs towards opting in or out of organ donation.
Countries utilizing opt-out consent still encounter organ donor shortages, indicating that completely changing the system may not solely resolve the issue. The authors suggest that changes in consent legislation or adopting elements of the "Spanish Model," which incorporates a transplant coordination network and improved public information about organ donation, could potentially improve donor rates.
Spanish organ donation rates are the highest globally, largely attributed to their deployment of opt-out consent, along with a robust transplant coordination network and high-quality public information about organ donation.
Recent discussions on whether to farm animal organs for human transplants as a potential solution to the organ shortage are gaining attention. This could be a solution or a problem to be addressed through changes to organ donation policy.
The article was written by James McIntosh.
- The researchers found that countries utilizing opt-out systems for organ donation experienced higher total numbers of kidney donations and a greater overall number of organ transplants compared to those using opt-in systems.
- In contrast, opt-in systems demonstrated a higher rate of kidney donations from living donors, but the influence of policy on living donation rates has not been reported before.
- The study acknowledges limitations, such as not differentiating between varying degrees of opt-out legislation in some countries and not assessing other factors that may influence organ donation.
- Recent debates on farming animal organs for human transplants as a potential solution to the organ shortage are gaining attention, bringing up questions about whether this could be a solution or a problem that needs to be addressed through changes to organ donation policy.
