Organ donation system: Should it be consent-based or presumed consent?
Organ donation policies around the globe differ significantly, leaving the question: Is it better to have an opt-in or opt-out system? A team of researchers from the UK took on this question, examining the organ donation protocols of 48 countries to determine which approach is more effective.
In an opt-in system, individuals must actively enroll in a registry to donate their organs posthumously. Conversely, in an opt-out system, organ donation occurs automatically unless a specific request is made before death to not donate organs.
Prof. Eamonn Ferguson, the lead author from the University of Nottingham, acknowledges that both systems are reliant on an active decision from individuals, which may lead to drawbacks like procrastination, indecision, or a belief that policy makers have made the right decision:
"People may not act for numerous reasons, including loss aversion, effort, and believing that the policy makers have made the 'right' decision and one that they believe in."
It's important to note that inaction in an opt-in system might result in individuals who would want to be a donor not donating (a false negative). On the other hand, inaction in an opt-out system might potentially lead to an individual who does not want to donate becoming a donor (a false positive).
The US currently employs an opt-in system. According to the US Department of Health & Human Services, 28,000 transplants occurred last year due to organ donors. Approximately 79 people receive organ transplants every day. Unfortunately, around 18 people die every day, unable to undergo surgery due to a scarcity of donated organs.
Taking Stock of Systems Worldwide
Researchers from the University of Nottingham, University of Stirling, and Northumbria University in the UK analyzed the organ donation systems of 48 countries for a 13-year period—23 using an opt-in system and 25 using an opt-out system.
The study authors measured overall donor numbers, numbers of transplant per organ, and the total number of kidneys and livers transplanted from both deceased and living donors. They found that countries using opt-out systems of organ donation had higher total numbers of kidneys donated, the organ most sought after by individuals on organ transplant lists. Opt-out systems also had the greater overall number of organ transplants.
Opt-in systems, however, had a higher rate of kidney donations from living donors. The apparent influence of policy on living donation rates "has not been reported before," says Prof. Ferguson, underscoring the importance of this discovery.
The authors admit that the study had limitations, specifically the failure to distinguish between different degrees of opt-out legislation in various countries. The observational nature of the study left other factors that may influence organ donation unassessed.
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 suggest that these findings could be used to inform future policy decisions. To reinforce their research, they recommend routinely collecting international organ donation information, such as consent type, procurement procedures, and hospital bed availability, for public availability.
Prof. Ferguson proposes that future studies should look at the perspectives of individuals who need to make 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 in term of beliefs, wishes, and attitudes, using a mixture of survey and experimental methods."
The authors note that countries utilizing opt-out consent still experience organ donor shortages. Completely changing the system of consent is unlikely to solve such a problem. Instead, they suggest that consent legislation or adopting aspects of the "Spanish Model" could be ways to improve donor rates.
Spain currently boasts the highest organ donation rate in the world. The Spanish employ opt-out consent but are credited with a transplant co-ordination network that operates both locally and nationally and improves the quality of public information about organ donation.
Recently, Medical News Today featured an informative piece on whether farming animal organs for human transplants could be a solution to the organ shortage. This raises the question: Is this a viable solution to the organ shortage or a problem to be addressed through changes to organ donation policy?
Written by James McIntosh
- The study conducted by a team of researchers from the UK, including Prof. Eamonn Ferguson from the University of Nottingham, found that countries using opt-out systems for organ donation had higher total numbers of kidneys donated and a greater overall number of organ transplants.
- In contrast, opt-in systems had a higher rate of kidney donations from living donors, but the research highlighted that this influence on living donation rates had not been reported before.
- The authors of the study propose that these findings could be used to inform future policy decisions regarding organ donation and suggest collecting international organ donation information for public availability.
- Prof. Ferguson also suggests further research focusing on the perspectives of individuals who need to make the decision to opt in or opt out, using a mixture of survey and experimental methods. This research could potentially address the ongoing organ donor shortages, either through changes to organ donation policy or the adoption of effective strategies like those employed in Spain.
