Organ donation: Which approach - consent prior or posthumous consent - yields more beneficial results?
Organ donation policies across the globe show significant diversity. The epic question is whether an opt-in or opt-out approach is more effective. To answer this, researchers from the UK conduct a comprehensive analysis of 48 countries' organ donation protocols.
With the opt-in method, individuals must proactively sign up to a registry to donate organs postmortem. On the flip side, opt-out systems automatically assume organ donation unless an explicit request is made against it.
Prof. Eamonn Ferguson, the lead author from the University of Nottingham, sheds light on potential pitfalls of both systems:
"People often fail to act due to reasons like loss aversion, lack of effort, and trusting policy-makers to make the 'right' decisions."
Inaction in an opt-in system may result in individuals who would willingly donate not doing so (a false negative). Conversely, inaction in an opt-out system could lead to a false positive, where someone who does not wish to donate becomes a donor.
The US currently employs an opt-in system. Last year, 28,000 transplants were made possible due to organ donors, but sadly, 18 people still die daily due to organ shortages.
The Great Controversy
Researchers from Nottingham, Stirling, and Northumbria Universities compared the organ donation systems of 48 countries over a 13-year period. They discovered that opt-out systems had a higher total number of kidney donations—an organ that most people on organ transplant lists are desperately waiting for. Opt-out systems also had the greater overall number of organ transplants.
Although opt-in systems had a higher rate of living donor kidney donations, this trend has gone unnoticed until now.[1]
The study authors acknowledged several limitations, primarily the lack of distinction between degrees of opt-out legislation and the omission of factors influencing organ donation.
The Way Forward
The researchers published their findings in BMC Medicine, concluding that opt-out consent may lead to an increase in deceased donations, but a decrease in living donation rates. Opt-out consent is also associated with an increase in the total number of liver and kidney transplants.[1]
They suggest that future policy decisions could be based on these results, but they could be reinforced further through the compilation and public disclosure of international organ donation data such as consent type, procurement procedures, and hospital bed availability.
Prof. Ferguson recommends future studies examining individual perspectives:
" additional research could explore the viewpoints of those making the decision to opt-in or opt-out, using a combination of surveys and experimental methods."
"By combining these diverse research methods, researchers can deepen their understanding of the impact of consent legislation on organ donation and transplantation rates," he says.
The researchers acknowledge that countries using opt-out consent still face organ donor shortages. Adopting a completely new system of consent may not solve this issue; instead, they propose that refining consent legislation or adopting aspects of the "Spanish Model" could improve donor rates.
Spain boasts the world's highest organ donation rate, which experts attribute to a transplant coordination network functioning both locally and nationally and enhanced public information availability about organ donation.[1]
Recently, Medical News Today featured a spotlight on the intriguing question: should we farm animal organs for human transplants? This could be a potential solution for organ shortages, or perhaps, the issue lies in refining organ donation policy.
[1] University of Nottingham. (2021, January 27). Opt-out consent may increase deceased organ donation but reduce living donation rates, research suggests. ScienceDaily. Retrieved April 18, 2021 from www.sciencedaily.com/releases/2021/01/210127114137.htm
- The research conducted by the team from Nottingham, Stirling, and Northumbria Universities revealed that opt-out systems generally have higher numbers of kidney and overall organ transplants compared to opt-in systems.
- Despite opt-in systems having a higher rate of living donor kidney donations, this trend was not previously recognized.
- Researchers suggest that future policy decisions could be based on their findings, but they recommend further investigation of international organ donation data and individual perspectives.
- Prof. Ferguson suggests that future studies should explore the viewpoints of those deciding to opt-in or opt-out using a combination of surveys and experimental methods.
- Researchers acknowledge that even countries using opt-out consent still face organ donor shortages and propose refining consent legislation or adopting aspects of the "Spanish Model," which has the world's highest organ donation rate.
- The Spanish Model's high organ donation rate is often attributed to a transplant coordination network operating at both local and national levels, as well as enhanced public information availability about organ donation.
