Organ donation: Which system - consent-based or presumed consent - promotes more donations?
Swapping Opt-in for Opt-out: A Global Look at Organ Donation Policies
Organ donation rules vary widely across the globe, leading to questions about whether it's better to have an opt-in or opt-out system. A team of researchers from the UK set out to examine organ donation policies in 48 countries to determine which approach is more effective.
In an opt-in system, people have to actively sign up to a registry to donate their organs post-mortem. Opt-out systems, on the other hand, automatically assume consent for organ donation unless a specific request is made before one's death to not donate organs.
Prof. Eamonn Ferguson, the study's lead author from the University of Nottingham, UK, recognizes the potential drawbacks of relying on individual decisions in either system:
"People may not act for numerous reasons, such as loss aversion, lack of effort, or the assumption that policy makers have made the 'right' decision."
In an opt-in system, inaction can result in people wanting to donate who never do (false negatives). On the other hand, inaction in an opt-out system could potentially lead to individuals who don't want to donate to become donors (false positives).
The US currently follows an opt-in system. Last year, 28,000 transplants were made possible thanks to organ donors, but an unfortunate 18 people still die each day due to a shortage of donated organs.
To Opt-in or Opt-out?
Researchers from the University of Nottingham, University of Stirling, and Northumbria University in the UK analyzed the organ donation policies of 48 countries for a period of 13 years. Of these nations, 23 used an opt-in system, and 25 used an opt-out system.
The researchers found that countries adopting opt-out systems had higher total numbers of kidneys donated – an organ that the majority of individuals on the organ transplant waiting list are waiting for. Opt-out systems also had a greater overall number of organ transplants.
Opt-in systems, however, had a higher rate of kidney donations from living donors. According to Prof. Ferguson, this influence on living donation rates "has not been reported before."
The study had limitations, as it did not account for the different degrees of opt-out legislation across countries, with some requiring permission from next-of-kin for organs to be donated. Moreover, other factors that may impact organ donation were not assessed in this observational study.
Forging Ahead
The researchers' results, published in BMC Medicine, indicate 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 even though their findings could be used to inform future policy decisions, stronger results could be achieved through the regular collection of international organ donation information – such as consent type, procurement procedures, and hospital bed availability – which should then be made publicly available.
Prof. Ferguson suggests that future research should consider the perspectives of the people making the decision to opt in or opt out:
"Further research could examine the beliefs, wishes, and attitudes of individuals through a combination of survey and experimental methods."
"By combining these different research methods, researchers can develop a broader understanding of the impact of consent legislation on organ donation and transplantation rates," he says.
The authors note that even countries utilizing opt-out consent still face organ donor shortages. A complete change in the system may not resolve this issue completely. They suggest that consent legislation or adopting aspects of the "Spanish Model" could help increase donor rates.
Spain currently holds the highest organ donation rate globally. The Spanish utilize opt-out consent but are credited for their success to measures such as a transplant coordination network working locally and nationally and improved public information regarding organ donation.
Recently, Medical News Today ran a feature on whether animal organs could be farmed for human transplants. Could this be a solution to the organ shortage, or is it a problem to be addressed through changes in organ donation policy?
Written by James McIntosh
- Although opt-in and opt-out systems for organ donation are implemented differently across 48 countries, the study found that opt-out systems yielded higher numbers of kidney donations and overall transplants.
- In contrast, opt-in systems had a higher rate of kidney donations from living donors, a finding that the researchers noted as previously unreported.
- The research, led by Prof. Eamonn Ferguson from the University of Nottingham, UK, did not account for the varying degrees of opt-out legislation across countries and other influencing factors on organ donation.
- Opt-out systems automatically assume consent for organ donation after death unless a specific request is made to opt-out, while opt-in requires individuals to proactively register as organ donors.
- In an opt-in system, inaction may lead to individuals desiring to donate who never do (false negatives), whereas in an opt-out system, inaction could potentially result in those who don't want to donate becoming donors (false positives).
- The researchers recommend the regular collection and public sharing of international organ donation data, such as consent type, procurement procedures, and hospital bed availability, to support stronger findings and informed policy decisions.
- Prof. Ferguson suggests conducting further research to explore the beliefs, wishes, and attitudes of individuals regarding organ donation through survey and experimental methods.
- The study reveals the potential for opt-out consent to increase deceased organ donation but decrease living donation rates and the overall number of livers and kidneys transplanted.
- A complete change in the system may not resolve the organ donor shortage entirely; however, adopting aspects of the "Spanish Model," which includes a transplant coordination network and improved public information, might help boost donor rates.
- The highest global organ donation rate is maintained by Spain, which uses opt-out consent, but its success is attributed to additional factors like a local and national transplant coordination network and better public information campaigns about organ donation.
- Consideration should be given to alternative solutions for addressing the organ shortage, such as exploring the potential for farming animal organs for human transplants, as discussed in a recent Medical News Today feature.
