Organ Donations: A Comparison Between Consent-Based and Presumed Consent Approaches
Organ Donation: Opt-In or Opt-Out? A Global Comparison of Policies
Globally, the approaches to organ donation vary significantly. Should donation be a personal choice or a presumed stance? To explore this question, a team from the UK delved into the organ donation policies of 48 nations to see which strategy delivers the best results.
In opt-in systems, individuals must actively register their intention to donate their organs posthumously. Conversely, in opt-out systems, organ donation ensues automatically unless a specific request is made to avoid donation before death.
Prof. Eamonn Ferguson, the study's lead author from the University of Nottingham, acknowledges that these systems, based on individual decisions, come with challenges:
"People may hold back due to various reasons such as loss aversion, effort, and believing that the policymakers have made the correct decision and one they support."
interestingly, inaction in an opt-in system can lead to missed opportunities for donors who would have wanted to contribute (a false negative). On the flip side, inaction in an opt-out system can potentially result in an individual who does not wish to donate becoming a donor (a false positive).
The US operates an opt-in system. Last year, over 28,000 transplants occurred due to organ donors, with 79 people receiving organ transplants every day. Unfortunately, around 18 people die daily due to a shortage of donated organs.
To Opt or Not?
Researchers from the University of Nottingham, University of Stirling, and Northumbria University scrutinized the organ donation mechanisms of 48 countries over a 13-year period - 23 utilizing an opt-in system and 25 employing an opt-out system.
The study authors evaluated overall donor numbers, the number of transplants per organ, and the total number of kidneys and livers transplanted from both deceased and living donors.
They found that countries with opt-out organ donation systems recorded higher total numbers of kidneys donated - the organ that the majority of transplant recipients are waiting for. Opt-out systems also boasted the 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," says Prof. Ferguson, "and is a subtlety that needs highlighting and consideration."
The authors acknowledge that their study was limited in that it did not classify various degrees of opt-out legislation, with some countries requiring permission from next-of-kin for organs to be donated. Additionally, other factors influencing organ donation, such as hospital bed availability, remained unassessed due to the observational nature of the study.
The Path Ahead
The researchers affirm that their results, published in BMC Medicine, demonstrate that "opt-out consent may lead to an increase in deceased donations 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 contend that these findings could inform future policy decisions, but could gain further strength through the collection and public availability of international organ donation data, including consent type, procurement procedures, and hospital bed availability.
Prof. Ferguson suggests that future research might delve into the perspectives of individuals making the decision to opt-in or opt-out:
"Further research outside of this country-level epidemiological approach would investigate issues from the individual's perspective in terms of beliefs, wishes, and attitudes, using a mixture of survey and experimental methods."
"By combining these different research methods, researchers can gain a greater understanding of the impact of consent legislation on organ donation and transplantation rates," he says.
The research team points out that even in countries with opt-out consent, organ donor shortages persist. Therefore, completely altering the system of consent is unlikely to alleviate the problem. They propose that consent legislation or adopting aspects of the "Spanish Model" may be viable methods to enhance donor rates.
Spain boasts the highest organ donation rate globally. The Spanish employ opt-out consent but are credited by experts for their success due to factors such as a transplant coordination network that operates on both a local and national scale, and the improvement of public information regarding organ donation.
Recently, Medical News Today spotlighted the potential for farm-raised animal organs for human transplants as a possible solution to the organ shortage. Could this be the answer, or should the focus instead be on adapting organ donation policies?
Written by James McIntosh
Enrichment Insights:
Countries with Opt-Out Organ Donation Systems
Several countries have adopted opt-out organ donation systems, where each individual is considered a potential donor unless they have explicitly opted out during their lifetime. Some of these countries include:
- Spain: Famous for having one of the highest organ donation rates worldwide, Spain's opt-out system has contributed to increased donations.
- United Kingdom: Except for some areas like Northern Ireland, the UK has begun moving towards an opt-out system, aiming to increase organ availability.
- Argentina: Also embraced an opt-out system to boost organ donation rates.
- Wales: A part of the UK, Wales has had an opt-out system since 2015, demonstrating positive results in increasing organ donations[1][2].
Benefits of Opt-Out Systems
Advantages:- Higher Donation Rates: Opt-out systems generally lead to higher organ donation rates compared to opt-in systems, as they presume consent and reduce the need for explicit consent from every individual[5].- Increased Availability of Organs: This presumed consent can expand the pool of available organs, potentially saving more lives[5].- Reduced Family Burden: Families may experience less burden regarding the decision, as it is presumed that consent has been given unless otherwise stated[5].
Drawbacks of Opt-Out Systems
Disadvantages:- Public Resistance: There can be resistance from the public, especially if they feel their autonomy is being compromised[5].- Ethical Concerns: Some raise ethical concerns if individuals are not adequately informed or if there are cultural or religious objections to organ donation[5].- Potential for Errors: There is the risk that individuals who have not made a decision may be mistakenly considered donors, emphasizing the need for robust data management systems[5].
Comparison to Opt-In Systems
Opt-In Systems necessitate individuals to explicitly consent to organ donation during their lifetime. This method is employed in countries like the United States, Canada, and Australia. The main advantage of opt-in systems is that they respect individual autonomy and avoid potential ethical issues related to presumed consent. However, they often result in lower donation rates compared to opt-out systems, as many individuals may not take the time to register their consent[5].
- The researchers suggest that completely altering the system of consent may not necessarily alleviate the organ donor shortage, but adopting aspects of the "Spanish Model" could enhance donor rates.
- In a global comparison of policies, countries with opt-out organ donation systems, such as Spain, the United Kingdom, Argentina, and Wales, generally record higher total numbers of kidneys donated and the greater overall number of organ transplants.
- The potential for farm-raised animal organs for human transplants has been highlighted as a possible solution to the organ shortage, but the focus could also be on adapting organ donation policies to increase donation rates.
- Interestingly, the study found that opt-in systems demonstrate a higher rate of kidney donations from living donors, a finding that has not been previously reported in the science of organ donation and transplantation.
