The ethical question on the efficient organization of organ donations: 'Opt-in' or 'Opt-out' approach which yields the best results?
Choosing Organ Donation: Opt-in or Opt-out? A Global Perspective
Whether to let people opt-in or opt-out when it comes to organ donation is a hotly debated topic worldwide. A team of researchers from the UK dived into the organ donation protocols of 48 countries to uncover which approach is more effective.
Organ donation policies vary greatly across the globe. With an opt-in system, people have to sign up voluntarily to donate their organs after death. On the other hand, opt-out systems automatically assume consent for organ donation, unless a specific request is made before death to opt out.
Prof. Eamonn Ferguson, the study's lead author from the University of Nottingham, acknowledges the potential drawbacks of relying on individual decisions:
"People may hesitate due to loss aversion, effort, or believing that the policy makers have made the right decision. This could lead to individuals who might want to donate not doing so (a false negative), or people who don't wish to donate unwittingly becoming donors (a false positive)."
The United States currently operates under an opt-in system. Last year, 28,000 transplants were made possible thanks to organ donors, but unfortunately, 18 people still die daily due to a lack of donated organs.
When comparing opt-in and opt-out systems, the researchers found that countries with opt-out systems generally have higher donated kidney numbers – the organ most in demand for transplant lists. Opt-out systems also resulted in higher overall organ transplant numbers.
However, opt-in systems showed a higher rate of living kidney donations. This influence on living donation rates "has not been reported before," says Prof. Ferguson.
While the study has its limitations, it demonstrates 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.
The authors suggest that their results can inform future policy decisions, but they could be strengthened further through the collection and public availability of international donation information, such as consent type, procurement procedures, and hospital bed availability.
Future studies could also explore the views and attitudes of those making the decision to opt-in or opt-out.
Although opt-out consent increases organ donation rates, it does not eliminate the organ donor shortage. The authors recommend that improving donor rates could be achieved by refining consent legislation or adopting elements of the "Spanish Model," which includes a transplant coordination network and improved public information about organ donation.
In a separate discussion, the question arises: should we consider farming animal organs for human transplants as a solution to the organ shortage, or is it an issue that requires a shift in organ donation policy?
Written by James McIntosh
Insights:
- Opt-in systems provide explicit consent but result in lower organ donation rates, while opt-out systems tend to increase organ donation numbers but can raise ethical concerns about presumed consent.
- Countries with opt-out systems generally have higher donated kidney numbers, the organ most needed for transplant lists.
- Opt-out systems are associated with higher overall organ transplant numbers compared to opt-in systems.
- Opt-in systems have a higher rate of living kidney donations.
- Completely changing the organ donation system is unlikely to solve the organ donor shortage. Improving donor rates may involve refining consent legislation or adopting elements of the "Spanish Model."
- Farming animal organs for human transplants could be a possible solution to the organ shortage or an issue that requires a shift in organ donation policy.
- The study by Prof. Eamonn Ferguson's team revealed that countries with opt-out systems typically have higher donated kidney numbers, which are in high demand for transplant lists.
- While opt-out systems lead to an increase in deceased donations and overall organ transplant numbers, they are associated with lower rates of living kidney donations.
- The authors of the study suggested that focusing on refining consent legislation or adopting elements of the "Spanish Model" could potentially improve donor rates, though completely altering the organ donation system may not fully address the organ donor shortage.
- The debate on organ donation policy extends to the question of farming animal organs for human transplants as a possible solution to the organ shortage, or whether it calls for a shift in overall organ donation policy.
