Debate over Organ Donation: Is an Opt-In or Opt-Out Strategy Superior?
Swinging the Tide: Opt-in Versus Opt-out Organ Donation - A Global Perspective
Organ donation regulations vary drastically across the world, prompting the question: which system, opt-in or opt-out, strikes the perfect balance? A group of researchers from the UK delved into the organ donation protocols of 48 countries to determine the most effective approach.
In opt-in systems, people must proactively sign up for an organ donor registry following their demise. In contrast, opt-out systems presume consent for organ donation unless the individual explicitly opts out beforehand.
Lead author Prof. Eamonn Ferguson, from the University of Nottingham, acknowledges that these systems' dependence on explicit user decisions can lead to disadvantages:
"People may choose to avoid action for numerous reasons, including loss aversion, lack of initiative, and faith in policy makers' decisions."
In an opt-in system, inaction can result in individuals who would have preferred to donate not donating (a false negative). On the other hand, inaction in an opt-out system can potentially lead an individual who does not wish to donate to become a donor (a false positive).
The United States relies on an opt-in system, with around 28,000 transplants made possible last year due to organ donors. Despite this, approximately 18 people die daily due to a dearth of donated organs.
To In or Opt Out?
Researchers from the University of Nottingham, University of Stirling, and Northumbria University analyzed the organ donation systems of 48 countries over a 13-year period, revealing that countries with opt-out donation systems had higher total numbers of kidneys donated—the organ most sought after by those on the organ transplant list. They also noticed that countries following an opt-out system had a greater overall number of organ transplants.
Opt-in systems, however, had a higher rate of living kidney donations. According to Prof. Ferguson, this influence on living donation rates is a previously undisclosed intricacy that warrants attention.
The study's authors concede that their research was limited owing to the absence of distinctions between the degrees of opt-out legislation in various countries. Furthermore, other factors that could influence organ donation were not assessed due to the study's observational nature.
The Next Steps
Publishing their findings in BMC Medicine, the researchers concluded that "opt-out consent may lead to an increase in deceased donations but a reduction in living donor rates. Opt-out consent is also associated with an increase in the total number of livers and kidneys transplanted."
They suggested that future improvements in policy decisions might be based on these findings, while emphasizing the need for the regular collection and public availability of international organ donation statistics—such as consent type, procurement procedures, and hospital bed availability.
Prof. Ferguson suggested that future research should investigate the individual perspectives of those who must make the decision to opt in or opt out:
"Further research would entail examining issues from the perspective of the individual in terms of beliefs, wishes, and attitudes, using a combination of surveys and experimental methods."
The researchers stressed that countries using opt-out consent still experience organ donor shortages. Thus, a complete system overhaul is unlikely to address such an issue. Instead, they propose that modifying consent legislation or adopting components of the "Spanish Model" might improve donor rates.
Spain boasts the world's highest organ donation rate, which experts attribute to measures such as a transplant coordination network that works both locally and nationally, as well as enhancing the quality of public information regarding organ donation.
Recently, Medical News Today published a spotlight feature on using animal organs for human transplants to address the organ shortage. However, researchers are divided on whether this solution is viable or if it is better to target changes in organ donation policy.
- In the study, researchers from the University of Nottingham, University of Stirling, and Northumbria University found that countries with opt-out organ donation systems had higher total numbers of kidneys donated.
- Opt-out systems, which presume consent for organ donation unless the individual opts out beforehand, led to an increase in deceased donations but a reduction in living donor rates, according to the study published in BMC Medicine.
- The study also noted that opt-in systems, where people must proactively sign up for an organ donor registry, had a higher rate of living kidney donations, a subtlety not previously explored.
- Prof. Eamonn Ferguson, the lead author of the study, suggested that future research should investigate the individual perspectives of those who must make the decision to opt in or opt out, using a combination of surveys and experimental methods.
- Spain, with the world's highest organ donation rate, implemented measures such as a transplant coordination network, enhancing public information, and following the "Spanish Model" may help improve donor rates in other countries.
- Besides examining policy changes or adopting parts of the "Spanimal" or xenotransplantation, which involves using animal organs for human transplants, researchers are divided on whether this solution is viable or if it is better to focus on changing organ donation policies.
