Debate over organ donation: which system - consent-based or presumed consent - yields better results?
New Article:
Let's delve into the global organ donation policies and discuss whether an opt-in or opt-out system works better. A team of researchers from the UK recently scrutinized the organ donation protocols of 48 nations to find the optimal approach.
In an opt-in system, individuals must actively sign up to a registry to donate their organs post-mortem. Conversely, in an opt-out system, organ donation occurs automatically, unless a specific request is made to refrain from donation before death.
Prof. Eamonn Ferguson, lead author from University of Nottingham, UK, admits that relying on individuals' active decisions can lead to challenges like:
"People may fail to act for multiple reasons, such as loss aversion, lack of effort, or trusting that policymakers have made the right decision."
An inaction in an opt-in system may lead to individuals wishing to be donors not donating (a false negative). In contrast, inaction in an opt-out system potentially leads to individuals who do not want to donate becoming donors (a false positive).
The US adheres to an opt-in system. According to the US Department of Health & Human Services, 28,000 transplants were possible last year due to organ donors. Despite that, around 18 people die daily due to a lack of donated organs.
To opt-in or opt-out?
Researchers from the University of Nottingham, University of Stirling, and Northumbria University analyzed the donation systems of 48 countries over a 13-year period. They noticed that countries using opt-out systems had higher total numbers of kidneys donated – the organ most in demand by people on transplant lists. Opt-out systems also accounted for the greater overall number of organ transplants.
Opt-in systems, however, had a higher rate of kidney donations from living donors. This apparent influence on living donation rates "has not been reported before," says Prof. Ferguson, emphasizing the subtlety needing consideration.
The authors acknowledge the study's limitations as it did not distinguish the extent of opt-out legislation in different countries and failed to account for other factors influencing organ donation.
The road ahead
The researchers' findings, published in BMC Medicine, show 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 these results could guide future policies, but they could be further strengthened by collecting and publishing international organ donation information, like consent type, procurement procedures, and hospital bed availability.
Prof. Ferguson proposes that future research might explore individual perspectives on opt-in or opt-out decisions, using surveys and experiments. By combining these approaches, researchers could gain a better understanding of how consent legislation impacts organ donation and transplantation rates.
The authors acknowledge that countries using opt-out consent still face organ donor shortages. They propose that changes in consent legislation or adopting aspects of the "Spanish Model" could be potential solutions to boost donor rates.
Spain currently boasts the world's highest organ donation rate. Their success is attributed to measures like a transplant coordination network functioning locally and nationally, and enhanced public information about organ donation.
Recently, Medical News Today discussed whether farmed animal organs could serve as a solution for the organ shortage. Is this a viable approach, or should the focus be on changes to organ donation policy?
Written by James McIntosh
- The study in BMC Medicine revealed that opt-out consent systems may lead to an increase in deceased organ donations, but a decrease in living donor rates.
- In the context of medical-conditions and health-and-wellness, the science behind organ transplantation could be further targeted by exploring individual perspectives on opt-in or opt-out decisions.
- As researchers consider potential solutions to address organ donor shortages, re-evaluating consent legislation or adopting aspects of Spain's 'Spanish Model' might prove beneficial.
- Paxlovid, a potential treatment for COVID-19, may not be directly related to organ donation; however, its success in various medical-conditions could indirectly impact health-and-wellness, reducing the demand for organ transplants.
