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Is it more effective for organ donation to be based on explicit consent (opt-in) or implicit consent (opt-out)?

Organ Donation: Which System – Opt-In or Opt-Out – Is More Effective?

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3 min read
Every 10 minutes, a fresh patient in the United States joins the line for a much-needed organ...
Every 10 minutes, a fresh patient in the United States joins the line for a much-needed organ transplant.

Organ donation policies around the globe come in two flavors: opt-in and opt-out. So, which one's better? A team of researchers from the UK decided to dig deep and analyze the organ donation protocols of 48 countries spanning over a 13-year period. Here's the lowdown.

In an opt-in system, you've got to sign up to the register to donate your organs posthumously. In opt-out, your organs get donated automatically unless you specifically request otherwise before taking your final bow. Prof. Eamonn Ferguson, from the University of Nottingham, UK, acknowledges that these systems rely on individuals making a decision, which can lead to drawbacks: "People might not act for a variety of reasons like loss aversion, laziness, or trusting policy-makers to have made the right call."

Now, inaction in an opt-in system might result in individuals who'd have been eager donors, not donating at all (a false negative). Conversely, inaction in an opt-out system might lead to an individual who doesn't want to donate, unwillingly becoming a donor (a false positive).

The US adopts an opt-in system. Last year, they managed 28,000 transplants thanks to organ donors, with around 79 people receiving transplants every day. Unfortunately, around 18 people die every day due to a lack of donated organs.

Researchers from the University of Nottingham, University of Stirling, and Northumbria University examined the organ donation systems of 48 countries. They discovered that countries using opt-out systems had higher numbers of kidneys donated - the organ most in demand for transplants. Opt-out systems also had a greater overall number of organ transplants.

However, opt-in systems showed a higher rate of kidney donations from living donors. This influence of policy on living donation rates is a subtlety that Ferguson says needs to be highlighted. The authors also acknowledged limits to their study, such as not considering various degrees of opt-out legislation and unassessed factors that might influence organ donation.

The researchers suggest that their results could help shape organ donation policies in the future. They recommend collecting international organ donation information, such as consent type, procurement procedures, and hospital bed availability, which should then be made public. Additionally, they propose future studies that analyze individual opinions, beliefs, and attitudes towards organ donation.

Countries using opt-out consent still experience organ donor shortages. Ferguson suggests that completely changing the system of consent may not be the answer. Instead, revising consent legislation or adopting aspects of the "Spanish Model" could help improve donor rates. Spain has the world's highest organ donation rate, credited to a network that coordinates transplants both locally and nationally and improved public information about organ donation.

Recent discussions have arisen around farming animal organs for human transplants as a potential solution to the organ shortage. However, it might be more beneficial to address the shortage through changes to organ donation policy. Stay tuned for more on this developing topic.

Written by James McIntosh

  1. In an opt-out system, individuals are automatically organ donors unless they specifically request otherwise, but this method may lead to unwilling donors due to individual decisions.
  2. The US, with an opt-in system, managed 28,000 transplants last year, but unfortunately, around 18 people still die daily due to a lack of donated organs.
  3. Researchers from the University of Nottingham, University of Stirling, and Northumbria University found that countries using opt-out systems had higher numbers of kidneys donated compared to opt-in systems.
  4. However, opt-in systems showed a higher rate of kidney donations from living donors, a subtlety that requires attention in organ donation policies.
  5. The researchers suggest that their findings could help form future organ donation policies, emphasizing the importance of collecting international donation information and making it public.
  6. Ferguson proposes revising consent legislation or adopting aspects of the "Spanish Model" to potentially improve donor rates and address the ongoing issue of organ donor shortages, rather than relying on farming animal organs for transplants.

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