Organ donation: Is an 'opt-out' or 'opt-in' approach more effective?
Organ donation policies across the globe are nationally customized, yet a question remains: should countries lean towards opt-in or opt-out systems to encourage more donations? A team of researchers from the United Kingdom has assembled to tackle this conundrum, examining the organ donation protocols in 48 countries over a 13-year period.
Opt-in systems necessitate that individuals actively register as organ donors. On the other hand, opt-out systems imply automatic organ donation unless the individual expresses otherwise before demise.
Prof. Eamonn Ferguson, the study's lead author from the University of Nottingham, UK, acknowledges that both systems are contingent on individual decisions, which could lead to drawbacks:
"Individuals may postpone their decision due to several reasons, including loss aversion, inertia, and the assumption that policymakers have made the appropriate decision."
In an opt-in system, inaction may lead to missing potential donors who would have opted in (false negatives). Conversely, inaction in an opt-out system can potentially result in individuals who do not want to donate becoming donors (false positives).
With an opt-in system, the United States managed to facilitate 28,000 transplants last year through organ donors. Unfortunately, approximately 18 people still die daily due to a shortage of donated organs.
The researchers, originating from the University of Nottingham, University of Stirling, and Northumbria University in the UK, observed that countries employing opt-out systems tended to have higher overall numbers of kidneys donated. This is the organ most sought after by individuals on organ transplant lists. Countries using the opt-out approach also recorded greater overall numbers of organ transplants.
Opt-in systems, however, demonstrated a higher rate of kidney donations from living donors. The research team during this observational study identified this influence on living donation rates as a novel finding, stating it as "a subtlety that needs to be highlighted and considered."
The authors admitted that their study had limitations; it did not categorize different degrees of opt-out legislation, as some countries require the next of kin's approval for organs to be donated. Additionally, they highlighted the study's observational nature, suggesting other factors may have influenced organ donation.
The findings published in BMC Medicine revealed that "opt-out consent might 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."
Moving forward, the researchers suggest that their results can guide future policymaking decisions. In the future, they propose the collection and public sharing of international organ donation information, such as consent type, procurement procedures, and hospital bed availability.
The researchers recommend that future studies should survey individual opinions regarding their beliefs, wishes, and attitudes towards opting in or out. By combining these different research methods, they believe researchers can develop a more comprehensive understanding of the influence of consent legislation on organ donation and transplantation rates.
The researchers acknowledge that opt-out consent doesn't address the organ donor shortage entirely. They suggest that consent legislation or adopting aspects of the "Spanish Model" might serve to improve donor rates.
Spain boasts the highest organ donation rate globally. The Spanish leverage opt-out consent but are lauded for their success due to additional measures, such as a well-established transplant coordination network (both locally and nationally) and enhanced public information on organ donation.
Recently, Medical News Today published a spotlight feature on "whether animal organs should be farmed for human transplants." This raises intriguing questions concerning potential solutions to address the organ shortage or whether it should be tackled through modifications to organ donation policy.
- The researchers' study, published in BMC Medicine, found that opt-out consent might increase the number of deceased donations, particularly for kidneys and livers, but it might also reduce living donation rates.
- In the context of organ donation policies, the researchers propose the collection and public sharing of international donation information, such as consent type, procurement procedures, and hospital bed availability, to guide future policymaking decisions.
- While opt-out consent systems may not address the organ donor shortage entirely, the researchers suggest that adopting aspects of the "Spanish Model", which includes more than just opt-out consent, might serve to improve donor rates.
- The emergence of alternative solutions, such as the farming of animal organs for human transplants, raises intriguing questions about potential solutions to the organ shortage or whether it should be addressed through modifications to organ donation policy.
