Organ donation: Should it be based on consent or presumed consent?
Organ donation policies around the globe manifest a significant diversity. Should it be a system where people actively opt in or one where automatic acceptance is the norm? To explore this question, a team of UK researchers scrutinized the organ donation protocols of 48 nations to identify which approach is more effective.
With an opt-in system, folks must intentionally sign up to a donor registry post-mortem. In contrast, automatic donations occur in opt-out systems unless a specific request states otherwise before death to prevent the removal of organs.
Prof. Eamonn Ferguson from the University of Nottingham admits that relying on an active individual decision in either system may have drawbacks:
"People may choose not to act due to numerous reasons, such as loss aversion, effort, and trusting policy makers to make the 'right' decision."
Inaction could lead to individuals who'd prefer to donate not doing so in an opt-in system (a false negative). In contrast, inaction in an opt-out system could result in individuals who don't want to donate unwittingly contributing (a false positive).
The US currently employs an opt-in system, with around 28,000 transplants performed last year thanks to organ donors. Sadly, around 18 people daily die due to a scarcity of donated organs.
In or Out?
Researchers from Nottingham, Stirling, and Northumbria Universities in the UK compared the organ donation systems of 48 countries over a 13-year span - 23 using an opt-in system and 25 using an opt-out system.
The study authors assessed overall donor numbers, the number of transplants per organ, and the total number of kidneys and livers transplanted from both deceased and living donors.
They discovered that countries using opt-out systems yielded higher total kidney donations - the most sought-after organ for transplant recipients. Opt-out systems also recorded higher overall organ transplant numbers.
Opt-in systems, however, showed a higher kidney donation rate from living donors. This influence of policy on living donation rates "has not been reported before," says Prof. Ferguson, "and is a subtlety that needs emphasis."
The authors admit that their study has limitations, such as failing to distinguish varying degrees of opt-out legislation in different countries and not assessing other factors that may impact organ donation.
Moving Forward
The researchers state that their findings, published in BMC Medicine, suggest "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 propose that these results could guide future policy decisions but could be further strengthened through the collection and public disclosure of international organ donation data, such as consent type, procurement procedures, and hospital bed availability.
Prof. Ferguson suggests future studies could investigate individual attitudes and beliefs about consenting to organ donation:
"More research could explore issues from the perspectives of the individuals themselves, using a mix of surveys and experimental methods."
"By combining these different research methods, researchers can develop a greater understanding of the influence of consent legislation on organ donation and transplantation rates," he says.
The authors highlight that countries using opt-out consent still experience donor shortages. drastically changing the system of consent may not fully resolve such issues. Instead, they suggest refining consent legislation or adopting aspects of the "Spanish Model" could improve donor rates.
Spain currently boasts the highest donation rate globally. Experts attribute Spain's success to a transplant co-ordination network operating on both local and national levels, and providing high-quality public information about organ donation.
Recently, Medical News Today delved into the debate surrounding animal organ farming for human transplants. Could this solution alleviate the organ shortage, or is this an issue better tackled through revising organ donation policy?
Written by James McIntosh.
- The study by researchers from Nottingham, Stirling, and Northumbria Universities found that opt-out systems led to higher total kidney donations, a more sought-after organ for transplant recipients, and higher overall organ transplant numbers.
- Opt-in systems, however, showed a higher kidney donation rate from living donors, a finding that Professor Ferguson says has not been reported before.
- While the research suggests that opt-out consent may increase deceased donations and total numbers of livers and kidneys transplanted, it also indicates a reduction in living donation rates.
- To further understand the influence of consent legislation on organ donation and transplantation rates, Professor Ferguson suggests future studies should explore individual attitudes and beliefs about consenting to organ donation.
