Organ donation: Which method - consent before or after death - is more effective?
Organ donation policies around the world exhibit significant variability, with the debate surrounding opt-in and opt-out systems remaining a contentious issue. To shed light on this matter, a team of researchers from the UK examined the organ donation protocols of 48 countries to determine which approach generates the most successful outcomes.
In opt-in systems, individuals are required to actively register their intention to donate organs posthumously. Conversely, in opt-out systems, organ donation is assumed unless an explicit request is made to the contrary before death.
Professor Eamonn Ferguson, the lead author from the University of Nottingham, acknowledges potential drawbacks associated with such systems, stating, "People may not act for numerous reasons, including loss aversion, effort, and believing that policy makers have made the 'right' decision and one that they believe in."
While inaction in an opt-in system may lead to missed opportunities for individuals who may wish to donate, inaction in an opt-out system could result in individuals who do not wish to donate unintentionally becoming donors.
The US currently operates under an opt-in system, with 28,000 transplants executed last year due to organ donors. Unfortunately, around 18 people die daily due to a scarcity of donated organs, unable to undergo surgery as a result.
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, finding that countries employing opt-out systems of organ donation generally exhibited higher total numbers of kidneys donated. This is the organ that the majority of individuals on organ transplant lists are waiting for. Opt-out systems also demonstrated higher overall numbers of organ transplants.
While opt-in systems did have a higher rate of kidney donations from living donors, the researchers note that their study did not account for various degrees of opt-out legislation or assess other factors influencing organ donation.
The authors suggest that their findings, published in BMC Medicine, can be used to inform future policy decisions, but they advocate for the regular collection of international organ donation data, such as consent type, procurement procedures, and hospital bed availability, and its subsequent public disclosure. Furthermore, they suggest that future studies could explore the opinions of individuals faced with the decision to opt in or opt out, using surveys and experimental methods to develop a better understanding of the impact of consent legislation on organ donation and transplantation rates.
Countries utilizing opt-out consent still encounter organ donor shortages, suggesting that a wholesale change in the system of consent is unlikely to resolve this issue. Instead, the authors suggest that modifications to consent legislation or the adoption of elements from the "Spanish Model" could potentially improve donor rates.
Spain currently possesses the highest organ donation rate in the world, with their success attributed to measures such as a transplant coordination network and improved public information about organ donation. Recent discussions surrounding the farm-raising of animal organs for human transplants have emerged as a potential solution to address the organ shortage, or alternately, the issue may be addressed through changes to organ donation policy.
- [1] https://www.ncbi.nlm.nih.gov/pubmed/30840935
- [2] https://www.ncbi.nlm.nih.gov/pubmed/26720210
- [3] https://www.ncbi.nlm.nih.gov/pubmed/22263443
- [4] https://www.ncbi.nlm.nih.gov/pubmed/34529447
- [5] https://www.ncbi.nlm.nih.gov/pubmed/31815381
- The researchers from the University of Nottingham, University of Stirling, and Northumbria University found that countries employing opt-out systems of organ donation generally exhibited higher total numbers of kidneys donated, which is the organ most in demand for transplantations.
- In their study, the researchers noted that countries utilizing opt-out consent still encounter organ donor shortages, suggesting that a wholesale change in the system of consent is unlikely to resolve this issue.
- The authors suggest that future policy decisions could be informed by their findings, published in BMC Medicine, and they advocate for the regular collection and public disclosure of international organ donation data, including consent type, procurement procedures, and hospital bed availability.
- To develop a better understanding of the impact of consent legislation on organ donation and transplantation rates, future studies could explore the opinions of individuals faced with the decision to opt in or opt out, using surveys and experimental methods. science, medical-conditions, health-and-wellness, organ, research, data, policy, opt-in, opt-out, kidneys, transplant, donation, Spanish Model, science, farm-raising, animal organs, human transplants
