Organ Donation: Which System - Opt-In or Opt-Out - is More Effective?
Organ Donation: Opt-In or Opt-Out? A Global Evaluation
Organ donation policies vary across the globe, leaving us to question which system is more effective - opt-in or opt-out? A team of researchers from the UK delved into the organ donation regimes of 48 countries to find some answers.
An opt-in system necessitates individuals to actively sign up to a donor registry for their organs to be used posthumously. In an opt-out system, organ donation is automatic unless specifically requested to withhold them.
Prof. Eamonn Ferguson, the lead author from the University of Nottingham, acknowledges the potential drawbacks of such systems:
"People may procrastinate for numerous reasons, like loss aversion, effort, or trusting that policy makers have made the right decision."
Inaction in an opt-in system might result in false negatives, denying donation for individuals who would have wanted to donate. Conversely, inaction in an opt-out system could lead to false positives, where those who don't wish to donate become donors.
The US employs an opt-in system. Last year, transplants were facilitated for 28,000 recipients due to organ donors. Unfortunately, 18 people die daily due to a shortage of donated organs.
The Big Question: In or Out?
Researchers from the University of Nottingham, University of Stirling, and Northumbria University analyzed organ donation protocols of 48 countries for a 13-year period. 23 countries used an opt-in system, while 25 utilized an opt-out system.
The study authors measured overall donor numbers, transplants per organ, and total kidneys and livers transplanted, both deceased and living donors.
Countries with opt-out systems demonstrated higher total kidney donations, with opt-out systems also accounting for the greater number of overall organ transplants. Opt-in systems, however, had a higher rate of kidney donations from living donors.
The researchers stress that while their study presents compelling results, it had limitations, such as not differentiating between varying degrees of opt-out legislation or assessing other potential factors that may influence organ donation rates.
The Path Ahead
The researchers' findings suggest that opt-out consent may boost deceased donation rates but decrease living donation rates. Opt-out consent is also associated with an increase in the total number of livers and kidneys transplanted.
They propose that future decisions on policy might be informed by these results, but they could be further strengthened by regularly collecting international organ donation information, such as consent type, procurement procedures, and hospital bed availability, and making it publicly available.
Prof. Ferguson suggests that future studies should delve into the individual's perspective, exploring beliefs, wishes, and attitudes using surveys and experimental methods.
The authors note that countries using opt-out consent still face organ donor shortages. A complete system change isn't likely to solve such a problem. Instead, they suggest that encouraging changes to organ donation policy or adopting aspects of the "Spanish Model" could improve donor rates.
Spain boasts the highest organ donation rate worldwide. Experts attribute their success to elements like a transplant co-ordination network operating at both local and national levels, as well as enhancing the quality of public information regarding organ donation.
Medical News Today recently published a spotlight feature on the possibility of farming animal organs for human transplants - a potential solution to the organ shortage, or a problem that should be addressed through improvements to organ donation policy?
Written by James McIntosh
[1] The study revealed that while opt-out systems are often presumed to boost donation rates, a direct impact on kidney donations and total organ transplants is minimal when family preferences are considered. Indirect effects, such as psychological and behavioral influences on individuals and families, were not covered by this study but might influence outcomes.
- The study by researchers from three universities, including the University of Nottingham, compared organ donation protocols in 48 countries over a 13-year period, finding that countries with opt-out systems had higher total kidney donations and overall organ transplants.
- While opt-out systems may boost deceased donation rates, this study found that they could potentially decrease living donation rates and the researchers suggested that future decisions on policy should consider these findings.
- Opt-in systems had a higher rate of kidney donations from living donors and the researchers noted that their study had limitations, such as not differentiating between varying degrees of opt-out legislation or assessing other factors that may influence organ donation rates.
- A complete shift in organ donation policy may not be the solution to organ donor shortages, but the researchers propose that encouraging changes to organ donation policy or adopting aspects of the "Spanish Model" could improve donor rates.
- Spain has the highest organ donation rate worldwide and experts attribute their success to factors such as a transplant coordination network, quality public information, and the inclusion of a 'presumed consent' system.
