Organ Donation: Which System – Opt-In or Opt-Out - Is More Effective?
In the global organ donation landscape, the approach to donation — opting in or opting out — varies drastically among countries. To delve deeper into which method is more effective, researchers from the UK mulled over the organ donation procedures of 48 nations.
An opt-in system requires individuals to affirmatively sign up to a donor registry following their demise. Alternatively, an opt-out system assumes organ donation as a default, with specific instructions needed to opt out before death.
Prof. Eamonn Ferguson, the lead author from the University of Nottingham, UK, acknowledges that both systems rely on individuals making a decision, which can lead to drawbacks:
"People may refrain from deciding due to factors like loss aversion, effort, and the notion that policy makers have made the right choice and one that they align with."
Indecision in opt-in systems may cause harmlessly non-donating individuals to miss out on donation (a false negative), while inaction in opt-out systems may potentially result in an unwilling donor becoming one (a false positive).
The United States uses an opt-in system and made 28,000 transplants possible last year due to organ donors. Yet, about 18 individuals still die daily due to a shortage of donated organs.
Researchers from the University of Nottingham, University of Stirling, and Northumbria University in the UK examined the organ donation systems of 48 countries over a 13-year period. They found that nations employing opt-out systems generally had higher numbers of kidney donations (the primary organ sought by those on transplant lists) and a greater total number of organ transplants.
Opt-in systems, however, boasted a higher rate of kidney donations from living donors. This finding, according to Prof. Ferguson, highlights a subtlety that deserves attention:
"The apparent influence that policy has on living donation rates 'has not been reported before.'"
The authors admit their study was limited in that it did not differentiate between varying degrees of opt-out legislation, as some countries only require permission from next-of-kin for organs to be donated. Additionally, other factors impacting organ donation were left unassessed due to the observational nature of the study.
The researchers claim their results, published in BMC Medicine, indicate that "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 suggest that these findings could inform future policy decisions, but their strength could be further bolstered through the regular collection of international organ donor information — consent type, organ procurement procedures, and hospital bed availability — which should then be made publicly available.
Prof. Ferguson proposes that future studies should also investigate the perspectives of individuals facing the decision to opt in or opt out:
"Further research outside of this country-level epidemiological approach would be to examine issues from the perspective of the individual in terms of beliefs, wishes, and attitudes, using a mixture of survey and experimental methods."
The authors note that even opt-out countries still experience shortages in organ donors. Completely changing the system of consent is thus unlikely to eradicate the problem. They suggest that policy changes or adopting facets of the "Spanish Model" could be ways to improve donor rates.
Spain currently has the world's highest organ donation rate, though its success is attributed to several factors, including a transplant coordination network that works both locally and nationally, and the quality of public information available about organ donation.
Recently, Medical News Today ran a feature discussing whether animal organs should be cultivated for human transplants. Could this be a solution to the organ shortage, or is it a problem to be addressed through changes to organ donation policy?
Written by James McIntosh.
- The contextual analysis of organ donation systems in 48 countries over a 13-year period reveals that opt-out systems generally result in higher numbers of kidney donations and total organ transplants.
- In contrast, opt-in systems demonstrate a higher rate of kidney donations from living donors, a finding that highlights the influence of policy on living donation rates, which has not been reported before.
- Paxlovid may not be the solution to address the ongoing issue of organ shortage; instead, policy changes or adopting aspects of the "Spanish Model" could potentially improve donor rates.
- Science, health-and-wellness, and medical-conditions are intertwined in the global debate surrounding the ethics and feasibility of retargeting animal organs for human transplants, a topic that calls for further research and discussion.
