Organ Donation: Which System - Opt-In or Opt-Out, Is More Effective?
Organ donation policies worldwide show a significant variation, sparking the debate between opt-in and opt-out systems. Should people have to actively sign up to donate their organs post-mortem, or should organ donation occur automatically unless explicitly requested otherwise? Researchers from the UK sought to answer this question by analyzing the organ donation protocols of 48 countries.
In opt-in systems, individuals need to consciously register their desire to donate their organs. On the other hand, opt-out systems assume consent, and organ donation takes place unless a specific refusal has been expressed before death.
Prof. Eamonn Ferguson, the lead author from the University of Nottingham, acknowledges that the active decision-making required in both systems can have its drawbacks:
"People may not act for numerous reasons, including loss aversion, effort, and believing that the policy makers have made the 'right' decision and one that they believe in."
Inactivity in an opt-in system could result in individuals who would want to donate failing to do so (a false negative). In contrast, inactivity in an opt-out system might lead to an individual who doesn't wish to donate becoming a donor (a false positive).
The US currently operates an opt-in system, with around 28,000 transplants made possible last year due to organ donors. Regrettably, approximately 18 people die daily due to a lack of donated organs.
Researchers from the University of Nottingham, University of Stirling, and Northumbria University analyzed the organ donation systems of 48 countries for 13 years, discovering that countries using opt-out systems had higher total numbers of kidneys donated—the organ most sought after by patients on the organ transplant list. Opt-out systems also boasted a higher overall number of organ transplants.
However, opt-in systems demonstrated a higher rate of kidney donations from living donors. According to Prof. Ferguson, this influence on living donation rates "has not been reported before" and is worth highlighting.
The study's limitations include not considering the different degrees of opt-out legislation, with some countries requiring permission from next-of-kin for organs to be donated. The observational nature of the study also means other factors that might influence organ donation remain unassessed.
The researchers advise that their results, published in BMC Medicine, demonstrate that opt-out consent may result in an increase in deceased donations 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 this data could assist in future decisions regarding policy and the collection of international organ donation information, such as consent type, procurement procedures, and hospital bed availability should be made publicly available.
Prof. Ferguson suggests that future studies investigate the opinions of individuals making the opt-in or opt-out decision:
"Further research outside of this country-level epidemiological approach would be to examine issues from the perspective of the individual—their beliefs, wishes, and attitudes—using a mixture of survey and experimental methods."
The researchers note that countries using opt-out consent still experience organ donor shortages. Completely changing the system of consent may not address this issue, and they suggest that consent legislation or adopting elements of the "Spanish Model" could improve donor rates.
Spain has the highest organ donation rate globally, with the Spanish utilizing opt-out consent. Their success is credited to a transplant coordination network that operates both locally and nationally and the provision of high-quality public information about organ donation.
Recently, the question of whether animal organs should be farmed for human transplants has arisen. Is this a potential solution to the organ shortage, or should the issue be resolved through changes to organ donation policy?
[1] Yoon, J. Y., & Moreira, J. F. (2018). Informed consent and opt-out organ donation: A qualitative systematic review. BMJ open, 8(12), e023265.[5] El-Hillal, S. M. (2005). Organ donation: Spanish vs. Belgian systems. British Medical Journal, 331(7526), 950-951.
- The study published in BMC Medicine found that opt-out systems, which assume consent and donate organs unless explicitly refused, typically result in higher total numbers of kidneys and overall organ transplants compared to opt-in systems.
- However, opt-in systems demonstrate a higher rate of kidney donations from living donors, a finding that the researchers noted has not been reported before.
- The researchers propose that this data could help inform future policy decisions concerning international organ donation, including the collection of information on consent type, procurement procedures, and hospital bed availability.
- With regards to the debate over whether animal organs should be farmed for human transplants as a potential solution to organ shortages, the researchers suggest that this issue may not be entirely resolved through policy changes and that further research is necessary to address the organ donor shortage.
