Organ donation: Which system – opt-in or opt-out – is more effective?
Organ donation policies across the globe exhibit significant variation, leading to the question: is it better to have an opt-in or opt-out system for organ donation? Researchers from the UK recently examined the organ donation procedures of 48 nations to determine which approach outperforms the other.
In an opt-in system, individuals must proactively register on a donor list to give their organs following their demise. Conversely, opt-out systems automatically authorize organ donation unless a specific preference is expressed prior to death for organs not to be taken.
Lead researcher Prof. Eamonn Ferguson from the University of Nottingham, UK, acknowledges potential downsides of both systems:
"Inaction in an opt-in system can result in individuals who would wish to donate not donating (false negative). In contrast, inaction in an opt-out system can potentially lead to an individual who does not want to donate becoming a donor (false positive)."
The USA follows an opt-in system. Last year, over 28,000 transplants were made possible by organ donors, with around 79 people receiving organ transplants every day [1]. Tragically, around 18 people die daily due to a lack of donated organs [1].
UK researchers from the University of Nottingham, University of Stirling, and Northumbria University examined the organ donation systems of 48 countries for 13 years. They found that countries with opt-out organ donation systems witnessed a higher total number of kidney donations, which is the primary organ that the majority of people on the organ transplant list are waiting for [2]. Opt-out systems also saw a larger overall number of organ transplants.
However, opt-in systems had a higher rate of living kidney donations. This influence on living donation rates, as noted by Prof. Ferguson, "has not been reported before" [2].
The authors of the study note that their findings could be utilized in the future to influence policy decisions but suggest collecting international organ donation information such as consent type, procurement procedures, and hospital bed availability to strengthen the results [2]. Research into the perspectives of those making the decision to opt-in or opt-out remains a promising avenue for further research [2].
Critics argue that opt-out systems also face organ donor shortages, suggesting that altering the consent system may not resolve the issue. Instead, adopting aspects of the "Spanish Model" and addressing public awareness could potentially improve donor rates [2]. Spain is currently the country with the highest organ donation rate in the world [2]. The Spanish utilize an opt-out consent policy, but experts attribute their success to measures such as a comprehensive transplant coordination network and improved public information availability about organ donation [2].
Recently, discussions about farming animal organs for human transplants have arisen as a potential solution to the organ shortage [2]. A more promising approach might involve refining organ donation policies rather than turning to animal-based solutions.
- The ethical perspective suggests that in an opt-in system, individuals who wish to donate but haven't registered might miss the opportunity, leading to a potential false negative.
- Opt-out systems, contrary to the opt-in system, potentially authorize organ donation for individuals who haven't expressed their preference against organ donation prior to death, resulting in a potential false positive.
- The research conducted by UK researchers from multiple universities revealed that countries with opt-out organ donation systems recorded a higher total number of kidney and overall organ transplants over a 13-year period.
- The study also pointed out that opt-in systems had a higher rate of living kidney donations, a finding not reported previously in the scientific context of organ donation policies.
