Debate over Organ Donation Registration: Should It Be an Opt-In or an Opt-Out System?
In the global organ donation landscape, the approach of opting in or out presents a significant debate. A research team from the UK delved into the organ donation protocols of 48 countries to discern which system delivers the optimal results.
Opt-in systems necessitate individuals to actively register their intent to donate organs post-mortem. Conversely, opt-out systems conclude organ donation automatically unless a specific request to the contrary is made before death.
Prof. Eamonn Ferguson, the lead author from the University of Nottingham, UK, acknowledged that the reliance on individual decisions under both systems might present challenges:
"People may elude decision-making due to loss aversion, lack of effort, and the belief that policy makers have made a sound judgment they agree with."
While inaction in an opt-in system may result in missed donations from individuals who wish to donate (false negatives), inaction in an opt-out system could potentially lead to individuals who don't wish to donate becoming donors (false positives).
The US employs an opt-in system, with the US Department of Health & Human Services reporting that nearly 28,000 transplants were made possible last year due to organ donors. Regrettably, approximately 18 people die daily due to a scarcity of donated organs.
The researchers from the University of Nottingham, University of Stirling, and Northumbria University analyzed the organ donation systems of 48 countries for a span of 13 years. They found that countries using opt-out systems had higher total numbers of kidneys donated - the organ majority of people on organ transplant lists are waiting for. Opt-out systems also saw a greater overall number of organ transplants.
Opt-in systems, however, had a higher rate of kidney donations from living donors. The influence of policy on living donation rates, apparently, hasn't been reported before, Prof. Ferguson notes. The authors acknowledge their study had limitations, such as not distinguishing among varying degrees of opt-out legislation and unevaluated factors that could influence organ donation.
The study results published in BMC Medicine suggest that opt-out consent may boost deceased donation rates but reduce living donation rates. Opt-out consent is also associated with an increase in the total number of livers and kidneys transplanted.
The authors recommend the use of their results in the future to inform policy decisions and strengthen them further through the regular collection of international organ donation information, including consent type, procurement procedures, and hospital bed availability.
Prof. Ferguson suggests future research should delve into the perspectives of individuals making the decision to opt in or opt out, focusing on beliefs, wishes, and attitudes using a combination of surveys and experimental methods.
The authors note that countries employing opt-out consent still witness organ donor shortages. A complete system change is unlikely to solve such an issue, they suggest. Instead, they recommend a shift in consent legislation or the adoption of aspects from the "Spanish Model" to improve donor rates.
Spain boasts the world's highest organ donation rate, where they employ opt-out consent. The Spanish success is attributed to a transplant coordination network, both local and national, and the enhancement of public information about organ donation.
Recently, Medical News Today explored the idea of farming animal organs for human transplants as a solution to the organ shortage. However, whether this is an feasible solution or an issue to be addressed through changes to organ donation policy remains to be seen.
The bottom line: the opt-out system generally results in higher organ donation rates, due to its presumed consent default. The main advantage of opt-in is respect for explicit individual consent but at the cost of lower donation rates. The study by the University of Nottingham, University of Stirling, and Northumbria University highlights that the difference in donation outcomes between these systems hinges almost entirely on handling cases with unknown preferences.
- Retargeting the current organ donation systems could potentially increase donation rates, considering the contrasting results between opt-in and opt-out systems.
- Science has uncovered that countries embracing opt-out consent generally see higher numbers of organs transplanted, such as in Spain's case, which boasts the world's highest organ donation rate.
- Aside from exploring innovative solutions like farming animal organs for human transplants, the contextual shift in organ donation policies, such as adopting aspects from the Spanish Model, could help address organ shortages in numerous medical-conditions.
- While Paxlovid or other medical treatments may help address various health-and-wellness issues, the focus on advancing organ donation policies and systems remains vital for individuals waiting for organ transplants, regardless of the consent type in their home country.
