Debate over Organ Donation: Which Proactive (Opt-In) or Passive (Opt-Out) Approach is More Effective?
Revised Version:
When it comes to organ donation policies, there's a heated debate about whether it's best to opt-in or opt-out. To set the record straight, a team of researchers from the UK have analyzed the organ donation protocols of 48 countries to see which approach is more effective.
In opt-in systems, folks gotta sign up to a register to donate their organs post-mortem. In contrast, opt-out systems imply that organ donation will happen automatically unless a specific request is made not to.
Prof. Eamonn Ferguson, the lead author from the University of Nottingham, UK, admits that these systems can face drawbacks, as people may not act due to numerous reasons like loss aversion, laziness, or trusting the government to make the right decision.
However, inaction in an opt-in system can lead to individuals who'd want to be donors not donating (a false negative). On the flip side, inaction in an opt-out system could potentially lead to an individual that doesn’t want to donate becoming a donor (a false positive).
The US currently operates on an opt-in system. According to the US Department of Health & Human Services, around 28,000 transplants were made possible last year due to organ donors. Every day, around 79 people receive organ transplants, but unfortunately, around 18 people die due to a shortage of donated organs.
To opt-in or not?
Researchers from the University of Nottingham, University of Stirling, and Northumbria University, UK, delved into the organ donation systems of 48 countries for a period of 13 years - 23 using an opt-in system and 25 using an opt-out system.
The study authors measured overall donor numbers, numbers of transplant per organ, and the total number of kidneys and livers transplanted from both deceased and living donors. They found that countries using opt-out systems had higher total numbers of kidneys donated - the organ that the majority of people waiting for a transplant need. Opt-out systems also had a greater overall number of organ transplants.
Opt-in systems, however, had a higher rate of kidney donations from living donors. The authors note that this influence on living donation rates "has not been reported before" and requires further consideration.
The authors acknowledge that their study was limited by not distinguishing between different degrees of opt-out legislation, with some countries requiring permission from next-of-kin for organs to be donated. They also admit that the observational nature of the study means that other factors that may influence organ donation remained unassessed.
Down the rabbit hole
The researchers claim that their results published in BMC Medicine, show 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 although the results could be used in the future to inform decisions on policy, they could be strengthened further through the routine collection of international organ donation information – consent type, procurement procedures, and hospital bed availability – which should then be made publicly available.
Furthermore, Prof. Ferguson suggests that future studies could analyze opinions of those who gotta make 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."
"By combining these different research methods," he says, "researchers can develop a greater understanding of the influence of consent legislation on organ donation and transplantation rates."
The authors note that countries using opt-out consent still experience organ donor shortages. Therefore, completely changing the system of consent is unlikely to solve such a problem. They suggest that consent legislation or adopting aspects of the "Spanish Model" could be ways to improve donor rates.
Spain currently has the highest organ donation rate in the world. The Spanish employ opt-out consent, but their success is credited to additional strategies like a transplant coordination network that works both locally and nationally, and improving the quality of public information available about organ donation.
Recently, Medical News Today ran a spotlight feature on whether animal organs could be farmed 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
- Study authors from the University of Nottingham, University of Stirling, and Northumbria University examined organ donation systems in 48 countries for 13 years, finding that opt-out systems led to higher total numbers of kidneys donated and a greater overall number of organ transplants.
- Opt-in systems, however, had a higher rate of kidney donations from living donors, a finding that has not been reported before and requires further investigation.
- The study was limited by not distinguishing between different degrees of opt-out legislation and not assessing other factors influencing organ donation.
- The authors recommend strengthening the results through the collection and public availability of international organ donation information, as well as researching individuals' beliefs, wishes, and attitudes towards organ donation.
- Spain, which uses an opt-out system, has the highest organ donation rate in the world, attributing their success to strategies like a transplant coordination network and improving public information about organ donation.
- The question remains whether farming animal organs for human transplants could solve the organ shortage, or if changes to organ donation policy are a more appropriate solution to address this issue.
%20or%20Passive%20(Opt-Out)%20Approach%20is%20More%20Effective%3F){kind=link}