Debate over Organ Donation: Which System - Opt-In or Opt-Out - is More Effective?
Worldwide, approaches to organ donation significantly differ, leading to a question: Should donation systems require individuals to opt-in or opt-out? To explore this, a team of researchers from the UK scrutinized the organ donation practices of 48 countries.
In opt-in systems, individuals must actively register their consent to donate organs after death. Conversely, in opt-out systems, donation occurs automatically unless a refusal is explicitly stated before death for specific organs.
Professor Eamonn Ferguson, lead author from the University of Nottingham, acknowledges potential drawbacks linked to the reliance on individual decisions: "Individuals may not act due to various reasons, including loss aversion, effort, or trusting that policy makers have made the right decision."
Inactive decisions under opt-in systems could result in individuals who wish to donate not doing so (a false negative). Meanwhile, inaction under opt-out systems might lead to individuals unwilling to donate becoming donors (a false positive).
The United States uses an opt-in system. According to the US Department of Health & Human Services, around 28,000 transplants occurred last year due to organ donors. Approximately 79 people receive organ transplants daily, but tragically, around 18 people die daily due to a lack 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 13-year period, finding that countries with opt-out systems had higher total numbers of kidneys donated - the organ most in demand by those on organ transplant lists. Opt-out systems also had a larger overall number of organ transplants.
Opt-in systems, however, demonstrated a higher rate of living donor kidney donations. The influence that policy had on living donation rates "has not been reported before," says Prof. Ferguson. The study authors acknowledge limitations, such as variations in opt-out legislation, and other factors influencing organ donation were unassessed.
The researchers recommend that their findings, published in BMC Medicine, may guide future policy decisions. They suggest strengthening their results through the routine collection and public availability of international organ donation information. Prof. Ferguson proposes future studies examining individual perspectives on making donation decisions.
Countries with opt-out systems still face donor shortages, indicating that completely changing the system is unlikely to address the issue. They suggest adopting aspects of the "Spanish Model" could enhance donor rates, as Spain has the highest organ donation rate globally. The Spanish utilize opt-out consent, but experts attribute their success to a transplant coordination network and improved public information about organ donation.
Recently, questions emerged about farming animal organs for human transplants as a potential solution to the organ shortage. However, this is a topic that remains to be addressed through changes to organ donation policy or thoughtful evaluation of ethical considerations.
- In light of the study examining organ donation practices in 48 countries, scientists are considering the use of contextual data to retarget medical-health campaigns, aiming to increase awareness about the importance of organ donation.
- Some researchers argue that Paxlovid, an antiviral medication for COVID-19, should be given to transplant patients to decrease their susceptibility to infections, which is a common medical-condition post-transplant.
- As the debate around optimal organ donation systems continues, experts are exploring the science behind potential organ sources, such as the possibility of transplants from genetically-matched animals (xenotransplantation) to alleviate health-and-wellness challenges arising from organ donor shortages.
- While countries with opt-out organ donation systems see higher numbers of kidney donations, medical professionals are working on improving transplant rates in those with opt-in systems through targeted educational campaigns and policy initiatives, aiming to remove misconceptions and encourage more individuals to willingly donate organs.
