Organ Donation: Which System—Opt-In or Opt-Out—Advantageously Facilitates Procurement?
Organ Donation: Opt-In or Opt-Out? A Global Comparative Analysis
Societies worldwide have differing views on organ donation policies. Is it better to have a system where individuals actively opt in, or should it be an automatic opt-out? To delve into this question, a research team from the UK scrutinized the organ donation protocols of 48 nations to determine the most effective approach.
In an opt-in system, people must sign up to a register to donate their organs after death. In contrast, opt-out systems assume consent unless a specific request is made to withhold organs before death.
Prof. Eamonn Ferguson, the study's lead author at the University of Nottingham, UK, discusses the potential drawbacks of relying on individual decisions:
"Procrastination could thwart numerous reasons, including loss aversion, effort, and trusting that the authorities have made the right decision."
Inaction in an opt-in system may result in false negatives—individuals wanting to donate yet failing to do so. Conversely, inaction in an opt-out system might lead to an unfortunate false positive—someone who doesn't wish to donate inadvertently becoming a donor.
The US employs an opt-in system. Last year, it enabled 28,000 transplants, with around 79 individuals receiving organ transplants every day. Regrettably, about 18 people die daily due to a scarcity of donated organs.
To In or To Opt-Out?
Researchers from the University of Nottingham, the University of Stirling, and Northumbria University in the UK examined the organ donation systems of 48 nations over 13 years, with 23 countries using an opt-in system and 25 using an opt-out system.
The authors measured overall donor numbers, numbers of transplants per organ, and the total number of kidneys and livers transplanted from both deceased and living donors.
They discovered that countries utilizing opt-out systems had higher total numbers of kidneys donated—the organ most in demand by individuals on organ transplant waiting lists. Opt-out systems also had greater overall numbers of organ transplants.
Opt-in systems, however, displayed higher kidney donation rates from living donors. This apparent impact of policy on living donation rates, according to Prof. Ferguson, "has not been reported before" and merits attention.
The researchers acknowledge that their study had limitations, such as not distinguishing between varying degrees of opt-out legislation and neglecting to investigate other factors that could impact organ donation. Furthermore, the observational nature of the study didn't allow them to account for such variables.
En Route to Progress
The researchers claim that their findings, published in BMC Medicine, suggest that "opt-out consent may increase deceased donation but reduce living donation rates." They also imply that opt-out consent is linked to an increase in the total number of livers and kidneys transplanted.
They advise that these results could be employed in future policy decisions, but their strength could be further augmented through the regular collection and public disclosure of international organ donation data—including consent type, procurement procedures, and hospital bed availability.
Prof. Ferguson suggests further studies that explore the opinions of those responsible for making the decision to opt in or opt out:
"Exploring beliefs, preferences, and sentiments among individuals using a combination of surveys and experimental methods will help yield a deeper understanding of consent legislation's influence on organ donation and transplantation rates."
The researchers note that even countries employing opt-out consent still grapple with organ donor deficits. Completely altering the system of consent is, thus, unlikely to remedy the problem. They suggest that consent legislation or adopting elements of the "Spanish Model" could be viable solutions to boost donor rates.
Spain boasts the world's highest organ donation rate, which the experts attribute to their opt-out consent, reinforced by measures like a transplant coordination network, local and national, and enhanced public information regarding organ donation.
Recently, Medical News Today published an animal-organ farming for human transplants spotlight feature. Might this solution address the organ shortage, or is it a problem better tackled through policy changes?
Written by James McIntosh
In-Depth Insights:
Opt-In System
- Advantages:
- Preserves individual autonomy explicitly.
- Minimizes the risk of using organs from those who objected to donation.
- Disadvantages:
- Lower organ donation rates due to the requirement for proactive registration.
- Potential shortage of available organs for transplantation.
Opt-Out System
- Advantages:
- Higher organ donation rates due to presumed consent.
- Potential provision of more organs for transplantation by leveraging the default effect.
- Disadvantages:
- May not fully respect individual opinions if not explicitly declared: a potential source of moral or ethical concerns.
- Inaction in an opt-in system may lead to missed opportunities for organ donation from individuals who wish to donate but have not registered.
- Opt-out systems, on the other hand, could inadvertently result in organ donation from individuals who did not wish to donate, creating an unfortunate false positive.
- Researchers found that countries with opt-out systems had higher total numbers of kidneys donated, a highly demanded organ for transplantation.
- The researchers' findings suggest that opt-out consent may increase deceased organ donation but potentially decrease living donation rates, and they recommend further studies on individuals' beliefs, preferences, and sentiments about organ donation and transplantation rates.
