Debate on Organ Donation: Which Method - Consent Based or Presumed Consent - is More Efficient?
Worldwide, the approach to organ donation varies significantly, with ongoing debate over whether an opt-in or opt-out system is more effective. A team of researchers from the UK has conducted an analysis of organ donation protocols in 48 countries to determine which system yields the best results.
Under an opt-in system, individuals must actively register their intention to donate organs following death. In contrast, an opt-out system assumes donation consent, with the process proceeding automatically unless a specific request is made to refrain from donation.
Prof. Eamonn Ferguson, the lead researcher from the University of Nottingham, UK, acknowledges potential drawbacks related to reliance on individual decisions in both systems:
"Individuals may fail to act for various reasons, including loss aversion, lack of effort, and a belief that policy-makers have made the correct decision."
While inactivity in an opt-in system can lead to potential false negatives, meaning individuals who would want to donate might not, inaction in an opt-out system could result in false positives, where individuals who do not wish to donate might inadvertently become donors.
The United States currently utilizes an opt-in system, with around 28,000 transplants made possible last year due to organ donors. Despite these efforts, approximately 18 people die daily due to a shortage of donated organs.
In the study, researchers from the University of Nottingham, University of Stirling, and Northumbria University in the UK examined the organ donation systems of 48 countries over a 13-year period - 23 using an opt-in system and 25 using an opt-out system.
The analysis revealed that countries employing an opt-out system had higher total numbers of kidneys donated, the organ most sought after by those on organ transplant waiting lists. Opt-out systems also recorded higher overall organ transplant numbers.
Opt-in systems, however, demonstrated a higher rate of kidney donations from living donors. The impact of policy on living donation rates "has not been reported before," says Prof. Ferguson.
The researchers acknowledge limitations in their study, as it did not evaluate the various degrees of opt-out legislation, such as the requirement for next-of-kin permission in some countries. Moreover, other factors influencing organ donation were left unassessed due to the observational nature of the study.
The researchers suggest that their findings can inform future policy decisions and recommend regular international organ donation data collection and public dissemination. Future studies could also examine individual perspectives on opt-in vs. opt-out decisions, including beliefs, wishes, and attitudes.
Countries employing opt-out consent still experience organ donor shortages, suggesting that completely changing the system may not solve the problem. Instead, the authors suggest that improvements could be made through consent legislation or adapting aspects of the "Spanish Model."
Spain boasts the highest organ donation rate globally, utilizing opt-out consent but acknowledged for success driven by factors such as a transplant coordination network and improved public information on organ donation.
While there is a growing debate about the farming of animal organs for human transplants as a potential solution to the organ shortage, further research is necessary to determine its feasibility and ethical implications.
- The analysis of organ donation protocols in 48 countries by a team of UK researchers revealed that countries employing opt-out systems had higher total numbers of kidneys donated.
- Professor Eamonn Ferguson, the lead researcher from the University of Nottingham, UK, suggests that improvements could be made through consent legislation or adapting aspects of the "Spanish Model," which uses opt-out consent but has a successful organ donation rate due to factors like a transplant coordination network and improved public information on organ donation.
- While inaction in an opt-out system could result in false positives, where individuals who do not wish to donate might inadvertently become donors, opt-in systems demonstrated a higher rate of kidney donations from living donors.
- The study conducted by researchers from the University of Nottingham, University of Stirling, and Northumbria University in the UK on organ donation systems over a 13-year period did not evaluate the various degrees of opt-out legislation, such as the requirement for next-of-kin permission in some countries.
