Debate over Organ Donation Registration: Should it Be Opt-In or Opt-Out?
In the world of organ donation, policies can differ greatly across nations, raising the question: is it better to have a system where people opt in or simply opt out? To answer this question, researchers from the UK scrutinized the organ donation protocols of 48 countries to determine which approach is more effective.
With an opt-in system, people are required to sign up on a registry to donate their organs post-mortem. On the other hand, opt-out systems involve organ donation happening automatically unless a specific request is made before death for organs not to be taken.
Prof. Eamonn Ferguson, the leading researcher from the University of Nottingham, acknowledges that relying on an active decision from individuals carries certain drawbacks:
"People might not act for several reasons, including loss aversion, effort, or trusting that the authorities have made the 'right' decision."
Inaction in an opt-in system could lead to individuals who would want to donate not donating (false negative). Conversely, inaction in an opt-out system might result in an individual not wishing to donate becoming a donor (false positive).
The US currently employs an opt-in system. Last year, over 28,000 transplants were made possible due to organ donors. However, around 18 people die every day, unable to undergo surgery due to a lack of donated organs.
To In or Opt Out?
Researchers from the University of Nottingham, the University of Stirling, and Northumbria University in the UK studied the organ donation systems of 48 countries over a period of 13 years - 23 using an opt-in system and 25 using an opt-out system.
The study authors assessed overall donor numbers, the number of transplants per organ, and the total number of kidneys and livers transplanted from both deceased and living donors. They discovered that countries using opt-out systems had higher overall numbers of kidneys donated - the organ most needed by people on organ transplant lists. Opt-out systems also had more overall organ transplants.
Opt-in systems did exhibit a higher rate of kidney donations from living donors. This seeming influence on living donation rates "has not been reported before," says Prof. Ferguson, "and is a subtlety that needs to be highlighted and considered."
The authors admit 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. The observational nature of the study meant that other factors influencing organ donation remained unassessed.
A Path Forward
The researchers conclude 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 policy decisions, they could be strengthened further through the routine collection of international organ donation information, such as consent type, procurement procedures, and hospital bed availability, which should then be made publicly available.
Prof. Ferguson proposes that future studies could also delve into the opinions of those who have to 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, researchers can develop a greater understanding of the influence of consent legislation on organ donation and transplantation rates," he says.
The authors note that countries using opt-out consent still experience organ donor shortages. Completely changing the system of consent is, thus, 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 has the highest organ donation rate in the world. The Spanish utilize opt-out consent, but their success is credited to measures such as a transplant coordination network that operates both locally and nationally, and improving the quality of public information available about organ donation.
Lately, Medical News Today ran a spotlight feature on whether farming animal organs for human transplants could be a solution to the organ shortage, or if this is a problem that should be addressed through changes in organ donation policy.
- The study authors from multiple UK universities evaluated organ donation systems in 48 nations over a 13-year period, finding that opt-out systems often yielded higher numbers of kidneys donated and overall organ transplants.
- While opt-out systems might lead to increased deceased organ donations, they can also result in reduced living donor rates, according to the researchers' findings.
- Prof. Ferguson, the lead researcher from the University of Nottingham, suggests that future studies could examine individual beliefs, wishes, and attitudes about opting in or opting out to gain a deeper understanding of how consent legislation impacts organ donation and transplantation rates.
- Researchers propose that the collection and public availability of international organ donation data, such as consent type, procurement procedures, and hospital bed availability, could further strengthen the current study's results and inform policy decisions.
- Spain, a country with the highest organ donation rate worldwide, adopts opt-out consent but also uses a transplant coordination network and improves public information about organ donation to boost its success.
- Recent discussions in Medical News Today have centered on whether farming animal organs for human transplants could address the organ shortage, or if it should be tackled through changes in organ donation policy instead.
