Organ Donation: A comparison between consent-based and presumed consent approaches
Let's dive into the organ donation debate: Opt-in vs. Opt-out
Organ donation policies across the globe vary like a kaleidoscope. Which approach, opt-in or opt-out, yields the best results? Researchers from the UK set out to find an answer by examining the organ donation protocols of 48 nations.
In the opt-in system, individuals must actively sign up to donate their organs post-mortem. Conversely, the opt-out system assumes consent, and organs are donated unless the person explicitly requests otherwise before death.
Prof. Eamonn Ferguson, the study's lead author from the University of Nottingham, acknowledges potential pitfalls in both systems:
"People may not act for numerous reasons, including loss aversion, effort, and believing that policy makers have made the 'right' decision and one that they believe in."
Inaction in an opt-in system may result in potential donors not donating (false negatives). On the flip side, inaction in an opt-out system could lead to individuals not wanting to donate become donors (false positives).
The United States currently follows an opt-in system. Last year, 28,000 transplants were made possible courtesy of organ donors. Regrettably, 18 people die every day due to insufficient donated organs.
To opt or not to opt?
Researchers from the Universities of Nottingham, Stirling, and Northumbria analyzed the organ donation systems of 48 countries over a 13-year period. They discovered that countries with opt-out systems had significantly higher total kidney donations—the primary organ in high demand for transplant lists. Additionally, opt-out systems boasted higher overall numbers of organ transplants.
However, opt-in systems registered a higher rate of kidney donations from living donors. This subtlety in policy influence on living donation rates was previously unreported according to Prof. Ferguson.
The authors concede that the study had limitations as it did not distinguish varying degrees of opt-out legislation, nor did it account for other factors affecting organ donation.
Moving ahead
The researchers published their results in BMC Medicine, concluding 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 these findings could guide future policy decisions, though they could be fortified further through the collection and public release of international organ donation data. Prof. Ferguson adds that future research could also explore the perspectives of those deciding to opt in or opt out.
The authors note that even opt-out consent countries still face donor shortages. A complete system change is likely insufficient to solve this issue. They propose that consent legislation or adopting elements of the "Spanish Model," which boasts the world's highest organ donation rate, might enhance donor rates.
Spain's success is attributed to factors like an extensive transplant coordination network and improved public information about organ donation.
Recently, Medical News Today delved into the debate about farming animal organs for human transplants. Could this be the solution to the organ shortage, or a problem best addressed through changes to donation policy?
Written by James McIntosh
- In the ongoing debate about organ donation policies, scientists from the Universities of Nottingham, Stirling, and Northumbria have recently suggested that the opt-out system, which assumes consent, could potentially increase both deceased and kidney transplants.
- The study, published in BMC Medicine, found that countries with opt-out systems exhibited higher total kidney donations and overall organ transplants compared to opt-in systems, although the opt-in system recorded a higher rate of kidney donations from living donors.
- However, the authors of the study acknowledgedthe need for further research to account for varying degrees of opt-out legislation and other factors affecting organ donation, and they suggested that public release of international organ donation data could strengthen their findings.
- Beyond policy changes, the researchers raised the question of alternative solutions such as farm-grown animal organs and contextual research on donors' perspectives towards opt-in or opt-out consent, which could provide additional insights to address the ongoing issue of donor shortage.
