Organ donation methodology: which consent-based system yields superior results?
Goin' Opt-In or Opt-Out? A Worldwide Look at Organ Donation Policies
Organ donation rules vary globally, raising the question: is it better to have a system where folks actively opt in or automatically opt out? To tackle this, researchers from the UK have delved into the organ donation protocols of 48 countries to find out which approach is truly effective.
Under an opt-in system, individuals must actively sign up to a registry to donate their organs following death. But in opt-out systems, organ donation automatically occurs unless a specific request is made before death for organs not to be taken.
Prof. Eamonn Ferguson, lead author from the University of Nottingham, UK, acknowledges some issues with 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."
However, inaction in an opt-in system can lead to individuals who would've wanted to donate not doing so (a false negative). Conversely, inaction in an opt-out system can potentially lead to someone who doesn't want to donate becoming a donor (a false positive).
The US currently employs an opt-in system, with the US Department of Health & Human Services reporting that 28,000 transplants were possible last year thanks to organ donors. Yet, approximately 18 people die every day due to a shortage of donated organs.
In or Out?
Researchers from the University of Nottingham, University of Stirling, and Northumbria University in the UK analyzed the organ donation systems of 48 countries for a period of 13 years - 23 using an opt-in system and 25 using an opt-out system.
The study 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 using opt-out systems of organ donation had higher total numbers of kidneys donated – the organ most people on organ transplant lists are waiting for – and a greater overall number of organ transplants.
Opt-in systems, however, had a higher rate of kidney donations from living donors. This apparent 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 acknowledged that their study had limitations, such as not distinguishing between different degrees of opt-out legislation and not assessing other factors that may influence organ donation. The observational nature of the study means that conclusions should be taken with a pinch of salt.
Moving Forward
The researchers suggest that their results, published in BMC Medicine, demonstrate 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 recommend collecting international organ donation information for future studies to solidify these findings, such as consent type, donor procurement procedures, and hospital bed availability. This data should then be made publicly available.
Prof. Ferguson suggests that future studies could also delve into the beliefs, wishes, and attitudes of individuals making 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."
By combining these different research methods, researchers can develop a greater understanding of the impact of consent legislation on organ donation and transplantation rates.
The authors note that countries using opt-out consent still encounter organ donor shortages. Completely changing the system of consent is therefore 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 currently boasts the highest organ donation rate in the world. Experts attribute Spain's success to measures such as a transplant coordination network that operates locally and nationally, and improvements in the quality of public information about organ donation.
A recent Medical News Today spotlight feature questioned the possibility of using animal organs for human transplants as a potential solution to organ donation shortages or a problem to be addressed through changes in organ donation policy.
- The study conducted by researchers from the University of Nottingham, University of Stirling, and Northumbria University investigated the effectiveness of organ donation systems in 48 countries, finding that opt-out systems resulted in higher total numbers of kidneys donated and a greater overall number of organ transplants.
- Under an opt-out system, organ donation automatically occurs unless a specific request is made before death, while in opt-in systems, individuals must actively sign up to donate their organs.
- The researchers suggest that future studies could delve into the beliefs, wishes, and attitudes of individuals making the decision to opt in or opt out to gain a better understanding of the impact of consent legislation on organ donation and transplantation rates.
- A recent report by Medical News Today discussed the possibility of using animal organs for human transplants as a potential solution to organ donation shortages or a problem to be addressed through changes in organ donation policy.
- In an opt-in system, inaction can lead to individuals who would've wanted to donate not doing so, resulting in a false negative. On the other hand, inaction in an opt-out system can potentially lead to someone who doesn't want to donate becoming a donor, creating a false positive.
