Organ donation: Should an individual's choice to donate organs be explicit or implied?
Organ donations vary world wide, and the question remains if opt-in or opt-out systems are more effective. A team of researchers from the UK have examined the organ donation rules of 48 countries to determine which approach is working best.
With opt-in, people have to register actively to donate their organs after death. In comparison, opt-out systems mean organ donation happens automatically unless a specific request is made to opt-out before death.
Prof. Eamonn Ferguson, the study's lead author from the University of Nottingham, acknowledges that relying on individuals to make a decision can result in drawbacks:
"People may not act for various reasons, like loss aversion, lack of effort, or believing that policy makers have made the right decision."
Inaction in an opt-in system may lead to people who would want to donate not doing so (false negative). On the other hand, inaction in an opt-out system could potentially result in a person who doesn't want to donate becoming a donor (false positive).
Currently, the US employs an opt-in system. Last year, 28,000 transplants were possible thanks to organ donors, but around 18 people still die daily due to a shortage of donated organs.
Researchers from the University of Nottingham, Stirling, and Northumbria analyzed the organ donation systems of 48 countries over a 13-year period. They found that countries with opt-out systems had more total kidneys donated. Opt-out systems also had more overall organ transplants. However, they also observed that opt-in systems had a higher rate of kidney donations from living donors.
The authors point out that their study's limitations include not accounting for different degrees of opt-out legislation in some countries and the observational nature of the study, which didn't assess other factors influencing organ donation.
Despite these limitations, the findings show that opt-out consent might lead to an increase in deceased donation but a drop in living donation rates. Opt-out consent is also linked to an increase in the total number of livers and kidneys transplanted.
They suggest that their findings could aid future policy decisions but could be reinforced by collecting international organ donation information, such as consent type, procurement procedures, and hospital bed availability, and making it publicly available.
Further research should also analyze the opinions of individuals making the decision to opt-in or opt-out, professor Ferguson adds. By combining this approach with survey and experimental methods, researchers could gain a better understanding of how consent legislation affects donation and transplantation rates.
The authors note that even countries with opt-out consent experience organ donor shortages, meaning completely changing the system is unlikely to solve the problem. They suggest that consent legislation or adopting aspects of the "Spanish Model" could help improve donor rates.
Spain currently has the highest organ donation rate in the world, thanks to measures like a transplant coordination network and improved public information about organ donation. Recently, there has been debate about whether animal organs should be farmed for human transplants as a potential solution to the donor shortage, or if this issue should be addressed through changes to organ donation policy.
- In the context of organ donation, opt-out systems, where organ donation happens automatically unless a specific request is made to opt-out before death, have been observed to lead to more total kidneys donated and overall organ transplants.
- However, opt-in systems, where people have to register actively to donate their organs after death, appear to have a higher rate of kidney donations from living donors.
- The science behind organ donation and transplantation has shown that opt-out consent might lead to an increase in deceased donation but a drop in living donation rates. This finding is also linked to an increase in the total number of livers and kidneys transplanted.
- In the realm of policy and legislation, the authors suggest that their findings could aid future policy decisions, but they also emphasize the need for collecting and publicizing international organ donation information to strengthen the evidence base.
- As politics and general news continue to discuss potential solutions for organ donor shortages, such as farming animal organs for human transplants, researchers propose that improvements to organ donation policy and adopting aspects of the "Spanish Model" could help address this issue more effectively.
