Organ donation: Should it be based on explicit consent or presumed consent?
Worldwide, organ donation policies exhibit significant variations, sparking debate over the most effective approach. A team of researchers from the UK delved into this issue, examining the organ donation practices of 48 nations to determine the best system: opt-in or opt-out.
In opt-in systems, individuals must actively register their intent to donate organs post-mortem. On the other hand, opt-out systems automatically assume organ donation unless a specific request to the contrary is made before death.
Professor Eamonn Ferguson, the lead author from the University of Nottingham, acknowledges potential drawbacks due to the reliance on individual decisions in both systems:
"Individuals may fail to act for various reasons, including loss aversion, lack of initiative, and belief that policy makers have made the right decision."
Inaction in an opt-in system may result in individuals who would have wished to donate not doing so (a false negative). Conversely, in an opt-out system, inaction could lead to an individual who does not wish to donate becoming one (a false positive).
The United States operates an opt-in system. Last year, 28,000 transplants were facilitated due to organ donors, but regrettably, around 18 people still died daily due to a shortage of donated organs.
To explore this issue, researchers from the University of Nottingham, University of Stirling, and Northumbria University analyzed the organ donation protocols of 48 countries for a 13-year period. They found that countries adopting opt-out systems had higher total numbers of kidneys donated, an organ highly sought after by those on transplant waiting lists. Additionally, opt-out systems resulted in a greater overall number of organ transplants.
Despite this, opt-in systems boasted a higher rate of kidney donations from living donors. The study's authors suggest this could be an unreported influence of policy on living donation rates.
To reinforce their findings from this country-level study, the researchers advocate for the routine collection and public dissemination of international organ donation information. They also propose future research focusing on the perspectives and attitudes of those making consent decisions.
Countries using opt-out consent still encounter organ donor shortages. Completely shifting the system might not resolve this issue, but changes in consent legislation or the adoption of aspects from the "Spanish Model," credited with Spain's high organ donation rate, could potentially improve donor rates.
The Spanish Model incorporates measures such as a transplant coordination network operating at both local and national levels, and enhanced public information about organ donation.
Further delving into the organ donation debate, Medical News Today recently covered the question of whether animal organs should be farmed for human transplants. This could potentially alleviate the organ shortage or be addressed through policy changes regarding organ donation.
In the realm of science and health-and-wellness, the analysis of international organ donation practices has sparked debates about the most effective systems. The study conducted by researchers from the University of Nottingham, University of Stirling, and Northumbria University found that opt-out systems, which assume consent for organ donation unless otherwise specified, yielded higher total numbers of kidneys donated and overall organ transplants. Conversely, opt-in systems, which require active registration for organ donation, had a higher rate of kidney donations from living donors. To combat the organ shortage, retargeting approaches might be needed, such as policy changes, the adoption of aspects from the Spanish Model, or controversy-provoking ideas like farming animal organs for human transplants. Regardless, contextual factors can greatly influence the success of organ donation policies, and it's crucial to understand these factors better through further research and public dissemination of information.
