Debate over Consent Methods for Organ Donation: Opt-In versus Opt-Out Approaches Compared
** goin' all a mess with organ donations**
Different countries got their ways of handling organ donation, wonderin' if it's better to have people opt in or opt out. A group of researchers from the UK took a gander at the organ donation protocols of 48 countries to see which system brings in the best results.
In opt-in systems, folks gotta actively sign up to a register to donate their organs post-mortem. Opt-out systems, though, make organ donation happen automatically if no specific request for the organs to be kept is made prior to death.
Prof. Eamonn Ferguson, the lead cat from Nottingham University, UK, acknowledges that both systems rely on individuals makin' a conscious decision, which can cause some hitches:
"People don’t act for numerous reasons, like losin' their marbles, puttin' in the bare minimum effort, and believin' that the policy makers have already made the right call."
Now, not doin' nothin' in an opt-in system might lead to individuals who'd be down to be donors not donatin'. On the flip side, not doin' nothin' in an opt-out system could potentially result in somebody who ain't keen on bein' a donor endin' up bein' one (false positive).
The US, at the moment, runs on an opt-in system. Accordin' to the US Department of Health & Human Services, 28,000 transplants were carried out last year thanks to organ donors. 'Bout 79 people get new organs every day, but 'bout 18 people die each day without an organ donor available.
To In or To Out?
Researchers from Nottingham University, Stirling University, and Northumbria University, all in the UK, had a squint at the organ donation systems of 48 countries for a period of 13 years - 23 took the opt-in route and 25 went with the opt-out route.
The researchers measured overall donor numbers, the number of transplants per organ, and the total number of kidneys and livers transplanted from both dead and livin' donors.
They learned that countries that went with the opt-out system saw greater numbers of kidneys donated - the organ most people on organ transplant waitlists are hankerin' for. Opt-out systems also delivered a higher number of overall organ transplants.
Opt-in systems, on the other hand, had a bigger rate of kidney donations from livin' donors. The apparent influence that policy had on livin' donation rates "has not been sighted before," says Prof. Ferguson, "and is somethin' that needs to be pointed out and taken into consideration."
The researchers reckon their study was limited by not distinguishin' between different degrees of opt-out legislation, with some countries requirein' permission from next-of-kin for organs to be donated. The observational nature of the study means that other factors that may’ve influenced organ donation remained unassessed.
Lookin' Ahead
The researchers state that their findings, published in BMC Medicine, show that "opt-out consent might lead to an increase in deceased donations but a reduction in livin' 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 decisions on policy, they could be made even stronger through the routine collection of international organ donation information - consent type, procurement procedures, and hospital bed availability, for example - which should then be made publicly available.
Prof. Ferguson suggests that future studies could also observe 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, usin' a mixture of survey and experimental methods."
"By combinin' these different research methods," says Prof. Ferguson, "researchers can develop a greater understanding of the influence of consent legislation on organ donation and transplantation rates."
The authors note that countries employin' opt-out consent still face organ donor shortages. Changin' the entire system seems unlikely to solve such a problem. They suggest that consent legislation or adopting aspects of the "Spanish Model" could be ways to boost donor rates.
Spain currently boasts the highest organ donation rate in the world. The Spanish utilize opt-out consent, but experts credit their success to a transplant co-ordination network that works both locally and nationally, as well as improvements in the quality of public information available about organ donation.
R'cently, Medical News Today shone a spotlight on whether animal organs should be farmed for human transplants. Could this be a solution to the organ shortage, or a problem to be tackled through changes to organ donation policy?
Penned by James McIntosh
- The study conducted by researchers from Nottingham University, Stirling University, and Northumbria University revealed that countries with opt-out organ donation policies saw greater numbers of kidneys donated and a higher number of overall organ transplants.
- Opt-in systems, on the other hand, had a higher rate of kidney donations from living donors, a finding that has not been noted before.
- The researchers suggest that future studies could observe the opinions of individuals making the decision to opt in or opt out, using a mixture of survey and experimental methods to gain a greater understanding of the influence of consent legislation on organ donation and transplantation rates.
- County-level epidemiological studies, such as this one, show that opt-out consent might lead to an increase in deceased donations but a reduction in living donation rates.
- The authors of the study note that countries employing opt-out consent still face organ donor shortages, suggesting that changing the entire system may not be the sole solution, and that consent legislation or adopting aspects of the "Spanish Model" could be ways to boost donor rates.
- The study published in BMC Medicine could be used in the future to inform decisions on policy, but the researchers suggest that the results could be made even stronger through the routine collection of international organ donation information, which should then be made publicly available.
