Debate over Opt-In vs. Opt-Out Organ Donation Systems: Which Method Wins the Favor?
Organ donation policies across the globe show a wide array of approaches, and the question remains: Is an opt-in or opt-out system better? A team of researchers from the UK delved into the donation protocols of 48 countries to shed light on the optimal strategy.
In an opt-in system, people need to proactively sign up for the organ donor registry. On the other hand, in an opt-out system, organ donation takes place automatically unless an explicit request is made to deny it before death.
Prof. Eamonn Ferguson, lead author from the University of Nottingham, UK, points out that both systems rely on individuals to make a decision, which can lead to drawbacks:
"People may not act for numerous reasons, including loss aversion, effort, and believing that policy makers have already made the 'right' decision."
Although inaction in an opt-in system can lead to potential false negatives, in which individuals who would want to donate fail to do so, inaction in an opt-out system might result in false positives, where individuals who don't wish to donate unknowingly become donors.
The US employs an opt-in system. Last year, 28,000 transplants were made possible due to organ donors, with roughly 79 transplants happening daily. Sadly, about 18 people die daily because of a shortage of donated organs.
The researchers from the University of Nottingham, University of Stirling, and Northumbria University analyzed the organ donation systems of 48 countries for 13 years, with 23 using an opt-in system and 25 using an opt-out system.
They found that countries using opt-out systems had higher total numbers of kidneys donated - the organ most in demand by people on the organ transplant list. Opt-out systems also had a greater overall number of organ transplants.
Opt-in systems had a higher rate of kidney donations from living donors, although this influence on living donation rates has not been reported before, as Prof. Ferguson notes.
The study's authors acknowledge limitations, such as not distinguishing between varying degrees of opt-out legislation and not assessing other factors influencing organ donation.
The results, published in BMC Medicine, suggest that opt-out consent could lead to an increase in deceased donations and a reduction in living donation rates. Opt-out consent is also associated with an increase in the total number of livers and kidneys transplanted.
The researchers propose that future decisions on policy could be informed by these findings. They also suggest regular collection and public availability of international organ donation information, such as consent type, procurement procedures, and hospital bed availability, could strengthen their results further.
Further research might examine the perspectives of individuals deciding to opt-in or opt-out, using a mix of surveys and experimental methods, according to Prof. Ferguson.
Countries using opt-out consent still experience organ donor shortages, suggesting that completely changing the system won't solve the problem. The authors suggest that consent legislation or adopting aspects of the "Spanish Model," which includes a transplant coordination network and improved public information about organ donation, could help improve donor rates.
Recently, the topic of farming animal organs for human transplants has gained attention as a potential solution to the organ shortage. Alternatively, this issue might be addressed through changes to organ donation policy.
Written by James McIntosh
- The study published in BMC Medicine found that countries using opt-out systems, like the Spanish Model, had higher total numbers of kidneys donated, greater overall numbers of organ transplants, and an increase in the total number of livers and kidneys transplanted.
- The researchers suggest that future decisions on organ donation policy could be informed by these findings, and they propose regular collection and public availability of international organ donation information to strengthen their results.
- Alongside the need for further research on individual perspectives, the authors of the study also suggest that consent legislation or adopting aspects of the Spanish Model, which includes a transplant coordination network and improved public information about organ donation, could help improve donor rates.
- In contrast, countries employing opt-in systems, such as the US, have a higher rate of kidney donations from living donors, but they face a shortage of donated organs, with approximately 18 people dying daily due to this shortage.
