Organ donation: Which approach - consensual or presumed consent - yields more successful outcomes?
Around the globe, organ donation policies differ significantly, sparking an ongoing debate on which approach - opt-in or opt-out, yields the best results. Researchers from the UK have delved into this matter, analyzing the donation protocols of 48 countries to determine which method is more effective.
In opt-in systems, individuals must actively register to donate their organs posthumously, whereas opt-out systems mandate that organ donation proceeds automatically unless an express request to opt-out is made prior to death.
Professor Eamonn Ferguson, from the University of Nottingham, UK, acknowledged the disadvantages that stem from relying on individuals to make an active decision: "People may hold back for multiple reasons, including loss aversion, effort, and the belief that policy makers have made the 'correct' decision and one they endorse."
The US, employing an opt-in system, registered 28,000 transplants last year due to organ donors. Daily, around 79 individuals receive organ transplants, while approximately 18 perish owing to a scarcity of donated organs.
Researchers from the Universities of Nottingham, Stirling, and Northumbria analyzed organ donation systems in 48 countries for 13 years, discovering that countries with opt-out donation policies generally had a higher total number of kidneys transplanted - an organ that the majority of individuals on organ transplant lists await. These countries also demonstrated higher overall organ transplant numbers.
However, opt-in systems boasted a higher rate of kidney donations from living donors. This apparent influence on living donation rates, according to Prof. Ferguson, has not been previously reported and should be given more attention.
The authors acknowledge that their study has limitations, as it did not distinguish between varying degrees of opt-out legislation, which can require family consent for organ donation. Additionally, the study's observational nature did not assess other factors that may influence organ donation.
In their conclusions, the researchers stated that their findings, published in BMC Medicine, indicate that opt-out consent may boost deceased donation rates but reduce living donation rates. Furthermore, opt-out consent is associated with an increase in the total number of livers and kidneys transplanted. These results could offer insights for future policy decisions, provided the routine collection of international organ donation data becomes consistent and publicly accessible.
Future studies, the authors suggest, should survey individual perspectives on the issue, examining beliefs, wishes, and attitudes regarding opting in or opting out. By combining research methods, researchers could gain a more profound understanding of the impact of consent legislation on organ donation and transplantation rates, potentially contributing to future policy improvements.
The researchers point out that countries adopting opt-out consent still face organ donor shortages, rendering a complete system overhaul unlikely to resolve the issue. They propose that adjustments to consent legislation or adopting elements of the "Spanish Model" may help boost donor rates.
Spain boasts the highest organ donation rate globally, with a success rate attributed to its opt-out consent policy, coupled with a robust transplant coordination network and high-quality public information on organ donation.
In recent times, Medical News Today published a feature delving into the prospects of farming animal organs for human transplants in light of the organ shortage. While this may be a possible solution, it remains to be seen whether addressing the organ shortage through changes to organ donation policy is a more preferable approach.
- The research, published in BMC Medicine, suggests that opt-out donation policies may lead to an increased number of kidneys and livers transplanted, but might lower the rate of living donor kidney transplants.
- In Spain, which has the highest organ donation rate globally, the success is largely due to its opt-out consent policy, a robust transplant coordination network, and high-quality public information on organ donation.
- Future studies should focus on individual perspectives regarding opting in or opting out, examining beliefs, wishes, and attitudes to gain a deeper understanding of the impact of consent legislation on organ donation and transplantation rates.
- The researchers propose that adopting elements of the "Spanish Model" or making adjustments to consent legislation could help increase donor rates, offering a more preferable approach to addressing the organ shortage compared to farming animal organs for human transplants.
