Debate over organ donation methods: should it be consent-based or presumed consent?
Organ donation practices worldwide differ significantly, sparking the question of whether an opt-in or opt-out system is more effective. To shed some light on this, a team of researchers from the UK scrutinized the organ donation policies of 48 countries.
In an opt-in system, individuals have to actively sign up to a registry to donate their organs postmortem. On the flip side, opt-out systems authorize organ donation automatically unless a specific request is made before death to withhold organs.
Prof. Eamonn Ferguson, the lead researcher from the University of Nottingham, acknowledges that reliance on an active individual decision can lead to blind spots: "People may not act for a variety of reasons, including fear of loss, lack of effort, and the belief that policy makers have already made the 'right' decisions."
Taking action in an opt-in system may lead to false negatives, wherein individuals who wish to donate fail to do so. Contrastingly, inaction in an opt-out system might lead to false positives, where an individual who doesn't wish to donate unintentionally becomes one.
The United States adheres to an opt-in system. According to the US Department of Health & Human Services, over 28,000 transplants took place last year due to organ donors. Unfortunately, around 18 people die daily due to a scarcity of donated organs.
The researchers analyzed the organ donation systems of 48 countries, 23 using an opt-in system and 25 employing an opt-out system. They found that countries utilizing opt-out systems had higher totals of kidney donations—an organ that the majority of individuals desperate for transplants are waiting for. Opt-out systems also yielded higher overall organ transplant numbers.
Interestingly, opt-in systems boasted a higher rate of kidney donations from living donors. This appears to be an unexpected influence that Prof. Ferguson highlights, stating, "This subtlety needs to be considered."
The study's authors caution that their work is limited since it lacks distinction between varying degrees of opt-out legislation and overlooks factors impacting organ donation that were left unassessed.
The researchers imply that their findings—published in BMC Medicine—show that opt-out consent tends to lead to an increase in deceased donation but results in lower living donation rates. Opt-out consent is also associated with increases in the total number of livers and kidneys transplanted.
They suggest that these results can be used to inform policy decisions in the future, but they could be fortified further through regular collection of international organ donation information, which should then be made publicly available.
Prof. Ferguson suggests that future research should examine the personal perspectives of individuals who must decide to opt in or opt out, as this could provide valuable insights. By blending various research methods, a more comprehensive understanding of organ donation and transplantation rates can be achieved.
The authors note that countries utilizing opt-out consent still struggle with organ donor shortages. A complete system overhaul is likely insufficient to resolve such an issue. They propose that modifying consent legislation or adopting aspects of the "Spanish Model" could potentially enhance donor rates.
Spain possesses the highest organ donation rate globally. The Spanish employ opt-out consent, but their success is credited to comprehensive donor identification strategies and enhancing the quality of public information about organ donation.
A heated debate ensues concerning the ethics of farming animal organs for human transplants. Could this solution potentially alleviate the organ shortage, or should this issue be addressed through alternate organ donation policies?
Sources:1. BMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m31182. Journal of Health Communication 2019; 24: 599–607, DOI: 10.1080/10810730.2019.16316593. American Journal of Transplantation 2012; 12: 2633-2640, DOI: 10.1111/j.1600-6143.2012.04303.x4. Transplant International 2010; 23: 646–652, DOI: 10.1111/j.1432-2277.2010.01139.x5. British Medical Journal 2009; 338: b1308, DOI: https://doi.org/10.1136/bmj.b13086. BMJ 2007; 334: 1243–1246, DOI: https://doi.org/10.1136/bmj.39236.428619.AE
- In their study published in BMC Medicine, the research team found that opt-out consent systems tend to lead to an increase in deceased organ donations but result in lower living donation rates, which is one of the key differences they noted when comparing opt-in and opt-out systems.
- In the case of the United States, which utilizes an opt-in system, over 28,000 transplants took place last year due to organ donors; however, around 18 people still die daily due to a scarcity of donated organs, demonstrating the ongoing challenge of organ donation in opt-in systems.
- On the other hand, countries employing opt-out systems, such as Spain, which has the highest organ donation rate globally, achieve success not only due to opt-out consent but also due to comprehensive donor identification strategies and improved public information about organ donation.
- Given the ongoing debate regarding the ethics of farming animal organs for human transplants, it is important to continue researching various organ donation policies and their effectiveness in addressing organ shortages, both through a scientific and a contextual perspective of health and wellness, as well as considering individual perspectives and concerns.
