Opting In or Out for Organ Donation: Which Approach is More Effective?
Organ donation policies across the globe display a vast array of differences. Should we have a donation system where people actively choose to opt-in, or one where they unintentionally opt-out? Researchers from the UK have delved into the organ donation protocols of 48 countries to determine the most effective approach.
With an opt-in system, individuals must willingly register to donate their organs posthumously. On the other hand, in an opt-out system, organ donation happens automatically unless a specific request is made stipulating otherwise before death.
Prof. Eamonn Ferguson, the lead author from the University of Nottingham, UK, recognizes that the reliance on active decisions from individuals can lead to drawbacks, such as inaction due to loss aversion, apathy, and the belief that policy makers have made the right decision.
However, inaction in an opt-in system might result in individuals who would have wanted to donate not doing so (a false negative). In contrast, in an opt-out system, inaction could potentially lead to an individual who does not wish to donate becoming one (a false positive).
The US currently employs an opt-in system. Last year, 28,000 transplants were facilitated due to organ donors, with around 79 people receiving organ transplants every day. Regrettably, approximately 18 people die daily due to a lack of donated organs.
Researchers from the University of Nottingham, University of Stirling, and Northumbria University in the UK analyzed the organ donation systems of 48 countries for 13 years, finding that countries using opt-out systems of organ donation had higher total numbers of kidneys donated. Opt-out systems also had the greater overall number of organ transplants.
Nevertheless, opt-in systems did have a higher rate of kidney donations from living donors, a subtlety the authors note has not been reported before. The researchers acknowledge limitations in their study, such as not distinguishing between different degrees of opt-out legislation.
The study results suggest that opt-out consent may lead to an increase in deceased donations but a reduction in living donor rates. Furthermore, opt-out consent is associated with an increase in the total number of livers and kidneys transplanted.
The authors suggest that their findings could be used to inform policy decisions in the future, but they recommend collecting and making publicly available international organ donation information such as consent type, procurement procedures, and hospital bed availability to strengthen them further. The researchers also propose examining the opinions, beliefs, wishes, and attitudes of individuals making opt-in or opt-out decisions through a combination of surveys and experimental methods.
Countries using opt-out consent still face organ donor shortages, suggesting that completely changing the system of consent may not solve the problem. Instead, the authors suggest that consent legislation or adopting aspects of the "Spanish Model" could help improve donor rates.
Spain currently boasts the highest organ donation rate in the world. The Spanish employ opt-out consent, but their success is attributed to measures such as a transplant co-ordination network that operates locally and nationally and improved public information about organ donation.
The question arises as to whether farming animal organs for human transplants could be a solution to the organ shortage, or whether this issue should be tackled through changes to organ donation policy.
- In the context of medical-conditions, the study reveals that countries with opt-out organ donation systems have a higher total number of kidneys donated and overall organ transplants.
- Science and policy makers should consider adopting aspects of the Spanish Model, such as a transplant coordination network and improved public information about organ donation, to increase donor rates and address organ shortages.
- While Paxlovid and other medical treatments offer hope in the realm of health-and-wellness, the question remains whether farming animal organs for human transplants could be a solution to the organ shortage, or whether this should be approached through changes to organ donation policy.
- The study findings suggest that opt-out consent may lead to an increase in deceased donations but a reduction in living donor rates, and propose examining individual attitudes towards opt-in or opt-out decisions to strengthen future policy decisions.
