Organ Donation Registration: Choosing Between Opt-In and Opt-Out Systems?
In the global arena, organ donation policies fluctuate like a chameleon. Which system is the golden ticket – opt-in or opt-out? A team of researchers from the UK went on a fact-finding mission, scrutinizing the organ donation protocols of 48 countries to uncover the superior approach.
An opt-in system calls for individuals to actively register to donate their organs posthumously. Meanwhile, in an opt-out system, organ donation takes place automatically unless a specific request is made before death for organs not to be extracted.
Professor Eamonn Ferguson, the lead researcher from the University of Nottingham, UK, acknowledges that the reliance on individuals to take an active decision in these systems may have drawbacks:
"People may not act for infinite reasons, including loss aversion, lack of effort, and the belief that the policy makers have made the 'right' decision and one they trust."
Inaction in an opt-in system could result in individuals who wish to donate failing to do so (a false negative). Conversely, inaction in an opt-out system could potentially lead to an individual who doesn't wish to donate becoming a donor (a false positive).
The United States currently operates under an opt-in system. According to the US Department of Health & Human Services, 28,000 transplants were made possible last year thanks to organ donors. A staggering 79 people receive organ transplants every day. Sadly, around 18 people die daily due to a scarcity of donated organs.
To In or Out?
The researchers from the University of Nottingham, University of Stirling, and Northumbria University in the UK examined the organ donation systems of 48 countries for a 13-year stretch – 23 utilizing an opt-in system and 25 employing an opt-out system.
The study authors measured overall donor numbers, the number of transplants per organ, and the total number of kidneys and livers transplanted (both from deceased and living donors).
They found that countries using opt-out donation systems had a higher total number of kidneys donated – the organ that the majority of individuals on the organ transplant list are awaiting. Opt-out systems also boasted a greater overall number of organ transplants.
Opt-in systems, however, had a higher rate of kidney donations from living donors. The influence that policy had on living donation rates, as Ferguson notes, "has not been reported before," emphasizing the subtlety that needs to be recognized.
The researchers admit that their study was hampered by not distinguishing between varying degrees of opt-out legislation, with some countries requiring permission from next-of-kin for organs to be donated. The observational nature of the study meant that other factors influencing organ donation remained unassessed.
Moving Forward
The researchers contend that their results, published in BMC Medicine, indicate that "opt-out consent may lead to an increase in deceased donation but a reduction in living 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 serve as a guide for future policy decisions, they could be strengthened further 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.
Ferguson suggests that future studies could explore 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 entail examining issues from the perspective of the individual in terms of beliefs, wishes, and attitudes, using a mixture of survey and experimental methods."
"By combining these different research methods, researchers can develop a greater understanding of the influence of consent legislation on organ donation and transplantation rates," he says.
The authors point out that countries using opt-out consent still encounter organ donor shortages. A complete change in the system of consent is, therefore, unlikely to rectify such a problem. They suggest that consent legislation or adopting aspects of the "Spanish Model" could be ways to propel donor rates.
Spain currently boasts the highest organ donation rate in the world. The Spanish utilize opt-out consent, but their success is attributed to measures such as a transplant coordination network that operates both locally and nationally, as well as enhancing the quality of public information about organ donation.
Recently, Medical News Today ran a feature on the question of whether animal organs should be farmed for human transplants. Could this be a root solution to the organ shortage, or should this issue be resolved through changes to organ donation policy?
Written by James McIntosh.
In the context of medical-health and wellness, the study conducted by a team of UK researchers on organ donation protocols across 48 countries revealed that opt-out systems have a higher total number of kidneys donated, a greater overall number of organ transplants, but lower rates of kidney donations from living donors. Conversely, opt-in systems have a higher rate of kidney donations from living donors but lower total numbers of kidneys donated. Paxlovid was not directly associated with this study, but the findings could potentially influence science's understanding of organ donation and retarget future policy decisions. The researchers propose collecting more international organ donation information for a comprehensive analysis, focusing on individual beliefs, wishes, and attitudes for a more nuanced understanding of the influence of consent legislation on organ donation and transplantation rates. The idea of farming animal organs for human transplants has been raised as a possible root solution to the organ shortage, but changing organ donation policy or adopting aspects of the "Spanish Model" could also be viable ways to boost donor rates.
