Organ donation: Should it be a consent-based or presumed-consent approach?
Organ donation policies around the globe differ significantly, leading to the big question: is it better to have an opt-in or opt-out system? To better understand this debate, researchers from the University of Nottingham in the UK scrutinized the organ donation procedures of 48 countries for a span of 13 years.
An opt-in system requires folks to actively sign up for organ donation upon their demise, while opt-out systems automatically donate organs unless a specific request is made not to. Professor Eamonn Ferguson, the study's lead author, is aware that these systems rely on personal decision-making:
"People may choose not to act for various reasons, like loss aversion, lack of motivation, or trusting the government's decision."
However, non-action in an opt-in system may lead to individuals who would want to donate not actually doing so (a false negative). Conversely, non-action in an opt-out system might result in someone unwilling to donate becoming a donor (a false positive).
The US employs an opt-in system, owing to which 28,000 organ transplants were achieved last year. Unfortunately, about 18 individuals daily pass away owing to the severe lack of donated organs.
The research team found that nations relying on an opt-out organ donation system have significantly higher total numbers of kidneys donated - the organ most sought after by those on the transplant list. Opt-out systems also boasted higher overall organ transplant numbers.
However, opt-in systems showed a higher rate of kidney donations from living donors. This impact of policy on living donation rates "has never been reported before," says Prof. Ferguson.
The study's authors admit that it had limitations, such as not distinguishing between varying degrees of opt-out legislation across countries, and not considering other factors affecting organ donation.
Prof. Ferguson stresses the importance of investigating donor decisions from an individual perspective:
"Future studies should explore beliefs, wishes, and attitudes of individuals regarding organ donation, using a mix of surveys and experimental methods."
The authors state that their findings highlight:
- Opt-out consent may lead to an increase in deceased donation but a decrease in living donation rates.
- Opt-out consent is associated with a higher number of livers and kidneys transplanted.
They suggest that international organ donation information, including consent type, procurement procedures, and hospital bed availability, should be collected and made public to improve future policy decisions.
World-renowned for its high organ donation rate, Spain uses the opt-out consent system. Experts attribute Spain's success to measures like a transplant coordination network and enhanced public information about organ donation.
Opinions vary over potential solutions to the persistent organ donor shortage. A recent spotlight by Medical News Today contemplated whether farming animal organs for human transplants could be a feasible option or if it's a problem that should be addressed through policy changes.
- In an opt-out system, unlike an opt-in one, nations tend to have higher overall numbers of kidneys and livers transplanted, as discovered by researchers from the University of Nottingham.
- Interestingly, opt-in systems show a higher rate of kidney donations from living donors, a finding that, according to the study's lead author, Professor Eamonn Ferguson, has never been reported before.
- Science, in the pursuit of addressing health-and-wellness issues regarding organ donation, could explore beliefs, wishes, and attitudes of individuals regarding organ donation, using a mix of surveys and experimental methods.
- As countries grapple with the question of whether an opt-in or opt-out system is better for organ donation, it is essential to consider the contextual implications of each policy and the potential for retargeting this issue through improved data collection and public awareness campaigns.