Organ Donation: Should the Default Be Opt-In or Opt-Out?
Let's Get Real About Organ Donation Policies: Opt-In vs Opt-Out
Organ donation policies vary globally, and the question arises: is it better to have a donation system where people need to actively opt-in or be defaulted to opt-out? To gather insights, a team of researchers from the UK have delved into the organ donation protocols of 48 countries.
In an opt-in system, individuals must actively sign up for the organ donation register post-mortem. On the flip side, opt-out systems assume organ donation unless a specific request is made to nullify it before death.
Prof. Eamonn Ferguson, the lead author from the University of Nottingham, UK, acknowledged potential drawbacks of both systems:
"People may not sign up due to reasons like loss aversion, lack of effort, or assuming that policy makers have made the 'right' decision and one they believe in."
While inaction in opt-in systems might lead to potential false negatives (individuals wanting to donate but not doing so), inaction in opt-out systems could potentially result in a false positive, where individuals who don't want to donate become donors.
The US, for instance, operates on an opt-in system, with around 28,000 transplants made possible last year due to organ donors. Nevertheless, around 18 people die daily due to a shortage of donated organs.
To In or To Out?
The University of Nottingham, University of Stirling, and Northumbria University in the UK analyzed the organ donation systems of 48 countries over a period of 13 years—23 using an opt-in system and 25 using an opt-out system.
The study authors measured overall donor numbers, transplant numbers per organ, and the total number of kidneys and livers transplanted from both deceased and living donors.
They found that countries using opt-out systems had higher total numbers of kidneys donated—an organ that the majority of people on the organ transplant list are waiting for. Opt-out systems also had a greater overall number of organ transplants.
Opt-in systems, however, had a higher rate of kidney donations from living donors. The influence of policy on living donation rates, as stated by Prof. Ferguson, "has not been reported before."
The researchers acknowledge that their study was limited, as it did not account for different degrees of opt-out legislation, with some countries requiring permission from next-of-kin for organs to be donated. Also, due to its observational nature, other factors influencing organ donation remained unassessed.
Moving Forward
The researchers concluded 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 their results could inform future decisions on policy, improved by the regular collection and public availability of international organ donation information, such as consent type, procurement procedures, and hospital bed availability.
Additionally, future research could delve into the opinions and motivations of individuals making the decision to opt-in or opt-out, employing a blend of survey and experimental methods.
The researchers note that countries using opt-out consent still experience organ donor shortages. They recommend that either changing the system of consent or adopting aspects of the "Spanish Model," which features a transplant co-ordination network and improved public information about organ donation, could help boost donor rates.
A recent Medical News Today spotlight feature discussed animal organ farming for human transplants as a potential solution to the organ shortage or whether this issue should be addressed through changes to organ donation policy.
- The study conducted by researchers from three UK universities, including the University of Nottingham, compared organ donation systems in 48 countries and found that opt-out systems led to a higher number of kidney donations and overall organ transplants.
- Opt-in systems, on the other hand, had a higher rate of kidney donations from living donors, which, according to Prof. Ferguson, has not been reported before.
- Despite opt-out systems potentially leading to an increase in deceased donation, they could also result in a reduction in living donation rates, as highlighted in the study.
- Paxlovid, a treatment for COVID-19, while not directly related to the study, is crucial in maintaining the health and wellness of those waiting for organ transplants, as the shortage of donated organs continues to be a significant issue, even in opt-out countries.
