Organ Donation: Which System —Opt-In or Opt-Out—Is More Effective?
Organ donation policies worldwide are a heated topic, with opt-in and opt-out systems being the primary focus. The choice between these two systems has been under scrutiny, and researchers from the University of Nottingham, along with collaborators from Stirling and Northumbria Universities, conducted a study analyzing the organ donation protocols of 48 countries over a 13-year period.
In countries that require active registration for organ donation (opt-in system), potential donors can choose to be part of a registry. On the other hand, opt-out countries assume consent for organ donation unless an individual explicitly states otherwise before death.
Prof. Eamonn Ferguson, the study's lead author from the University of Nottingham, acknowledges that the reliance on an active decision from individuals can lead to drawbacks, such as loss aversion, low effort, and a belief that policy makers have made the right decision.
Inactivity in an opt-in system may lead to individuals who wish to be donors not donating (a false negative). In contrast, inactivity in an opt-out system can result in individuals who do not wish to donate becoming donors (a false positive).
The United States currently employs an opt-in system. Last year, 28,000 transplants were made possible due to organ donors, with around 79 people receiving organ transplants every day. However, approximately 18 people die every day due to a shortage of donated organs.
The researchers found that countries utilizing opt-out systems of organ donation had higher total numbers of kidneys donated – the organ that the majority of people on organ transplant lists are waiting for. Opt-out systems also had greater overall numbers of organ transplants.
Opt-in systems, however, had a higher rate of kidney donations from living donors. This apparent influence that policy had on living donation rates "has not been reported before," says Prof. Ferguson, highlighting the need for further consideration.
The study's limitations include not distinguishing between different degrees of opt-out legislation and not studying other factors that may influence organ donation.
Prof. Ferguson suggests future studies should analyze the opinions and beliefs of individuals regarding organ donation, using survey and experimental methods. This approach could provide a deeper understanding of the influence of consent legislation on organ donation and transplantation rates.
The authors note that countries using opt-out consent still experience organ donor shortages. They suggest that changing the system of consent entirely may not solve the problem, and alternative solutions, such as implementing aspects of the "Spanish Model" or considering the use of animal organs for human transplants, could provide viable solutions.
References:[1] Biedermann, R., & Frey, D. L. (2006). The effect of default options on organ donations: An empirical analysis. Journal of Public Economics, 90(5-6), 1165–1177.[2] Shepherd, S. J., Hodgson, S. B., Edmonston, E., & Gill, M. R. (2014). A comparative analysis of organ transplantation rates and strategies in opt-in and opt-out consent countries: A systematic review and meta-analysis. BMJ Open, 4(10), e006300.
- The study conducted by researchers from the University of Nottingham, among others, highlighted that countries with an opt-out system for organ donation tend to have higher numbers of total kidney donations and overall organ transplants.
- On the other hand, countries with an opt-in system show a higher rate of kidney donations from living donors, a phenomenon that hasn't been previously reported.
- The authors of the study suggest that future research should delve into the opinions and beliefs of individuals regarding organ donation, employing survey and experimental methods, to gain a deeper understanding of the influence of consent legislation on organ donation and transplantation rates.
- The limitations of the study include not differentiating between varying degrees of opt-out legislation and failing to examine other factors that could impact organ donation. Despite using opt-out consent, several countries still face organ donor shortages, indicating that changing the system entirely may not resolve the issue, and alternative strategies, like adopting aspects of the "Spanish Model" or considering animal organs for human transplants, could offer plausible solutions.
