Debate over Organ Donation Consent Methods: Opt-in vs. Opt-out Approaches Compared
Worldwide, organ donation policies exhibit significant variations. The debate persists over whether an opt-in or opt-out system is more effective. To explore this question, a team of researchers from the UK scrutinized the organ donation regulations of 48 countries to ascertain the most efficient approach.
An opt-in system mandates individuals to actively register to a donor registry post-mortem. In an opt-out system, organ donation automatically occurs unless a specific request is made before death to prohibit donation.
Professor Eamonn Ferguson, the lead author from the University of Nottingham, UK, acknowledges potential drawbacks of both systems due to their reliance on an individual's active decision-making:
"Individuals may avoid making a decision for numerous reasons, such as loss aversion, effort, and the belief that policy makers have made the correct choice, which they support."
Inaction under an opt-in system might lead to individuals who would have wished to donate failing to do so (a false negative). Conversely, inaction in an opt-out system could potentially result in an individual who does not wish to donate becoming a donor (a false positive).
The US currently adheres to an opt-in system. US Department of Health & Human Services data indicates that 28,000 transplants were facilitated last year due to organ donors. Approximately 79 people receive organ transplants daily. Regrettably, about 18 people die daily due to a scarcity of donated organs.
To Opt-In or Opt-Out?
The research team from the University of Nottingham, University of Stirling, and Northumbria University in the UK analyzed the organ donation systems of 48 countries over a 13-year period. 23 countries employed an opt-in system, while 25 countries used an opt-out system.
The study authors quantified overall donor numbers, transplants per organ, and the total number of kidneys and livers transplanted from both deceased and living donors. They found that countries utilizing opt-out systems had higher totals of kidneys donated—the organ most required by individuals on transplant lists. Additionally, opt-out systems exhibited a greater overall number of organ transplants.
Opt-in systems, however, yielded a higher rate of kidney donations from living donors. This apparent influence of policy on living donation rates, according to Prof. Ferguson, "has not been previously reported" and necessitates attention.
The authors acknowledge limitations in their study, as it did not account for variations in the strictness of opt-out legislation, with some countries requiring family permission for organs to be donated. Moreover, additional factors that may influence organ donation remained unassessed in the observational study.
Proceeding Forward
The researchers assert that their findings, published in BMC Medicine, suggest that "opt-out consent might lead to an increase in deceased donation but a reduction in living donation rates." They also found an association between opt-out consent and an increase in the total number of transplanted livers and kidneys.
They propose that future decisions on policy could incorporate their findings, although they recommend strengthening the data through the routine collection and public availability of international organ donation information, such as consent type, procurement procedures, and hospital bed availability.
Further research could delve into the opinions and motivations of individuals making the decision to opt-in or opt-out:
"Future studies should examine issues from the perspective of the individual in terms of beliefs, wishes, and attitudes, using a mixture of survey and experimental methods," says Prof. Ferguson.
The authors acknowledge that countries using opt-out consent still experience organ donor shortages. A complete change in the system of consent is unlikely to remedy such a problem. They propose that consent legislation or adopting aspects of the "Spanish Model" could be avenues to enhance donor rates.
Spain currently holds the world's highest organ donation rate. The Spanish system, which employs opt-out consent, is widely acclaimed for its success, attributable to a robust transplant coordination network and high-quality public information about organ donation. A recent Medical News Today spotlight feature posed the question of whether animal organs could be farmed for human transplants as a potential solution to the organ shortage, or if this should be tackled through changes to organ donation policy.
- The study, published in BMC Medicine, suggests that an opt-out system might increase the overall number of deceased organ donations but decrease living donation rates.
- Spain, a country with the highest organ donation rate globally, employs an opt-out system and is recognized for its success due to a robust transplant coordination network and excellent public information about organ donation.
- Future research could examine individuals' opinions, beliefs, and attitudes towards opt-in or opt-out consent for organ donation using a combination of surveys and experimental methods.
- Researchers propose that strengthening the collection and public availability of international organ donation information, such as consent type, procurement procedures, and hospital bed availability, could aid in making informed decisions about organ donation policies and addressing organ shortages.
