Organ Donation: Advantages and Dis advantages of Opt-In versus Opt-Out Process
Organ donation practices differ significantly across the globe, sparking debate over whether an opt-in or opt-out system works best. A team of researchers from the University of Nottingham, University of Stirling, and Northumbria University in the UK has conducted an analysis of the organ donation protocols of 48 countries over a 13-year period to determine the most effective approach.
An opt-in system necessitates individuals to proactively sign up to a donor registry following their demise. Conversely, in an opt-out system, organ donation is initiated by default unless an explicit request is made before death for organs not to be taken.
Prof. Eamonn Ferguson, the study's lead author from the University of Nottingham, acknowledged the potential pitfalls stemming from the reliance on individual action:
"People may delay their decision for a variety of reasons, including fear of loss, apathy, and a belief that policy makers have made the correct and morally sound choice."
In an opt-in system, inactivity may result in individuals who would have liked to donate not doing so (false negatives). On the other hand, inaction in an opt-out system can lead to an individual who does not wish to donate unintentionally becoming a donor (false positives).
The US employs an opt-in system, and according to the US Department of Health & Human Services, 28,000 transplants were possible last year due to organ donors. Despite this, approximately 18 people die each day due to a scarcity of donated organs, unable to undergo surgery.
The researchers analyzed the organ donation systems of 48 countries, 23 of which utilized an opt-in system and 25 opt-out. Their investigation measured overall donor numbers, transplants per organ, and the total number of kidneys and livers transplanted from both deceased and living donors.
They discovered that countries utilizing opt-out systems of organ donation experienced a higher total number of kidneys donated, which is the organ sought by the majority of individuals on the organ transplant waiting list. Additionally, opt-out systems had a greater overall number of organ transplants.
Opt-in systems, however, exhibited a higher rate of kidney donations from living donors. The influence of policy on living donation rates, as per Prof. Ferguson, has not been documented before, making it a noteworthy observation.
The authors acknowledged the study's limitations, notably the lack of differentiation between various degrees of opt-out legislation among countries and the assessment of factors other than consent that may impact organ donation.
The researchers' findings, published in BMC Medicine, demonstrated that opt-out consent may lead to an increase in deceased donation but a reduction in living donation rates, as well as a rise in the total number of livers and kidneys transplanted.
They suggested that while these results could inform future policy decisions, they could be further strengthened through the regular collection and public availability of international organ donation data, such as consent type, procurement procedures, and hospital bed availability.
Prof. Ferguson also proposed the need for further research examining the opinions and beliefs of individuals facing the choice to opt in or opt out, utilizing a mixture of surveys and experimental methods.
The authors noted that countries employing opt-out consent still encounter organ donor shortages, implying that completely changing the system may not solve the issue. Instead, they suggested that consent legislation or adopting aspects of the "Spanish Model" could be prospective solutions to enhance donor rates.
Spain currently boasts the highest organ donation rate in the world, credited to measures like a transplant coordination network that functions both regionally and nationally, and the provision of superior quality public information about organ donation.
Lately, Medical News Today published a feature discussing the potential of farming animal organs for human transplants as a possible means to address the organ shortage or an issue to be tackled through adjustments in organ donation policy.
- The study by researchers from three UK universities revealed that opt-out organ donation systems, as in Spain, lead to a higher total number of kidneys donated and a greater overall number of organ transplants.
- In opt-in systems, such as the one in the US, there's a higher rate of kidney donations from living donors. However, the study found that opt-out systems may result in a reduction in living donation rates.
- The authors of the study, published in BMC Medicine, suggested that future policy decisions could be informed by these findings, but stressed the need for regular collection and public availability of international organ donation data for more accurate conclusions.
- Moreover, Prof. Ferguson proposed further research on individual opinions and beliefs about organ donation, using surveys and experimental methods, to better understand factors that influence opt-in or opt-out decisions in health-and-wellness contexts.
