Organ donation procedures: which system - opt-in or opt-out - is more effective?
Let's dive into the organ donation debate: Opt-in vs Opt-out
Worldwide, organ donation policies differ vastly. Should we have a system where individuals opt in or simply assume they're opting out? A team of UK researchers from the University of Nottingham, University of Stirling, and Northumbria University took a closer look at the organ donation procedures of 48 countries to find the most effective approach.
Here's the lowdown on opt-in and opt-out systems:
With an opt-in system, people must actively sign up to a register to donate their organs after death. In contrast, an opt-out system automates the process; unless a specific request is made before death for organs not to be taken, organ donation occurs.
Prof. Eamonn Ferguson, the lead researcher from the University of Nottingham, acknowledges that the active decision-making of both systems can have drawbacks:
"People may not act for numerous reasons, including loss aversion, effort, and believing that the policy makers have made the 'right' decision and one that they believe in."
Inaction in an opt-in system might result in individuals who'd prefer to be donors not doing so (a false negative). On the flip side, inaction in an opt-out system may potentially lead to an individual who doesn't want to donate becoming one (a false positive).
The United States currently operates an opt-in system. Last year, 28,000 transplants were made possible thanks to organ donors, with around 79 individuals receiving organ transplants every day. Unfortunately, approximately 18 people still die daily due to a scarcity of donated organs.
The researchers analyzed the organ donation systems of 48 countries over a 13-year period, with 23 using an opt-in system and 25 employing an opt-out system.
The study authors measured overall donor numbers, numbers of transplants per organ, and the total number of kidneys and livers transplanted. They discovered that countries using opt-out systems had higher total numbers of kidneys donated—an organ that the majority of people on organ transplant lists are waiting for. Opt-out systems also boasted the greater overall number of organ transplants.
Opt-in systems, however, had a higher rate of kidney donations from living donors. The impact of policy on living donation rates seems to be a new observation, according to Prof. Ferguson.
The authors acknowledge that their study was limited by not distinguishing between varying degrees of opt-out legislation, with some countries requiring permission from next-of-kin for organs to be donated. The observational nature of the study meant that other factors that may have influenced organ donation remained unassessed.
The researchers suggest that their results, published in BMC Medicine, demonstrate 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 recommend that future decisions on policy could be informed using these results, but they could be strengthened further through the regular collection of international organ donation information, including consent type, procurement procedures, and hospital bed availability, which should be made publicly available.
Prof. Ferguson suggests that future studies should delve into the opinions and beliefs of individuals faced with the decision to opt in or opt out:
"Further research outside of this country-level epidemiological approach would be to examine issues from the perspective of the individual in term of beliefs, wishes, and attitudes, using a mixture of survey and experimental methods."
"By combining these different research methods, researchers can develop a greater understanding of the influence of consent legislation on organ donation and transplantation rates," he says.
The authors note that countries using opt-out consent still experience donor shortages. Changing the entire system of consent is, therefore, unlikely to solve such a problem. They suggest that consent legislation or adopting aspects of the "Spanish Model" could be ways to improve donor rates.
Spain currently boasts the highest organ donation rate globally. Their success is reportedly due to measures such as a transplant coordination network that operates locally and nationally, as well as improving the quality of public information available about organ donation.
Recently, Medical News Today ran a spotlight feature on whether farming animal organs for human transplants could be a solution to the organ shortage, or if it's a problem that could be addressed through changes to organ donation policy. Stay tuned for more insights on this intriguing topic!
Written by James McIntosh.
Insights:- Opt-out systems tend to yield higher organ donation rates compared to opt-in systems.- The success of Spain's organ donation system is attributed to their use of opt-out consent in conjunction with measures such as a transplant coordination network and improved public information about organ donation.- Research could be conducted on individuals' opinions and beliefs regarding organ donation to gain a deeper understanding of the impact of consent legislation on donation and transplantation rates.
- The study conducted by a team of UK researchers revealed that countries using opt-out systems have higher total numbers of kidneys donated, which is often the most sought-after organ on organ transplant lists.
- Despite the higher total number of organ transplants in opt-out systems, these systems tend to have lower rates of kidney donations from living donors compared to opt-in systems.
- The researchers suggest that future decisions on policy could be informed by these findings, but they also recommend the regular collection of international organ donation information to strengthen these results.
- In the pursuit of addressing donor shortages, discussions about farming animal organs for human transplants have emerged, but some experts argue that changes to organ donation policy could potentially be a more viable solution.
- Furthermore, researchers propose that studies should delve into individual beliefs, wishes, and attitudes towards organ donation to develop a more comprehensive understanding of the influence of consent legislation on organ donation and transplantation rates.
