Organ Donation: Which Approach - Opt-In or Opt-Out - Is More Effective?
Rewritten Article:
Globally, organ donation policies take different forms. But which approach—opt-in or opt-out—works best? To seek answers, researchers from the UK scrutinized the organ donation methodologies of 48 countries, studying the pros and cons of each system.
In an opt-in system, individuals are required to register as organ donors upon their death, whereas opt-out systems allow organ donation to occur automatically unless an individual explicitly expresses their desire not to donate before death.
Prof. Eamonn Ferguson, the study's lead author from the University of Nottingham, UK, acknowledges that these systems rely on individual choices, which can lead to drawbacks:
"People may not act for a multitude of reasons, including loss aversion, lack of effort, and the belief that the government's decision is the correct one and one they stand behind."
However, inaction in an opt-in system may result in individuals who wish to donate failing to do so (a false negative). Conversely, inaction in an opt-out system could lead to an individual who doesn't want to donate becoming one (a false positive).
The US adheres to an opt-in system. Last year, 28,000 transplants were possible due to organ donors. Approximately 79 people receive organ transplants every day. Regrettably, around 18 people pass away each day due to a lack of donated organs.
Weighing In
The authors from the University of Nottingham, University of Stirling, and Northumbria University in the UK analyzed the organ donation systems of 48 countries for 13 years—23 countries using opt-in and 25 using opt-out systems.
They measured overall donor numbers, transplants per organ, and the total numbers of kidneys and livers transplanted from both deceased and living donors.
They discovered that countries with opt-out organ donation policies had higher total numbers of kidneys donated—the organ most sought after by individuals on the organ transplant waiting list. Moreover, opt-out policies resulted in more overall organ transplants.
Opt-in systems did, however, have a higher rate of kidney donations from living donors. The effect of policy on these rates was a previously unreported finding, says Prof. Ferguson.
The authors admit that their study had some limitations, such as not accounting for varying degrees of opt-out legislation across countries, with some requiring permission from next-of-kin for organs to be donated. Additionally, other factors that may influence organ donation were not assessed due to the observational nature of the study.
Stepping Forward
The researchers state that their findings, published in BMC Medicine, suggest 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 propose that while their results could guide future policy decisions, they could be strengthened further through the routine collection of international organ donation data, such as consent type, procurement procedures, and hospital bed availability, which should then be made publicly available.
Prof. Ferguson suggests that future studies could explore the perspectives of individuals making the decision to opt in or opt out:
"Further research outside of this country-level epidemiological approach would be to examine issues from the individual's perspective—their beliefs, wishes, and attitudes—using a mixture of survey and experimental methods."
"By blending these different research methods," he says, "researchers can develop a deeper understanding of the influence of consent legislation on organ donation and transplantation rates."
The authors note that countries employing opt-out consent still face organ donor shortages. Therefore, a complete system change is unlikely to fully solve the problem. They suggest that consent legislation or adopting aspects of the "Spanish Model" could potentially improve donor rates.
Spain currently boasts the highest organ donation rate in the world. The Spanish utilize opt-out consent, but their success is attributed to measures such as a transplant coordination network, both locally and nationally, and the improvement of public information regarding organ donation.
Recent discussions have raised questions about the feasibility of farming animal organs for human transplants as a potential solution to the organ shortage or a problem to be solved through changes in organ donation policy.
- The researchers at the University of Nottingham, in cooperation with universities in Stirling and Northumbria, investigated organ donation policies in 48 countries over a period of 13 years.
- They found that countries with opt-out organ donation policies recorded higher total numbers of kidneys donated, the organ most demanded by individuals on the transplant waiting list, and more overall organ transplants.
- Opt-in systems, on the other hand, had a higher rate of kidney donations from living donors, a previously unreported finding, according to Prof. Ferguson.
- The authors suggest that their findings provide a basis for future policy decisions, but they acknowledge limitations such as varying degrees of opt-out legislation across countries and unassessed factors influencing organ donation.
- As their study reveals, countries employing opt-out consent still face organ donor shortages, and a complete system change may not solve the problem completely.
- Prof. Ferguson proposes that future research should delve into the individual perspectives of those deciding to opt in or opt out, blending survey and experimental methods to gain a deeper understanding of the influence of consent legislation on organ donation and transplantation rates in the context of health-and-wellness and medical-conditions.
