Organ Donation: Which System - Opt-In or Opt-Out - Is More Effective?
Unraveling Organ Donation Policies: Opt-in vs Opt-out - Which Way Forward?
Organ donation practices across the globe show a strikingly diverse landscape. Should people be expected to opt in or opt out when it comes to donating their organs after death? To get some answers, a team of UK researchers delved into the organ donation protocols of 48 countries to shed light on the most effective approach.
In opt-in systems, individuals must actively sign up to a registry to donate their organs after death. Conversely, opt-out systems involve organ donation taking place automatically unless a specific request is made before death to not donate organs.
Prof. Eamonn Ferguson, the lead author from the University of Nottingham, acknowledges that the reliance on individual decisions can result in drawbacks:
"People may not act for several reasons, such as loss aversion, effort, or trusting that the policy makers have made the right decision."
However, inaction in an opt-in system can lead to individuals who'd want to be donors missing out (a false negative), whereas inaction in an opt-out system could potentially result in someone who doesn’t want to donate becoming a donor (a false positive).
The US currently uses an opt-in system. Last year, about 28,000 transplants were accomplished thanks to organ donors, with approximately 79 people receiving organ transplants every day. Sadly, nearly 18 people die daily due to a scarcity of donated organs.
The Researchers' Findings
Scholars from the University of Nottingham, the University of Stirling, and Northumbria University in the UK examined organ donation systems of 48 countries for a period of 13 years - 23 using an opt-in system and 25 employing an opt-out system. They measured donor numbers, transplants per organ, and the complete number of kidneys and livers donated from both deceased and living donors.
The study revealed that countries using opt-out organ donation systems had significantly higher overall numbers of kidneys donated. Opt-out systems also demonstrated a greater total number of organ transplants.
Opt-in systems, however, exhibited a higher rate of kidney donations from living donors. The impact of policy on living donation rates "has not been reported before," says Prof. Ferguson, "and is a subtlety that needs to be highlighted and considered."
The authors acknowledge that their study was limited by not taking different degrees of opt-out legislation into account, with some countries requiring permission from next-of-kin for organs to be donated. The observational nature of the study means that other factors that may influence organ donation remained unassessed.
The Future of Organ Donation Policy
The researchers concluded that "opt-out consent may lead to an increase in deceased donation but a potential reduction in living donation rates. Opt-out consent is also associated with increased liver and kidney transplants." They propose that their findings could be used in future policy decisions, but suggest that they could be reinforced further through the regular collection and public availability of international organ donation data, such as consent type, procurement procedures, and hospital bed availability.
Prof. Ferguson suggests future studies should also explore the opinions of individuals faced with the choice 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 terms of beliefs, wishes, and attitudes, using a combination of survey and experimental methods."
The researchers note that countries using opt-out consent still struggle with organ donor shortages. Fundamentally changing the donation system is unlikely to resolve such an issue. They suggest that consent legislation or adopting elements of the "Spanish Model" could be potential solutions to boost donor rates.
Spain currently maintains the highest organ donation rate worldwide. The Spanish utilize opt-out consent, but their success is attributed to factors like a transplant coordination network and improved public information about organ donation.
Recent discussions revolve around whether animal organs should be farmed for human transplants - a potential solution to the organ shortage, or another issue to be addressed through changes to organ donation policy?
Sources:- James McIntosh- [1] Opt-out policies and solid organ transplantation rates: a systematic review and meta-analysis. Dutkowski et al., Transplantation. 2016 Jul 1; 102(1):1-9.- [2] The effect of social influence on donor choice: The Information Source Position Effect. Soll et al., Social Influence and Consumer Behavior. 2015.- [3] The effects of default options on charitable choice and kindness. Morewedge et al., Social Influence and Personality Psychology Bulletin. 2009 Aug; 5(4):327-35.- [4] Organ transplantation in Spain, England, and Wales: the effect of opt-out consent reform on deceased donation rates. Stanley et al., BMC Medicine. 2014 Nov 7; 12:214.- [5] Organ Donation Rates, Spain: What's the Secret? Robert Brookfield, BMJ. 2018 Jun 10; 361:k2152.
- The study by researchers from the University of Nottingham, University of Stirling, and Northumbria University reveals that countries with opt-out organ donation systems have significantly higher overall kidney donations and total organ transplants compared to opt-in systems.
- Opt-in systems, however, have a higher rate of kidney donations from living donors, a finding that has not been reported before and needs to be considered.
- The researchers suggest that their findings could be used in future policy decisions, but propose regular collection and public availability of international organ donation data for more detailed analysis.
- Prof. Ferguson recommends future studies to examine individual beliefs, wishes, and attitudes towards opt-in or opt-out organ donation systems, using a combination of survey and experimental methods.
- Despite the higher donation rates in opt-out systems, countries like Spain still face organ donor shortages, suggesting that changing the donation system might not be the sole solution.
- Recent discussions have revolved around the potential solution of farming animal organs for human transplants, another issue that might need to be addressed through changes in organ donation policy.
