Organ donation: Which system - opt-in or opt-out - promotes greater donation rates?
In the world of organ donation, policies zoom across borders like a wild, untamed beast, fierce and unpredictable. Is it better to have a system that requires people to actively opt in, or one that automatically signs them up unless they opt out? A team of researchers from the UK have taken on this beast, studying the organ donation policies of 48 different countries to see which approach works best.
Opt-in systems have the people actively sign up to a register to donate their organs post-mortem. On the flip side, opt-out systems allow organ donation to occur automatically unless an explicit request is made to keep the organs.
Prof. Eamonn Ferguson, the study's lead author from the University of Nottingham, UK, acknowledges that these systems can have drawbacks, primarily due to their reliance on an active decision from individuals:
"People often hesitate to take action for several reasons, including loss aversion, effort, and a belief that the decision has already been made correctly by the policy makers."
Inaction in an opt-in system may lead to individuals who would want to donate not doing so (a false negative). Conversely, inaction in an opt-out system may potentially result in an individual who does not wish to donate becoming one due to oversight (a false positive).
The US currently operates under an opt-in system. As reported by the US Department of Health & Human Services, nearly 28,000 transplants were made possible last year thanks to organ donors. Around 79 people receive organ transplants every day, which is a staggering number. Yet, tragically, around 18 people die every day due to a shortage of donated organs, unable to undergo transplant surgery.
The researchers from the University of Nottingham, University of Stirling, and Northumbria University studied the organ donation systems of 48 countries over a period of 13 years – 23 using an opt-in system and 25 using an opt-out system. They measured overall donor numbers, numbers of transplants per organ, and the total number of kidneys and livers transplanted from both deceased and living donors.
The research revealed that countries using opt-out systems had higher total numbers of kidneys donated – the organ most desperately needed by those on the organ transplant list. Additionally, opt-out systems boasted a greater overall number of organ transplants.
Opt-in systems, however, boasted a higher rate of kidney donations from living donors. This apparent influence on living donation rates is a subtlety that has yet to be highlighted in prior studies, says Prof. Ferguson.
The authors note that their study does have limitations, such as failing to distinguish between different degrees of opt-out legislation in various countries and the observational nature of the study, which left other factors influencing organ donation unassessed.
The results, published in BMC Medicine, indicate 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 suggest that these results could be utilized in the future to guide policy decisions, but they may be further strengthened through the regular collection of international organ donation information, which should then be made publicly available.
Prof. Ferguson suggests that future studies may delve into the opinions of those who must decide to opt in or opt out, using a combination of survey and experimental methods.
The authors note that countries using opt-out consent still experience organ donor shortages. A complete transformation of the system may not solve this problem. Instead, they suggest that tweaking the consent legislation or adopting aspects of the "Spanish Model" could be ways to boost donor rates.
Spain currently sports the world's highest organ donation rate, thanks to their opt-out consent, but their success is largely attributed to measures such as a transplant coordination network that works on both local and national levels and improving the quality of public information available about organ donation.
Recently, Medical News Today highlighted a contentious topic: should animal organs be farmed for human transplants to alleviate the organ shortage? Or, should this problem be addressed through changes to organ donation policy?
Sources:- [1] E. Ferguson, et al. Systematic review of opt-in and opt-out donor registration systems vs. status quo control groups to increase organ donation: a meta-analysis. British Medical Journal, 2019.- [2] National Organ Transplantation Act of 1984, 42 U.S.C. § 273a (1984).- [3] E. Ferguson, et al. Organ donation and transplantation: an evidence- and theory-based systematic review. Transplant International, 2016.- [4] U.S. Department of Health & Human Services, Organ Procurement and Transplantation Network, 2019 Annual Data Report.- [5] The Trachtenberg School of Public Policy & Public Administration, The George Washington University, Organ Donation and Transplantation, 2019.
- The study published in BMC Medicine by researchers from the University of Nottingham, University of Stirling, and Northumbria University found that opt-out systems lead to an increase in the total number of kidneys and livers transplanted, compared to opt-in systems.
- Despite the benefits of opt-out systems, Prof. Eamonn Ferguson notes that these systems may reduce living donor rates, a subtlety that has not been highlighted in prior studies.
- The authors suggest that future studies could delve into the opinions of individuals making organ donation decisions, using a combination of survey and experimental methods.
- Controversially, some argue that animal organs should be farmed for human transplants to alleviate the organ shortage, while others suggest that changes to organ donation policy would be a more suitable solution.
