Debate over Organ Donation: Should System Lean Towards Informed Consent or Presumed Consent?
New Approach to Organ Donation: Opt In or Opt Out? Let's Break it Down
Organ donation policies globalize diverse cultural and political landscapes. Is it better to have a donation system where people need to opt in or simply skip the step and opt out? A research crew from the UK delves into the organ donation protocols of 48 countries to uncover which method excels.
In the opt-in system, people are required to sign up on a register to donate their organs upon death. On the flip side, the opt-out system authorizes organ donation automatically unless a specific request is made before death for organs not to be harvested.
Prof. Eamonn Ferguson, the study's ringleader from the University of Nottingham, UK, acknowledges the drawbacks that stem from dependency on individual decisions:
"People may shirk the responsibility for numerous reasons, including loss aversion, laziness, or believing that policy makers have made the right decision."
However, inaction in an opt-in system can result in individuals who would desire to donate not donating (a false negative). Meanwhile, inaction in an opt-out system can potentially lead to an individual who does not wish to donate becoming a donor (a false positive).
The US follows an opt-in system. As per the US Department of Health & Human Services, 28,000 transplants were made possible last year due to organ donors. A heartening figure, but regrettably, around 18 people still die each day due to a deficiency in donated organs.
In or Out?
The researchers from the University of Nottingham, University of Stirling, and Northumbria University in the UK analyzed the organ donation policies of 48 countries for a 13-year period - 23 using an opt-in system and 25 using an opt-out system.
They observed a trend in countries using an opt-out system. These countries had higher total numbers of kidneys donated, an organ most coveted by those awaiting transplants. They also documented a greater overall number of organ transplants.
While countries using the opt-in system had a higher rate of kidney donations from living donors, the researchers found that this was a previously unreported influence that policy had on living donation rates.
The authors admit that their study was limited by not distinguishing between different degrees of opt-out legislation. Moreover, they left unassessed other factors that could potentially influence organ donation.
The Future Ahead
The researchers emphasize that their findings, published in BMC Medicine, reveal that "opt-out consent may lead to an increase in deceased donation but a reduction in living donation rates." They suggest that opt-out consent is associated with an increase in the total number of livers and kidneys transplanted.
The researchers propose that while their results could be utilized to inform future policy decisions, they could be strengthened further through the systemic collection of international organ donation information, which should then be made publicly available.
Further studies could also explore the opinions of those who are called to make the decision to opt in or opt out:
"By combining these different research methods," says Ferguson, "researchers can develop a greater understanding of the influence of consent legislation on organ donation and transplantation rates."
The authors discern that countries still using opt-out consent face organ donor shortages. A radical policy change is unlikely to rectify such a problem. Instead, they propose that changes to consensus legislation or adopting aspects of the Spanish Model could potentially boost donor rates.
Spain boasts the highest organ donation rate worldwide. They use opt-out consent but are widely acclaimed for their transplant coordination network that operates on both a local and a national level, as well as the enhanced quality of public information on donation.
Lately, Medical News Today shone the spotlight on whether animal organs should be cultivated for use in human transplants. Is this a viable solution to the organ shortage or a problem that necessitates policy changes regarding organ donation?
Written by James McIntosh
Additional Insights:When comparing the effectiveness of opt-in versus opt-out systems for organ donation, the opt-out system is generally considered more effective. Key reasons include:
- Presumed Consent: In an opt-out system, individuals are presumed to be organ donors unless they explicitly choose to opt-out. This approach increases the number of available organs for donation because it expands the pool of potential donors.
- Increased Donation Rates: Countries with opt-out systems typically have higher organ donation rates than countries with opt-in systems.
- Simplified Decision Process: By making donation the default, the decision-making process becomes easier for families and individuals.
- Increased Donor Pool: The opt-out system broadens the potential donor pool by including those who have not explicitly opted out, thereby increasing the number of available organs for transplantation.
- Psychological and Behavioral Impacts: The default of presumed consent can positively influence people’s decisions, as they are less likely to opt out than to actively opt in.
On the flip side, opt-in systems are supported by advocates who argue that explicit consent ensures that only those who have explicitly agreed to donate are considered donors. However, these systems often result in lower organ donation rates due to barriers to registration and a smaller potential donor pool.
- The research conducted by a team from the UK reveals that opt-out systems lead to an increase in the total number of livers and kidneys transplanted, possibly due to the presumed consent approach.
- In contrast, the opt-in system, as in the US, may result in a higher rate of kidney donations from living donors but generally leads to lower organ donation rates due to the smaller potential donor pool.
- Science and policy are crucial in this context as the findings suggest that opt-out consent strategies could be utilized to improve organ donation policies in various medical-health conditions.
- According to the University of Nottingham researchers, future studies focused on understanding the influence of consent legislation on organ donation and transplantation rates are necessary to strengthen the existing knowledge and develop effective health-and-wellness policies.
