Organ donation preference: Should it be an active or passive approach?
In a globe where organ donation policies differ significantly, an age-old question persists: is it more effective to have a donation system where individuals need to opt in, or opt out? To dig deeper, researchers from the UK have examined the organ donation practices of 48 nations to determine which approach yields the best results.
With an opt-in policy, people are obligated to actively enroll in a registry to donate their organs post-mortem. Conversely, in opt-out systems, organ donation takes place automatically unless specific instructions are given before death for organs to not be harvested.
Prof. Eamonn Ferguson, the lead author from the University of Nottingham, UK, recognizes that the reliance on individual decisions in both systems comes with its challenges:
"Worldwide, people may neglect to act for various reasons, such as aversion to loss, perceived effort, and trusting that policymakers have made the 'right' decision that they believe in."
Action in an opt-in system can, however, lead to false negatives—individuals wishing to donate but not doing so—while inaction in an opt-out system can result in potential false positives—individuals who don't wish to donate unknowingly becoming donors.
The US adheres to an opt-in system, with 28,000 organ transplants facilitated last year by organ donors. Sadly, around 18 people still die daily due to a scarcity of donated organs.
Researchers from the University of Nottingham, along with the University of Stirling and Northumbria University in the UK, analyzed the organ donation methods of 48 countries over a 13-year period, discovering some intriguing results:
- Higher Kidney Donations in Opt-Out Systems: Researchers found that countries employing an opt-out system of organ donation had significantly higher numbers of kidneys donated—the organ most sought after by individuals on transplant waiting lists.
- Overall Higher Transplant Rates in Opt-Out Systems: Opt-out systems also yielded higher overall numbers of organ transplants.
- Living Donor Rates in Opt-In Systems: While opt-out systems had more deceased donor transplants, opt-in systems demonstrated a higher rate of living donor kidney transplants.
The authors of the study acknowledge limitations, as they didn't distinguish between varying degrees of opt-out legislation (e.g., some countries require permission from next-of-kin before organs can be donated), and the observational nature meant that other contributing factors weren't assessed.
The researchers suggest that while their findings could guide future policy decisions, they could be further strengthened through the collection and dissemination of international organ donation data—consent type, procurement procedures, and hospital bed availability should be documented and made publicly accessible.
Future studies could also investigate individual perceptions and decision-making around opting in or opting out:
"More research is needed to explore individual viewpoints, beliefs, attitudes, and opinions regarding organ donation consent, using a combination of survey and experimental methods," says Prof. Ferguson.
The authors note that countries using opt-out consent still face organ donor shortages. A complete policy overhaul is unlikely to solve this issue, and they suggest that modifying consent legislation or adopting aspects of Spain's "Spanish Model" may help improve donor rates.
Spain currently boasts the highest organ donation rate globally. The success of Spain's donation practices is attributed to measures such as a transplant coordination network that operates both locally and nationally, and improved public information dissemination about organ donation.
Recently, Medical News Today explored the idea of farming animal organs for human transplants as a potential solution to the donor shortage. Is this the answer, or is the issue better addressed by changing organ donation policy?
As technology advances and attitudes toward organ donation evolve, it is vital to continue researching and examining policy options to ensure the best possible outcomes for those in need of life-saving organ transplants.
- The study reveals that opt-out systems, such as the one employed in Spain, tend to result in higher numbers of kidney donations, which are commonly sought after by individuals on transplant waiting lists.
- On a larger scale, opt-out systems have also demonstrated higher overall numbers of organ transplants, suggesting a more effective approach to organ donation.
- However, it's important to note that opt-in systems maintain a higher rate of living donor kidney transplants. This suggests a balance in the advantages and disadvantages of both systems.
- The researchers emphasize that while their findings may influence future policy decisions, more comprehensive international organ donation data should be collected and made publicly accessible for more accurate analysis.
- Future research could also delve into individual perceptions and decision-making processes regarding organ donation consent, aiming to better understand the factors influencing people's choice between opting in or opting out.
