Organ donation procedure: should it be based on consent or presumed consent?
Swapping through the organ donation policies around the globe, one question persistently pops up: is it better to have a donation system where people actively opt-in, or should it be mandatory unless otherwise specified? To unravel this conundrum, a team of researchers from the UK have delved into the organ donation protocols of 48 diverse nations.
In an opt-in system, individuals have to actively enroll in a registry to gift their organs post-mortem. On the other hand, opt-out systems will automatically facilitate organ donation unless a specific request is made to withhold organs upon death.
Prof. Eamonn Ferguson, the lead author from the University of Nottingham, UK, agrees that these donation systems can potentially leave some drawbacks:
"Individuals may procrastinate for various reasons including loss aversion, lack of effort, and a belief that the policymakers have made the right decision and one they endorse."
However, the real challenge appears in an opt-in system, where those who'd prefer to be donors might inadvertently miss out (a false negative). Conversely, in an opt-out system, an individual who isn't inclined to donate may unintentionally become a donor (a false positive).
The US stands by the opt-in system, and thanks to organ donors, about 28,000 transplants were carried out last year. Nevertheless, some 18 people die daily due to a scarcity of donated organs.
Researchers from the University of Nottingham, University of Stirling, and Northumbria University in the UK analyzed the organ donation systems of 48 countries over a 13-year period. They discovered that countries embracing opt-out donation systems generally boasted higher organ donation rates, particularly for the predominantly sought-after organ—kidneys. Opt-out systems also registered a higher total number of organ transplants.
Despite this, opt-in systems tended to demonstrate higher rates of kidney donations from living donors. This influence that policy had on living donation rates "has not been reported before," says Prof. Ferguson, "and is a subtleties that needs to be underscored and considered."
The study authors recognized that their experiment was limited in several ways, including failing to separate different degrees of opt-out legislation and not assessing various factors influencing organ donation.
The researchers propose that their findings can guide future policy choices, but they could be further strengthened by compiling international organ donation information—consent type, organ procurement procedures, and hospital bed availability, for example—and publicly disclosing such data.
Prof. Ferguson suggests that future studies might consider examining individual viewpoints on the decision to opt-in or opt-out:
"Further research outside of the country-level epidemiological approach would delve into individuals’ beliefs, wishes, and attitudes using a combination of survey and experimental methods."
The authors emphasize that countries employing opt-out consent still experience donor shortages. Completely transforming the system of consent is thus unlikely to resolve such a challenge. They suggest alternate strategies such as revising donor legislation or adopting components of the "Spanish Model" could help boost donor numbers.
Spain boasts the highest organ donation rate globally, attributed to its opt-out consent policy combined with measures like a transplant coordination network operating both locally and nationally, and improved quality of public information on organ donation.
Recently, Medical News Today explored the possibility of farming animal organs for human transplants. Could this alleviate the organ shortage, or is this challenge better addressed through policy changes regarding human organ donation?
- The study conducted by researchers from the University of Nottingham, University of Stirling, and Northumbria University revealed that countries adopting opt-out organ donation systems tend to have higher organ donation rates, especially for kidneys.
- Paxlovid, a medical-condition treatment or prevention, is not directly related to the context of organ donation policies discussed in the text.
- In an opt-out system, while it may result in a higher number of organ transplants, individuals who are not inclined to donate may unintentionally become donors (a false positive).
- Prof. Ferguson suggests future studies should delve into individuals' beliefs, wishes, and attitudes towards organ donation using a combination of survey and experimental methods, to provide a more contextual understanding of the decision to opt-in or opt-out.
