Organ donation protocol: Should it be an affirmative or presumed consent system?
Organ donation policies across the globe exhibit striking disparities, with the question of whether people should opt in or opt out being hotly debated. To shed light on this topic, a team of researchers from the UK delved into the organ donation protocols of 48 nations to determine which approach yields the best results.
An opt-in system calls for individuals to actively register as organ donors upon their demise. On the other hand, opt-out systems automatically donate organs unless a specific request is made before death to forego donation.
Prof. Eamonn Ferguson, the lead author from the University of Nottingham, acknowledges the potential drawbacks of relying on an active decision from individuals:
"Individuals may not act for numerous reasons, including loss aversion, effort, and believing that the policy makers have made the 'right' decision and one that they believe in."
Inaction in an opt-in system can lead to individuals who desire to donate not actually doing so (false negatives). Conversely, inaction in an opt-out system could potentially result in an individual who doesn't wish to donate becoming a donor (false positive).
The US currently operates under an opt-in system. Last year, 28,000 transplants were made possible due to organ donors. Unfortunately, around 18 people die every day due to a scarcity of donated organs.
Sign 'em up or let 'em go?
Researchers from the University of Nottingham, University of Stirling, and Northumbria University in the UK analyzed the 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.
The study authors measured overall donor numbers, organ transplants per organ, and the total number of kidneys and livers transplanted from both deceased and living donors.
They found that countries utilizing opt-out systems of organ donation had higher total numbers of kidneys donated - the organ most sought-after by those on organ transplant lists. Opt-out systems also boasted the highest overall number of organ transplants.
Opt-in systems, however, displayed a higher rate of kidney donations from living donors. The authors attribute this discrepancy to the influence of policy on living donation rates, a factor they claim hasn't been reported before.
The authors admit that their study has limitations, such as not taking into account differences in the degrees of opt-out legislation and not assessing other factors that may affect organ donation. The study's observational nature means that these variables remained unaddressed.
Looking to the future
The researchers posit that their findings, published in BMC Medicine, show 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 guide future policy decisions, but could be strengthened further through the collection and sharing of international organ donation information. Consent type, procurement procedures, and hospital bed availability are examples of aspects that should be evaluated and made public.
Prof. Ferguson suggests that future studies could examine individual beliefs, wishes, and attitudes towards opting in or opting out:
"Further research outside of this country-level epidemiological approach would be to examine issues from the perspective of the individual."
The authors point out that countries using opt-out consent still experience organ donor shortages. A complete overhaul of the system may not solve such a problem, but changes to consent legislation or adopting aspects of the "Spanish Model" could potentially improve donor rates.
Spain currently owns the highest organ donation rate in the world. The Spanish employ opt-out consent, but experts credit their success to measures such as a transplant coordination network that operates both locally and nationally and improved public information about organ donation.
Recently, Medical News Today featured a spotlight on animal organ farming for human transplants. Could this be a solution to the organ shortage, or is this a problem to be addressed through changes to organ donation policy?
Written by James McIntosh
- The study conducted by the UK researchers comparing opt-in and opt-out organ donation systems revealed that opt-out systems led to higher total numbers of kidneys donated and the highest overall number of organ transplants.
- Interestingly, opt-in systems showed a higher rate of kidney donations from living donors, a discrepancy the authors attribute to policy influence on donation rates.
- In light of these findings, the authors suggest that future policy decisions could benefit from considering the impact of opt-out consent on both deceased and living donations, as well as the adoption of measures such as Spain's transplant coordination network and improved public information about organ donation.
- With the ongoing debate about the organ shortage, the question arises whether we should focus on alternative solutions like animal organ farming for human transplants, or address the issue through changes to organ donation policy and legislation.
