Organ donation: should it be a matter of choice or a presumed consent?
Organ Donation Policies: Boosting Organ Transplants Through Opt-In or Opt-Out?
An investigation issued by a team of UK researchers analyzes the organ donation protocols of 48 diverse countries to decipher which approach effectively maximizes organ transplants.
Two prominent organ donation systems present themselves globally – opt-in and opt-out. In the former, individuals must actively sign up to a donor registry, while in the latter, organ donation ensues unless an explicit objection is communicated before death.
Prof. Eamonn Ferguson, the study's lead author from the University of Nottingham, UK, illuminates the drawbacks of both systems that rely on individuals' active decisions:
"People may procrastinate for numerous reasons, including loss aversion, apathy, and the presumption that policy makers have made informed, morally sound choices."
However, a failure to act in an opt-in system can result in individuals wishing to donate not doing so (a false negative). Meanwhile, a failure to act in an opt-out system can potentially culminate in an individual who does not wish to donate, unintentionally becoming a donor (a false positive).
The United States operates under an opt-in system, with the US Department of Health & Human Services reporting that 28,000 transplants were facilitated last year due to organ donors. Yet despite this, an unfortunate 18 individuals still meet their end daily due to a deficient amount of donated organs.
The Great Debate: In or Out?
Researchers from the University of Nottingham, University of Stirling, and Northumbria University delved into the organ donation systems of 48 countries over a 13-year period, only to discover that countries employing opt-out systems showcased higher overall numbers of kidney donations – an organ that the majority of individuals awaiting a transplant desperately need. Opt-out systems also boasted greater overall organ transplant numbers.
Opt-in systems, however, exhibited a higher rate of kidney donations from living donors. Professor Ferguson points out that "the influence this policy has on donation rates from living donors 'has not been reported before,' underscoring its importance."
The researchers admit that their study was constrained by not distinguishing varying degrees of opt-out legislation, as some countries require permission from next-of-kin for organs to be donated. Additionally, the observational nature of the study meant other potential factors behind organ donation were unaccounted for.
Paving the Way Forward
The authors conclude that "opt-out consent may lead to an increase in deceased donations 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 future policy decisions could be informed by these findings, but could be made even more robust through the systematic collection and public disclosure of international organ donation information such as consent type, procurement methods, and hospital bed availability.
Professor Ferguson suggests further studies that examine individual viewpoints and attitudes towards organ donation, as well as investigating how these perspectives might impact donation and transplantation rates.
The authors also emphasize that countries using opt-out consent still face organ donor shortages. Transforming the system of consent alone is unlikely to overcome such a challenge. Instead, they suggest that revising consent legislation or adopting elements of the "Spanish Model" could improve donation rates.
Spain, which currently holds the highest organ donation rate globally, swears by opt-out consent. Experts attribute their success to various factors like a transplant co-ordination network spanning both local and national levels and a commitment to enhancing the quality of public information about organ donation.
Recently, Medical News Today published a feature discussing the ethical complexities of farming animal organs for human transplants. Could this potential solution alleviate organ shortages, or is this a problem that should be addressed through changes to organ donation policy?
Written by James McIntosh
- The study conducted by a team from the University of Nottingham, University of Stirling, and Northumbria University investigated organ donation systems in 48 countries over a 13-year period, finding that countries with opt-out systems had higher overall organ transplant numbers, including kidneys, a crucial organ for individuals waiting for transplants.
- Opt-in systems, however, displayed a higher rate of kidney donations from living donors, a factor that Professor Ferguson points out has not been previously reported.
- Despite adhering to an opt-in system, the United States still experiences daily deaths for lack of organ donors, emphasizing the need for more donors in the system.
- The authors of the study propose that future policy decisions could be strengthened by gathering and disclosing international organ donation information, such as consent type, procurement methods, and hospital bed availability.
- In addition to revising consent legislation or adopting aspects of the "Spanish Model," the authors suggest focusing on individual perspectives and attitudes towards organ donation to help address donation and transplantation rates.
- The ethical complexities of farming animal organs for human transplants have been discussed in recent publications, raising questions about whether this could alleviate organ shortages or if policy changes should address the issue instead.
