Organ Donation: Which System - Opt-In or Opt-Out - Is More Effective?
In the vast world, the approach to organ donation varies drastically from nation to nation. Both opt-in and opt-out systems exist, but which one is more effective? A team of researchers from the UK has delved into the organ donation practices of 48 countries to shed light on this subject.
An opt-in system encourages individuals to actively participate in the donor registry, registering their intention to donate organs after death. Alternatively, an opt-out system assumes people are donors unless they specifically request otherwise before passing.
Prof. Eamonn Ferguson, the lead author from the University of Nottingham, recognizes potential drawbacks of these systems, which are reliant on personal decisions:
"People might choose not act for numerous reasons, such as loss aversion, effort, or the belief that policy makers have made the right decision."
However, inaction in an opt-in system may result in potential donors not donating (a false negative). In contrast, inaction in an opt-out system could lead to someone who doesn't want to donate unintentionally donating (a false positive).
Currently, the US operates under an opt-in system, with 28,000 transplants achieved last year due to donors. Unfortunately, around 18 people die each day due to a lack of donated organs.
To opt-in or opt-out?
The researchers from the University of Nottingham, the University of Stirling, and Northumbria University analyzed the organ donation policies of 48 countries for a period of 13 years, with 23 utilizing opt-in systems and 25 using opt-out systems.
The team measured overall donor numbers, number of transplants per organ, and the total number of kidneys and livers transplanted from both deceased and living donors.
They discovered that countries employing opt-out systems of organ donation had higher total numbers of kidneys donated. Opt-out systems also recorded the greater overall number of organ transplants.
Opt-in systems, however, had a higher rate of kidney donations from living donors. This apparent impact of policy on living donation rates is a novel finding, according to Prof. Ferguson, and is a subtlety that deserves attention.
The researchers admit that their study had limitations, as it did not differentiate between varying degrees of opt-out legislation and did not assess other factors influencing organ donation.
The road ahead
The researchers state that their findings, published in BMC Medicine, suggest 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 be utilized in the future to inform policy decisions. However, they could be strengthened further through the regular collection and public availability of international organ donation information, such as consent type, procurement procedures, and hospital bed availability.
Prof. Ferguson proposes that future studies should examine the perspectives of individuals making the decision to opt in or opt out, using a combination of surveys and experimental methods.
"By combining these different research methods, researchers can develop a greater understanding of the influence of consent legislation on organ donation and transplantation rates," he says.
The authors acknowledge that countries utilizing opt-out consent still face organ donor shortages. A complete change in the donation system is unlikely to eradicate this problem. Instead, they suggest that changes to consent legislation or adopting aspects of the "Spanish Model" could enhance donor rates.
Spain currently boasts the highest organ donation rate in the world. Their success is attributed to a transplant coordination network that operates locally and nationally, and the improvement of public information available about organ donation.
Recently, Medical News Today explores the notion of farmed animal organs for human transplants. Could this be a solution to the organ shortage, or is it a problem that should be addressed through changes to organ donation policy?
- The study conducted by the researchers from the University of Nottingham, University of Stirling, and Northumbria University found that countries employing opt-out systems of organ donation had higher total numbers of kidneys donated and a greater overall number of organ transplants.
- Opt-in systems, on the other hand, had a higher rate of kidney donations from living donors, according to the research team, which is a novel finding.
- In the future, these results could be utilized to inform policy decisions, but the researchers admit that their study had limitations, as it did not differentiate between varying degrees of opt-out legislation and did not assess other factors influencing organ donation.
- As the debate about potential solutions to organ shortage continues, some are exploring the idea of using farmed animal organs for human transplants, as recently reported by Medical News Today, but Prof. Ferguson proposes that changes to organ donation policy or adopting aspects of the "Spanish Model" could be a more effective approach to enhancing donor rates.
