Organ Donation: Which Method - Consent-Based or Presumed Consent

Organ Donation: Should it Be 'Opt In' or 'Opt Out'?

The world is divided over organ donation policies, with some nations opting for individuals to actively register their consent (opt-in) and others assuming consent unless otherwise stated (opt-out). A team of researchers from the UK took a deep dive into the organ donation practices of 48 countries to determine which approach works best.

Under an opt-in system, people must proactively sign up to become organ donors, either before or after death. In opt-out systems, organ donation takes place automatically unless an individual specifically declines before passing.

Prof. Eamonn Ferguson, the study's lead author from the University of Nottingham, acknowledges that the dependence on individual decisions can present challenges. "People often don't act for a myriad of reasons such as loss aversion, laziness, or trusting that policy makers have made the 'right' decision," he states.

While inaction in an opt-in system can result in potential 'false negatives' – individuals who would want to donate but don't – inaction in an opt-out system can lead to 'false positives' – persons who wouldn't wish to donate yet end up doing so.

The United States adheres to an opt-in system. Last year, 28,000 transplants were made possible due to organ donors. Sadly, approximately 18 people die every day due to a shortage of donated organs, unable to receive life-saving surgery.

In or Out?

The research team, comprising members from the University of Nottingham, University of Stirling, and Northumbria University in the UK, analyzed the organ donation policies of 48 countries over 13 years. 23 countries followed an opt-in system, while 25 adopted an opt-out approach.

The study investigated overall donor numbers, transplants per organ, and the total number of kidneys and livers transplanted from both deceased and living donors. They found that opt-out systems resulted in higher total numbers of kidneys donated – the organ most in demand among those on organ transplant lists. Opt-out systems also recorded higher overall organ transplant numbers.

Opt-in systems, however, had a higher rate of kidney donations from living donors. This apparent impact of policy on living donation rates, according to Prof. Ferguson, is novel and merits further scrutiny.

It's worth noting that the study's limitations include the lack of distinction between various degrees of opt-out legislation, as some countries require permission from next-of-kin for organ donation. Additionally, the observational nature of the study neglects other factors that might impact organ donation.

The Future

The researchers' findings, published in BMC Medicine, underscore 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, while these results could guide future policy decisions, they could be strengthened through collecting and making public international organ donation information, such as consent type, procurement procedures, and hospital bed availability.

Prof. Ferguson encourages future research to examine individual perspectives on donation consent, including beliefs, wishes, and attitudes, employing a mix of surveys and experimental methods. This would provide insight into the impact of consent legislation on organ donation and transplantation rates.

The authors note that countries employing opt-out consent still face organ donor shortages. They propose that refining consent legislation or adopting aspects of the "Spanish Model" could be methods to boost donor rates.

Spain boasts the highest organ donation rate globally, attributing their success to measures such as a transplant co-ordination network operating locally and nationally, and improved public information about organ donation.

Recently, Medical News Today explored the feasibility of farming animal organs for human transplants. This potential solution to the organ shortage or a problem to be addressed through changes to organ donation policy merits further discussion.

Written by James McIntosh

Insights:- Opt-out vs Opt-in: Opt-out systems usually lead to higher overall organ donation rates and increased organ transplants, primarily due to a broader donor pool. Opt-in systems tend to produce more living donor kidney transplants but fewer overall and deceased donor transplants.- Disparities: Regarding disparities in minority communities, enhanced education and outreach efforts are essential to bridge gaps in donor registration rates and trust issues. Complementary measures beyond consent systems are needed to address these disparities.- Artificial Intelligence: While artificial intelligence is improving transplant outcomes and allocation, it does not compensate for the fundamental impact of donor registration systems on the organ donation supply.- Spanish Model: Countries wishing to improve their organ donation rates could learn from Spain's success by implementing their combination of opt-out consent, coordinated transplant networks, and exemplary public information about organ donation.

The research, published in BMC Medicine, suggests that opt-out systems may lead to an increase in deceased organ donation but a reduction in living donation rates.
In contextualizing the study, Prof. Ferguson acknowledges that the dependence on individual decisions can present challenges, and people often don't act due to various reasons such as loss aversion or trusting that policy makers have made the 'right' decision.
Under a retargeted approach, medical-health organizations might focus on increasing awareness about the importance of organ donation, especially in minority communities, to bridge gaps in donor registration rates and address trust issues.
The implementation of science-driven organ donation practices, such as those seen in Spain, might provide solutions for health-and-wellness issues related to organ shortages by adopting aspects like opt-out consent, coordinated transplant networks, and increased public information.