Debate over Organ Donation: Should It Be an Opt-In or Opt-Out System?

Across the globe, the approach to organ donation varies substantially, with ongoing debate over whether an opt-in or opt-out system is more effective. Researchers from the University of Nottingham, UK, have examined the organ donation protocols of 48 countries to determine which method is achieving the best results.

Opt-in systems require individuals to actively sign up to a donor registry following their death, while opt-out systems automatically donate organs unless an individual specifically requests otherwise before passing. One concern with both systems relates to inaction, according to Professor Eamonn Ferguson, lead author from the University of Nottingham. He explains that individuals may not act for various reasons, such as loss aversion, minimal effort, and the belief that policy makers have made informed decisions.

In an opt-in system, inaction can result in those who would have willingly donated failing to do so (a false negative). In contrast, inaction in an opt-out system can lead to an individual not wishing to donate becoming a donor inadvertently (a false positive).

The US adheres to an opt-in system, with transplants being made possible for over 28,000 patients last year thanks to organ donors. Regrettably, approximately 18 people die daily due to a shortage of donated organs, having missed the opportunity for life-saving surgery.

Researchers from the University of Nottingham, University of Stirling, and Northumbria University analyzed the organ donation systems of 48 countries for a 13-year period, finding that countries utilizing opt-out systems yielded a higher volume of kidney donations – the organ most in need by those on transplant lists. These countries also reported greater overall organ transplant numbers.

Opt-in systems did exhibit a higher rate of kidney donations from living donors, a point acknowledged by the study's authors as previously unreported. They suggest that policy can indeed impact living donation rates, requiring further consideration.

It is important to note that the study authors did not differentiate between the degrees of opt-out legislation, with some countries requiring permission from next-of-kin for organs to be donated. Additionally, the observational nature of the study meant that other factors affecting organ donation remained unassessed.

The researchers suggest that their findings, published in BMC Medicine, demonstrate that opt-out consent may result in increased deceased donations but reduced living donation rates, with a corresponding increase in the total number of livers and kidneys transplanted. While their results may inform future policy decisions, the authors propose that the collection of international organ donation information – such as consent type, procurement procedures, and hospital bed availability – could provide valuable insight and should be made available to the public.

Further research could delve into the perspectives of those making the decision to opt in or opt out, exploring beliefs, wishes, and attitudes through a mixture of surveys and experimental methods. This approach might offer greater understanding of the impact of consent legislation on donation and transplantation rates.

The authors acknowledge that countries using opt-out consent still experience donor shortages and suggest that consent legislation or adopting elements of the "Spanish Model" could potentially improve donor rates in the future. Spain currently boasts the highest organ donation rate globally, attributed to a robust national transplant system, public awareness campaigns, strong public information, and a dedicated transplant coordination network.

The debate over whether animal organs should be farmed for human transplants remains an ongoing consideration, with some viewing this as a potential solution to the organ shortage or a problem to be addressed by altering organ donation policies.

The study's authors propose that the collection of international organ donation information could provide valuable insight, such as consent type, procurement procedures, and hospital bed availability.
Research suggests that opt-out consent may result in increased deceased donations but reduced living donation rates, potentially impacting the total number of livers and kidneys transplanted.
Scientists have contemplated the consideration of farming animal organs for human transplants as a potential solution to the organ shortage, but it remains an ongoing debate.
In the realm of health-and-wellness, contextual factors such as beliefs, wishes, and attitudes toward donation and transplantation may be influenceable through retargeting strategies based on survey results and experimental methods.