Is the opt-in or opt-out approach more effective for organ donation?
Living (and Dying) on the Organ Donor Spectrum: A Global Perspective on Opt-In vs Opt-Out Strategies
Organ donation policies worldwide dance a delicate balance between respecting individual wishes and saving lives. The question stands: is it better to opt in or opt out? To find answers, a team of researchers from the UK dived into the organ donation practices of 48 nations.
In opt-in systems, people must actively sign up to be donors posthumously. In contrast, opt-out systems presume consent, and organs are donated unless explicitly specified otherwise.
Prof. Eamonn Ferguson, the study's lead author from the University of Nottingham, recognizes that both systems are subject to their drawbacks:
"Individuals may not act for numerous reasons, including loss aversion, effort, and assuming policy makers make the 'right' decision."
Inaction within an opt-in system can result in unintentional non-donation from individuals who'd otherwise wish to donate. On the other hand, inaction in an opt-out system may cause unintentional donation from those who have no desire to donate.
The US relies on an opt-in system, with the U.S. Department of Health & Human Services reporting 28,000 transplants last year thanks to organ donors. However, around 18 people daily face an untimely death due to a lack of donated organs.
In or Out? The Great Divide
Researchers from the University of Nottingham, University of Stirling, and Northumbria University examined the organ donation systems of 48 countries over a 13-year span – 23 with opt-in systems and 25 with opt-out systems.
They measured total donor numbers, transplants per organ, and the total number of kidneys and livers transplanted from deceased and living donors. Their findings? Opt-out systems boasted higher total numbers of kidneys donated – the organ most in demand among transplant recipients. Opt-out systems also claimed a higher overall number of organ transplants.
Opt-in systems, however, showed a higher rate of kidney donations from living donors. The unexpected influence of policy on living donation rates, as stated by Prof. Ferguson, has previously gone unnoticed: "This subtlety needs to be highlighted and considered."
The authors acknowledge their study's limitations, such as the varying degrees of opt-out legislation across countries and the observational nature of the research. Other factors that may impact organ donation remain unassessed.
Moving Forward
The researchers Published in BMC Medicine state that their results 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 propose that future decisions on policy could benefit from the results, along with the collection and public availability of international organ donation information, such as consent type, procurement procedures, and hospital bed availability.
Prof. Ferguson encourages future studies to delve into the thoughts, wishes, and beliefs of individuals faced with the decision to opt in or opt out:
"Further research outside of the country-level epidemiological approach would focus on issues from the individual perspective, using survey and experimental methods."
The researchers note that countries using opt-out consent still face organ donor shortages. A complete system overhaul is unlikely to eradicate the problem. They propose that conceipt legislation or adopting aspects of the "Spanish Model" could help to boost donor rates.
Spain boasts the highest organ donation rate globally. The Spanish utilize opt-out consent, with their successes attributed to:
- A nationwide and local transplant coordination network
- Improved public information about organ donation
Recent discussions have prompted questions about the use of animal organs for human transplants as a potential solution to the organ shortage, or if this is an issue that should be addressed through changes to organ donation policy.
Written by James McIntosh
- The research by a team from the University of Nottingham, University of Stirling, and Northumbria University found that opt-out systems, where consent is presumed, result in higher total numbers of kidneys being donated compared to opt-in systems.
- The study also revealed that opt-out systems have a higher overall number of organ transplants, but opt-in systems show a higher rate of kidney donations from living donors, a subtlety that has previously gone unnoticed in the context of science and medical-conditions.
- Prof. Eamonn Ferguson suggests that future policy-and-legislation discussions could benefit from the study's findings, along with the collection and public availability of international organ donation information, as this could aid in retargeting efforts toward increasing donor rates.
- In addition, researchers propose that concept legislation or adopting aspects of the "Spanish Model" could help to boost donor rates, as Spain has the highest organ donation rate globally, which they attribute to a nationwide and local transplant coordination network and improved public information about organ donation.
- With ongoing discussions surrounding the potential use of animal organs for human transplants as a solution to organ shortages, the general-news realm is abuzz with the question of whether this issue should be addressed through changes to organ donation policy or through advancements in science and politics.
