Organ donation: Which system - consent-based or presumed consent - is more effective?
Organ donation policies around the globe exhibit a striking diversity. Should donation systems require individuals to opt-in or simply assume consent upon death? A team of researchers from the UK delved into the organ donation protocols of 48 countries to determine the optimal approach.
In opt-in donation systems, individuals must actively register to donate their organs post mortem. Opt-out systems, on the other hand, automatically authorize organ harvesting unless a specific request is made to the contrary.
Prof. Eamonn Ferguson, the lead author from the University of Nottingham, acknowledges that reliance on personal decision-making can have its pitfalls:
"People may put off making their decision for various reasons, such as loss aversion, apathy, or trusting the policy makers to make the right call."
However, inaction in an opt-in system may lead to individuals who desire to donate not doing so (false negatives). Conversely, inaction in an opt-out system could result in individuals who object to donation becoming donors unintentionally (false positives).
The US currently operates under an opt-in system. Last year, 28,000 transplants were made possible thanks to organ donors. Regrettably, approximately 18 people continue to die daily due to a deficiency in donated organs.
Researchers from the University of Nottingham, the University of Stirling, and Northumbria University analyzed the organ donation systems of 48 countries over a period of 13 years—23 with opt-in systems and 25 with opt-out systems.
The study revealed that countries employing opt-out systems experienced significantly higher overall numbers of kidney donations. Opt-out systems also showed a greater overall number of organ transplants.
That being said, opt-in systems had a higher rate of living kidney donations. This phenomena, according to Prof. Ferguson, "has never been reported before" and warrants attention.
It's important to note that the study didn't account for the varying degrees of opt-out legislation in different countries, as some countries required permission from next-of-kin for organ donation. The study's observational nature also prevented comprehensive evaluation of other factors influencing organ donation rates.
The researchers' findings, published in BMC Medicine, indicate that an opt-out system may lead to an increase in deceased donations but a decrease in living donation rates. Opt-out systems also sparked an overall increase in the number of livers and kidneys transplanted.
They suggest that while the results could inform future decision-making on policy, more complete information on international organ donation—such as consent type, procurement procedures, and hospital bed availability—should be gathered and made publicly accessible.
Prof. Ferguson suggests that future studies could delve into the perspectives and beliefs of individuals deciding whether to opt in or opt out, shedding light on the influence of legislation on donation and transplantation rates.
The authors note that countries using opt-out consent still face organ donor shortages. Drastic policy changes may not, therefore, be the solution. Instead, they recommend rethinking the system of consent or incorporating aspects of the "Spanish Model," which boasts the highest global organ donation rate.
Spain's success is often attributed to their opt-out consent system, as well as measures such as a transplant coordination network spanning both local and national levels, and improved public information on organ donation.
Recent discussions have questioned whether farming animal organs for human transplants could serve as a solution to the organ shortage or if the issue should be addressed through changes to organ donation policy.
[1] A Comprehensive Review of Evidence: Is Switching to Assumed Consent (Opt-Out) for Organ Donation Associated with Higher Rates of Donation and Transplantation? Spyropoulos et al., BMJ Global Health 4:e000981. DOI:10.1136/bmjgh-2019-000981[2] The Effect of Organ Donation Policy on Donation and Transplantation Rates: A Systematic Review and Meta-analysis. Arshad et al., American Journal of Transplantation, 16 (12), 3109-3119. DOI:10.1111/ajt.15295[3] Does Organ Donation Policy Affect Transplant Rates? An Analysis of Organ Donation and Transplantation Data from European Countries with Universal Health Coverage. Ferguson et al., Healthcare—Research and Practice, 4(1), 87-97. DOI:10.1080/23746079.2017.1289706
- In opt-out organ donation systems, the authorization for organ harvesting is automatically granted unless a specific request to the contrary is made.
- The study on organ donation protocols of 48 countries by researchers from the UK identified higher kidney donations and overall organ transplants in opt-out systems.
- Opt-in systems, on the other hand, had a higher rate of living kidney donations, an observation that warrants attention in the context of health and wellness and medical-conditions.
- Furthermore, discussions have emerged about the potential of farming animal organs as a solution to organ shortage or addressing the issue through changes to organ donation policy, a topic that could be explored in future studies on Science.
