Organ Donation: Which System - Opt-In or Opt-Out - Is More Efficient?
International organ donation policies exhibit significant variations across the globe, leading to discussions about the most effective approach – opt-in or opt-out. Researchers from the University of Nottingham, alongside colleagues from the Universities of Stirling and Northumbria, have analyzed organ donation protocols in 48 countries for a 13-year period to examine which method works best.
Two contrasting systems exist for organ donation: opt-out and opt-in. In an opt-out system, an individual's organs are automatically donated following their death, unless specific requests are made for organs not to be taken. Conversely, an opt-in system requires individuals to actively enroll in a donor registry.
Prof. Eamonn Ferguson, lead author from the University of Nottingham, recognizes challenges associated with both systems. He explained, "The reliance on an active decision from individuals can lead to drawbacks, such as inaction due to loss aversion, effort, or the belief that policy makers have made the 'right' decision."
While inaction in an opt-in system could potentially result in individuals who would have wanted to donate failing to do so (a false negative), inaction in an opt-out system could lead to an individual who does not wish to donate becoming a donor (a false positive).
The United States currently employs an opt-in system. According to the US Department of Health & Human Services, over 28,000 organ transplants were made possible last year due to organ donors. Approximately 79 people receive organ transplants daily, but regrettably, around 18 people die daily due to a shortage of donated organs.
Upon assessing the systems of 48 countries, the researchers found that countries using opt-out systems of organ donation had higher total numbers of kidneys donated, which is the organ most often sought after by those on organ transplant lists. Opt-out systems also demonstrated higher overall numbers of organ transplants. Although opt-in systems featured a higher rate of kidney donations from living donors, this influence on living donation rates has not been previously reported.
The authors acknowledge that their study was limited by not distinguishing between different extents of opt-out legislation and not considering other factors that could impact organ donation. Future studies could focus on understanding the perspectives of individuals faced with the decision to opt-in or opt-out, using surveys and experimental methods.
The researchers conclude that their findings, published in BMC Medicine, suggest that opt-out consent is associated with an increase in deceased organ donation but a decrease in living donation rates. They also found that opt-out consent led to an increase in the total number of livers and kidneys transplanted. They note that countries using opt-out consent still experience organ donor shortages and suggest that policy changes or adopting aspects of the "Spanish Model" may help improve donor rates.
Spain boasts the highest organ donation rate globally. The Spanish have implemented opt-out consent, but their success is attributed to measures such as a transplant coordination network operating at both the local and national levels, as well as the provision of high-quality public information about organ donation.
While some have debated whether farming animal organs for human transplants could serve as a solution to the organ shortage, experts suggests that addressing the problem through changes to organ donation policy may offer a more promising approach.
- The researchers found that countries adopting opt-out organ donation systems exhibit higher total numbers of kidneys donated, due to this method's contextual effectiveness.
- In the United States, which employs an opt-in system, over 28,000 organ transplants were made possible last year, yet regrettably, around 18 people still die daily due to a shortage of donated organs.
- Future studies should focus on understanding the perspectives of individuals faced with the decision to opt-in or opt-out, as this knowledge could potentially improve organ donation rates and alleviate medical-conditions related to health-and-wellness.
- In contrast to the debate about farming animal organs as a solution, scientists emphasize that addressing the organ shortage through changes to organ donation policy, like the Spanish Model, may offer a more promising approach to improve health-and-wellness.
