Debate over Organ Donation: Which System - Consent-Based or Presumed Consent - is More Effective?
Revamped Discourse: Opt-In or Opt-Out: Which Organ Donation System Makes the Cut?
Across the globe, organ donation protocols take a plethora of shapes. The question remains: Is it better to have a system where people intentionally enroll or one where they are automatically included? To shed light on this conundrum, researchers from the UK dived deep into the organ donation procedures of 48 nations.
The debate centers around opt-in and opt-out systems. With the former, people are obligated to sign up to a registry to donate their organs posthumously. In contrast, the latter implies that organ donation happens automatically unless a specific request is made before death for organs to be ignored.
Prof. Eamonn Ferguson, the lead author from the University of Nottingham, UK, acknowledges potential drawbacks stemming from the reliance on active participation from individuals:
"People might not act for numerous reasons, such as loss aversion, lack of effort, or the belief that policy makers have made the right decision."
However, inaction in an opt-in system might result in individuals wishing to donate but not getting the chance (false negatives). On the flip side, inaction in an opt-out system could potentially lead to individuals against donation unwittingly becoming donors (false positives).
The United States opts for an opt-in system. According to the US Department of Health & Human Services, 28,000 transplants were made possible last year due to organ donors, with approximately 79 individuals receiving organ transplants daily. Regretfully, approximately 18 people die each day due to a shortage of donated organs.
Systematic Assessment:
Scholars from the University of Nottingham, the University of Stirling, and Northumbria University in the UK scrutinized the organ donation systems of 48 countries over a period of 13 years - 23 utilizing an opt-in system and 25 adopting an opt-out system.
The study authors gauged overall donor numbers, the number of transplants per organ, and the total number of kidneys and livers transplanted from both deceased and living donors.
Intriguingly, they found that countries using opt-out systems witnessed higher total kidney donations - the organ most sought after by individuals on organ transplant lists. Moreover, opt-out systems had the greater overall number of organ transplants.
Opt-in systems, however, boasted a higher rate of kidney donations from living donors. The influence exerted by policy on the living donation rates, as Prof. Ferguson points out, is an unprecedented finding.
The researchers caution that their study was limited by not distinguishing between different 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 that may impact organ donation went unassessed.
Big Picture Thinking:
The researchers express that their findings, published in BMC Medicine, show that opt-out consent could potentially boost deceased donation while reducing living donation rates. Moreover, opt-out consent is associated with an increase in the total number of livers and kidneys transplanted.
They propose that the results could be used in the future to shape policy decisions, but could be further bolstered by the systematic collection and dissemination of international organ donation information, such as consent type, procurement procedures, and hospital bed availability.
Prof. Ferguson suggests that future studies could delve into individual perspectives, examining beliefs, wishes, and attitudes related to consent legislation:
"By combining these different research methods, researchers can develop a comprehensive understanding of the impact of consent legislation on organ donation and transplantation rates."
The authors concede that nations using opt-out consent still encounter organ donor shortages. A total transformation of the system might not solve this problem. Instead, they propose that tweaking consent legislation or emulating aspects of the "Spanish Model" could help augment donor rates.
Spain currently has the world's highest organ donation rate. The country's success is credited to measures such as a transplant coordination network that spans both locally and nationally, and enhancing the quality of public information available on organ donation.
Recently, Medical News Today explored whether farming animal organs for human transplants could be a solution to the organ shortage or an issue that ought to be tackled via changes in organ donation policy.
- The study from the University of Nottingham, University of Stirling, and Northumbria University found that countries using opt-out systems had a greater overall number of organ transplants, particularly for kidneys, which is the organ most sought after by individuals on organ transplant lists.
- Opt-in systems, however, boasted a higher rate of kidney donations from living donors, and the influence exerted by policy on living donation rates is an unprecedented finding.
- The researchers caution that the study was limited by not distinguishing between different degrees of opt-out legislation and the observational nature of the study meant that other factors that may impact organ donation went unassessed.
- In the future, researchers could delve into individual perspectives, examining beliefs, wishes, and attitudes related to consent legislation and combining these different research methods to develop a comprehensive understanding of the impact of consent legislation on organ donation and transplantation rates.
