Debate over Organ Donation: Which System - Opt-In or Opt-Out - Is More Effective?
Global organ donation policies differ significantly, prompting a question: is an opt-in or opt-out system more effective? A UK-based research team analyzed the organ donation procedures of 48 countries to determine the best approach, comparing opt-in and opt-out systems.
In an opt-in system, individuals must actively register to donate organs postmortem. On the other hand, under opt-out systems, organ donation automatically occurs unless a specific request is made to prohibit it before death.
Prof. Eamonn Ferguson, the study's lead author from the University of Nottingham, notes certain drawbacks associated with both systems due to their reliance on individuals' active decisions:
"People may procrastinate for various reasons, including loss aversion, effort, and trust in policy makers' decisions."
Inaction in an opt-in system may result in undesired non-donation by individuals who would have agreed to donate (a false negative). In contrast, inaction in an opt-out system could lead to an individual who does not wish to donate becoming a donor (a false positive).
The US employs an opt-in system. Last year, 28,000 transplants were facilitated via organ donors but unfortunately, 18 people still died daily due to a shortage of donated organs.
The researchers from the University of Nottingham, University of Stirling, and Northumbria University examined the organ donation systems of 48 countries over a 13-year period, with 23 using an opt-in system and 25 employing an opt-out system.
The study revealed higher total numbers of kidneys donated in countries using opt-out systems—the most sought-after organ for those on transplant lists. Opt-out systems also had more overall organ transplants. However, opt-in systems boasted a higher rate of kidney donations from living donors.
The authors acknowledge limitations in their study, such as varying levels of opt-out legislation and unassessed factors influencing organ donation. They suggest future research delving into the opinions and perspectives of those making the decision to opt in or opt out.
The researchers contend that, while opt-out consent may increase deceased donation and total numbers of livers and kidneys transplanted, complete policy change is unlikely to eradicate organ donor shortages. Instead, they suggest reconsidering consent legislation or adopting aspects of the "Spanish Model," which includes a transplant coordination network and improved public information about organ donation.
Spain boasts the highest organ donation rate globally. Experts attribute their success to the Spanish Model's implementation of opt-out consent, a nationwide and local transplant coordination network, and improved public information about organ donation.
Recent discussions have focused on whether to farm animal organs for human transplants as a potential solution to the organ shortage. Further research may help uncover whether this is a viable option or if the problem should be addressed through changes to organ donation policy.
This study, published in BMC Medicine, offers some insights but further investigation is needed to gain a more comprehensive understanding of the impact of consent legislation on donation and transplantation rates.
- User procrastination can lead to undesired non-donation in an opt-in system, as individuals may not actively register to donate organs postmortem.
- The study conducted by Prof. Eamonn Ferguson's team showed that opt-out systems result in higher total numbers of kidneys donated, due to automatic organ donation unless a specific request is made to prohibit it before death.
- The researchers suggest future investigations should delve into the opinions and perspectives of those making the decision to opt in or opt out, as unassessed factors influencing organ donation were not accounted for in the study.
- Improving public understanding and dialogue about organ donation, as well as changes to organ donation policy, could potentially help address organ donor shortages, according to the researchers, citing Spain's success using the Spanish Model.
