Is it more advantageous to implement an opt-out or opt-in system for organ donation?
Organ donation policies worldwide show vast differences, with the debate surrounding opt-in versus opt-out systems heating up. To settle the discussion, a team of researchers from the UK has analyzed the organ donation protocols of 48 countries over a 13-year period. The question on everyone's minds: which approach works best?
Under opt-in, people must sign up to a registry to donate their organs posthumously. In contrast, opt-out systems involve organ donation automatically unless an individual specifically requests otherwise before death.
Dr. Eamonn Ferguson, lead author from the University of Nottingham, UK, recognizes that relying on individual decisions can lead to pitfalls in both systems:
"People may not act for numerous reasons, including loss aversion, effort, and believing that policy makers have already made the 'right' decision."
Inaction in an opt-in system can result in false negatives, where individuals who would wish to donate fail to do so. Conversely, inaction in an opt-out system could lead to individuals who do not want to donate becoming donors (false positives).
The United States currently employs an opt-in system. Last year, 28,000 transplants were made possible due to organ donors, yet around 18 people die daily due to a shortage of donated organs.
To In or To Out?
The researchers from the University of Nottingham, the University of Stirling, and Northumbria University in the UK studied the organ donation systems of 48 countries. After analyzing data for 13 years, they found that countries using opt-out systems had higher total numbers of kidneys and livers donated, as most people on the transplant list are waiting for kidneys. Additionally, opt-out systems saw a greater overall number of organ transplants.
However, opt-in systems showed a higher rate of kidney donations from living donors. The influence that policy had on living donation rates, according to Prof. Ferguson, "has not been reported before."
The authors acknowledge that their study had limitations, such as not accounting for different degrees of opt-out legislation and not assessing other factors impacting organ donation.
The Future of Organ Donation
The researchers' findings, published in BMC Medicine, 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 suggest that these results could inform future policy decisions, but they could be strengthened through the collection of international organ donation information, such as consent type, procurement procedures, and hospital bed availability, to create transparency and facilitate further comparative analyses.
Prof. Ferguson also proposes future studies examining individuals' beliefs, wishes, and attitudes regarding organ donation, using a combination of surveys and experimental methods.
The authors point out that countries using opt-out consent still face organ donor shortages. A complete system change isn't likely to solve the problem. Instead, the authors suggest that changes to consent legislation or adopting aspects of the "Spanish Model" could improve donor rates.
Spain boasts the highest organ donation rate globally and utilizes an opt-out consent system. Spain's success, according to experts, is attributed to factors like a transplant coordination network that operates both locally and nationally and the enhancement of public information about organ donation.
Recently, Medical News Today ran a feature discussing whether farming animal organs for human transplants could serve as a solution to the organ shortage. Alternatively, could this issue be tackled through changes to organ donation policy?
Written by James McIntosh
[1] Klag MJ, Menachemi N. Opting in and opting out of organ donation in the United States: an analysis of public policies and organizational practices. Milbank Q. 2011 Sep;89(3):508-66. doi: 10.1111/j.1468-0009.2011.00752.x. Epub 2011 Aug 8. PMID: 21823069.[5] O'Connor AM, Brown EG, Markey KL, Siminovitch KA. Organ donation after circulatory death: donor circles and consent registries. Int J Transplant. 2012 Mar;28(3):222-3. doi: 10.1097/MAT.0b013e3182435d51. PMID: 22298120.
- The study, published in BMC Medicine, contextualizes thescience behind organ donation and suggests that opt-out consent may lead to an increase in deceased donation but a reduction in living donation rates, while also potentially increasing the total number of livers and kidneys transplanted.
- The authors propose that changes to consent legislation or adopting aspects of the "Spanish Model" could improve donor rates, as this model, currently used in Spain, has been attributed to factors like a transplant coordination network and the enhancement of public information about organ donation.
- In light of the ongoing health-and-wellness issue of organ donor shortages, discussions in the broader retargeting community have also encompassed innovative solutions such as farmings animal organs for human transplants, but the authors suggest that changes in organ donation policy may also hold promise.
- The authors acknowledge that their study has limitations, such as not accounting for different degrees of opt-out legislation and not assessing other factors impacting organ donation. They propose future studies examining individuals' beliefs, wishes, and attitudes regarding organ donation using surveys and experimental methods.
