Debate over Organ Donation: Should It Be Consent-Based or Presumed Consent?

Organ donation policies worldwide come in two flavors: opt-in and opt-out. But which one is truly the best? To get some answers, a team of researchers from the UK delved into the organ donation protocols of 48 countries.

In an opt-in system, people need to actively sign up to donate their organs after death. On the other hand, opt-out systems presume consent, meaning organ donation will occur automatically unless a specific request is made to opt out before death.

Prof. Eamonn Ferguson, the lead author from the University of Nottingham, UK, acknowledged that the reliance on individual decisions in both systems can lead to drawbacks:

"People may be hesitant for numerous reasons, such as loss aversion, lack of effort, and trusting that the policy makers have made the 'right' decision."

While inaction in an opt-in system could lead to individuals who wish to be donors not donating, inaction in an opt-out system could potentially cause an individual who doesn't want to donate to become one.

The US currently employs an opt-in system. Last year, 28,000 transplants were made possible due to organ donors, but around 18 people still die every day due to a shortage of donated organs.

Researchers from the University of Nottingham, University of Stirling, and Northumbria University compared the organ donation systems of 48 countries over a 13-year period. They found that countries using opt-out systems had higher total numbers of kidneys donated, the organ that the majority of people on organ transplant lists are waiting for. Opt-out systems also had the greater overall number of organ transplants.

However, opt-in systems had a higher rate of kidney donations from living donors. Prof. Ferguson noted that this influence on living donation rates is a subtlety that needs to be highlighted and considered.

The study's limitations include not distinguishing between different degrees of opt-out legislation and not assessing other factors influencing organ donation.

The researchers recommend that their results could be used to inform policy decisions in the future. They suggest collecting international organ donation information such as consent type, procurement procedures, and hospital bed availability, which should then be made publicly available.

Prof. Ferguson also suggested future studies could examine individual beliefs, wishes, and attitudes towards organ donation using survey and experimental methods. He indicated that these studies could help develop a greater understanding of the influence of consent legislation on organ donation and transplantation rates.

The authors noted that countries using opt-out consent still experience organ donor shortages. Completely changing the system of consent is unlikely to solve the problem. They suggest that consent legislation or adopting aspects of the "Spanish Model" could be ways to improve donor rates.

Spain currently has the highest organ donation rate in the world. The Spanish utilize opt-out consent, but their success is attributed to their transplant co-ordination network and improving the quality of public information about organ donation.

One potential solution to the organ shortage could be farming animal organs for human transplants. But is this a problem to be addressed through changes to organ donation policy or something else entirely?

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In an opt-out system, organ donation occurs automatically unless a specific request is made to opt out before death, in contrast to an opt-in system where individuals need to actively sign up to donate their organs after death.
The study found that countries using opt-out systems had higher total numbers of kidneys donated and a greater overall number of organ transplants compared to opt-in systems.
However, opt-in systems had a higher rate of kidney donations from living donors, which the researchers noted as a subtlety that needs to be highlighted and considered.
The study was limited to not distinguishing between different degrees of opt-out legislation and not assessing other factors influencing organ donation.
The researchers suggested that their results could be used to inform policy decisions in the future, including collecting international organ donation information, making it publicly available, and examining individual beliefs, wishes, and attitudes towards organ donation using survey and experimental methods.