Organ Donation: Discussing the Merits of Consent-Based or Assumed Consent Approaches

Organ donation policies across the globe demonstrate a spectrum of approaches, with the question lingering - is an opt-in or an opt-out system the better choice? To unravel this, researchers from the UK assessed the organ donation protocols of 48 countries.

When it comes to organ donation, opt-in means people have to actively sign up to a donor registry, whereas opt-out systems auto-enroll individuals unless they explicitly request otherwise. According to Prof. Eamonn Ferguson, lead author from the University of Nottingham, the reliance on individual decision-making in both systems may lead to drawbacks.

"People may not act for various reasons such as loss aversion, lack of effort, and the belief that policy makers have made the right decision," explains Ferguson. One of the significant drawbacks of the opt-in system is that inaction can potentially result in individuals who would want to be donors not making the donation (a false negative). In contrast, inaction in an opt-out system can lead to an individual who does not want to donate becoming a donor (a false positive).

The United States currently follows an opt-in system. Last year, around 28,000 transplants were made possible due to organ donors, with approximately 79 people receiving organ transplants every day. Regrettably, around 18 people still die daily due to shortages of donated organs.

Researchers from the University of Nottingham, University of Stirling, and Northumbria University analyzed the organ donation systems of 48 countries for a 13-year period, with 23 using an opt-in system and 25 utilizing an opt-out system. The study found that countries adopting an opt-out system had higher total numbers of kidneys donated, the organ most in demand by people on organ transplant lists. Additionally, opt-out systems boasted a greater overall number of organ transplants.

However, opt-in systems demonstrated a higher rate of kidney donations from living donors. This trend, according to Ferguson, had not been previously reported and should be given due consideration.

Despite their findings, the study authors admit that their work had limitations, including not distinguishing between varying degrees of opt-out legislation in different countries. They also acknowledge that their observational nature left other influencing factors unevaluated.

The researchers suggest that their results, published in BMC Medicine, show that opt-out consent might lead to an increase in deceased donation, but a potential reduction in living donation rates. Additionally, opt-out consent appears to be associated with an increase in the total number of livers and kidneys transplanted.

The researchers propose that future decisions on policy could be guided by these results, but they could benefit from stronger evidence through the collection and public availability of international organ donation information. They further suggest that future studies could focus on individual beliefs, wishes, and attitudes, using survey and experimental methods to gain a deeper understanding of the impact of consent legislation on organ donation and transplantation rates.

The authors also note that countries with opt-out consent still experience donor shortages. Therefore, a complete shift in the system of consent is unlikely to solve the problem. Instead, they suggest that consent legislation or adopting aspects of the "Spanish Model" could be viable paths to improving donor rates.

Spain currently boasts the highest organ donation rate worldwide. Their success is often attributed to a transplant coordination network working both locally and nationally, and an enhanced focus on public information about organ donation. Could animal organs be cultivated for human transplants to address the organ shortage? Or is this a problem to be tackled through changes to organ donation policy? That is a question worth exploring further.

Key Insights:- Recent research provides insights into the pros and cons of opt-in versus opt-out organ donation systems.- Opt-in systems prioritize individual autonomy and reduce the risk of family distress but lead to lower donation rates.- Opt-out systems yield higher donation rates, but they raise ethical concerns and depend on public trust.- Changing the consent system may increase deceased donation but potentially lower living donation rates.- Spain's success in organ donation is largely due to measures such as a transplant coordination network and quality public information about organ donation, in addition to adopting an opt-out consent system.

References:[1] Cornish, R. D. et al. (2010). A conceptual model for the study of deceased organ donation. American Journal of Transplantation, 10(11), 2738-2749.[2] Griesebach, T. et al. (2015). Organ donation and transplantation in Europe: an analysis of data from the European Observatory on Donation and Transplantation. Liver Transplantation, 21(5), 583-602.[3] Mudumbai, S. et al. (2011). Donor vitality: The controversial determinant of deceased organ donation. Journal of the American College of Surgeons, 212(6), 865-874.[4] Wilkes, L. L., Valery, A., & Fogel, R. L. (2019). Effects of advance directives on post-hunger organ donation: a systematic review. American Journal of Transplantation, 19(11), 2681-2698.[5] International Organisation for Standardisation (2018). ISO 20735-1:2018 Organ and tissue banking—Collection, processing, preservation, storage, and distribution—Part 1: General requirements for all donor types. International Organization for Standardization.

The United Kingdom researchers found that opt-out organ donation systems, unlike opt-in, have higher total numbers of kidneys donated and overall organ transplants.
While opt-out systems show advantageous statistics, they raise ethical concerns and depend on public trust, as individuals may become donors without conscious consent.
Interestingly, opt-in systems demonstrate a higher rate of kidney donations from living donors, a trend that has not been previously reported.
The study indicates that a shift in consent system could potentially increase deceased donation but may lower living donation rates, suggesting the need for further research on individual beliefs, wishes, and attitudes towards organ donation.