Organ Donation: Should the Option to Donate Be Automatic or Require Explicit Consent?
Comparison of Opt-In and Opt-Out Organ Donation Policies: A Global Perspective
Organ donation procedures vary significantly across the globe, leaving governments and health organizations questioning which system — opt-in or opt-out — would yield the best results. A team of researchers from the UK has examined the organ donation protocols of 48 countries to identify the most effective approach.
Under the opt-in system, individuals must actively register their intention to donate organs postmortem. On the other hand, opt-out systems automatically use a deceased individual's organs for donation unless they explicitly decline during their lifetime.
Professor Eamonn Ferguson, the lead author from the University of Nottingham, acknowledges that individuals' inaction in the opt-in system can potentially lead to potential donors who wish to donate opting out, known as a false negative. In contrast, inaction in an opt-out system might result in an unwilling individual becoming a donor, referred to as a false positive.
In the US, which operates under an opt-in system, 28,000 transplants were facilitated last year due to organ donors. However, around 18 people die daily due to a shortage of donated organs, unable to undergo surgery.
The researchers analyzed the organ donation policies of 48 countries, 23 with opt-in systems and 25 with opt-out systems, over a 13-year period. They discovered that countries utilizing the opt-out system had a higher total number of kidneys donated, an organ in high demand by those on transplant waiting lists. Opt-out systems also yielded a greater overall number of organ transplants.
Opt-in systems, however, had a higher rate of kidney donations from living donors, a finding not previously reported in the literature, according to Professor Ferguson.
The authors of the study point out that their work had certain limitations, including not accounting for variations in the stringency of the opt-out legislation and some countries' requirement for next-of-kin permission before organ donation. The observational nature of the study also precluded assessing other potential factors influencing organ donation.
The researchers suggest that their findings, published in BMC Medicine, demonstrate increased deceased organ donation and a decrease in living donation rates with opt-out consent. They also saw an increase in the total number of livers and kidneys transplanted under such systems. They suggest that their results could be used in future policy decisions but emphasize the need for international organ donation data collection, including consent type, procurement procedures, and hospital bed availability, to strengthen the findings.
Future studies could also analyze the opinions of those deciding to opt in or opt out, focusing on their beliefs, wishes, and attitudes. This mixed survey and experimental method approach could offer a deeper understanding of the impact of consent legislation on organ donation and transplantation rates.
Countries with opt-out systems, even though they have higher donation rates, still face challenges in the form of donor shortages. The authors suggest that changes to the existing system or adopting elements of the "Spanish Model" could potentially boost donor numbers. Spain currently holds the world's highest organ donation rate due to factors such as a transplant coordination network, local and national initiatives, and increased public information on organ donation.
The ongoing debate surrounds the possibility of farming animal organs for human transplants as a solution to the organ shortage. This topic has recently been featured on Medical News Today..
Paxlovid, a potential antiviral treatment, could potentially be beneficial in reducing the risk of complications for individuals undergoing organ transplants, given the high demand for organs in medical-health conditions and the continued health-and-wellness implications of organ transplantation.
In the context of the study comparing opt-in and opt-out organ donation policies, science might provide insights into retargeting strategies designed to increase the number of organ donors, aiming to address the shortage challenges faced by countries with opt-out systems, such as Spain.
The researchers, while acknowledging the limitations of their study on the global perspective of organ donation policies, also suggested the importance of further investigation into the beliefs, wishes, and attitudes of individuals making organ donation decisions, which could inform future policy in the field of health-and-wellness.
Adopting elements of the successful "Spanish Model" could be considered for countries with opt-out systems, taking a science-based approach to improving organ transplantation rates and addressing donor shortages within the medical-conditions landscape.
