Debate over Organ Donation: Advantages of Opt-In and Opt-Out Approach Compared
Swapping the Organ Donation Game: Opt-in vs Opt-out
Organ donation policies differ worldwide, prompting a question: is it better to have a system where people must opt-in or opt-out? A team of researchers from the UK decided to scrutinize the organ donation protocols of 48 countries to find an answer.
In an opt-in system, people must actively sign up to a registry to donate their organs after death. On the other hand, in an opt-out system, organ donation occurs automatically unless a specific request is made before death for organs not to be taken.
Prof. Eamonn Ferguson, lead author from the University of Nottingham, UK, acknowledges the challenges with these systems relying on individuals' active decisions:
"People may not act for a multitude of reasons, such as loss aversion, lack of effort, and trusting decision-makers have made the 'right' choice."
Silence in an opt-in system, however, can potentially lead to individuals who would want to be donors not donating (a false negative). In contrast, silence in an opt-out system could potentially lead to an individual who doesn't wish to donate inadvertently becoming a donor (a false positive).
The US, for instance, uses an opt-in system. Last year, 28,000 transplants were made possible due to organ donors. Regrettably, around 18 people die daily waiting for transplants due to a shortage of donated organs.
Making the Call: In or Out?
Researchers from the University of Nottingham, University of Stirling, and Northumbria University in the UK analyzed the organ donation systems of 48 countries for a period of 13 years—23 using an opt-in system, and 25 using an opt-out system.
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.
Opt-in systems did, however, have a higher rate of kidney donations from living donors. Curiously, the influence that policy had on living donation rates has not been reported before, according to Prof. Ferguson.
The authors of the study recognize some limitations, including not differentiating degrees of opt-out legislation and unassessed factors influencing organ donation.
Embracing Change
The researchers state that their 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."
While these results could be used in the future to inform policy decisions, they could be strengthened further through the routine collection of international organ donation information, such as consent type, procurement procedures, and hospital bed availability, and subsequently making it publicly available.
Prof. Ferguson suggests future studies could also analyze the opinions of individuals making the decision to opt-in or opt-out:
"Further research, moving beyond country-level epidemiological approaches, would be to investigate issues from the perspective of the individual, examining beliefs, wishes, and attitudes using a mix of survey and experimental methods."
The authors note that countries using opt-out consent still experience organ donor shortages. Completely changing the system of consent is unlikely to eradicate such a problem. They suggest that consent legislation or adopting aspects of the "Spanish Model" could be potential ways to enhance donor rates.
Spain currently boasts the world's highest organ donation rate. Experts attribute this success to measures such as a transplant coordination network and improving the quality of public information available about organ donation.
Recently, Medical News Today featured a spotlight on the idea of farming animal organs for human transplants. Could this be a solution to the organ shortage, or should the problem be addressed through changes to organ donation policy?
Written by James McIntosh
- In the context of organ donation, science suggests that opt-out systems might lead to an increase in deceased donations, particularly for kidneys and livers, compared to opt-in systems.
- The UK team of researchers, following a 13-year study of 48 countries, found a higher total number of kidneys donated and a greater overall number of organ transplants in countries with opt-out systems.
- However, living donor kidney donations were more prevalent in opt-in systems, and this influence on living donation rates has not been previously reported.
- Researches also propose that future studies should consider individual perspectives and attitudes towards organ donation, as completely changing the consent system might not eradicate the issue of organ donor shortages. Instead, changes in legislation or adopting aspects of the "Spanish Model" could be potential solutions.
