Debate over Organ Donation: Opt-In vs. Opt-Out Approach Evaluated
Worldwide, organ donation policies exhibit considerable variability, with the debate persisting over whether an opt-in or opt-out system is more effective. Researchers from the University of Nottingham, UK, have delved into the organ donation protocols of 48 countries to determine the optimal approach.
An opt-in system necessitates individuals to actively register their intent to donate organs post-mortem. In contrast, opt-out systems facilitate organ donation automatically, except in cases where a specific request is made prior to death to withhold organs.
Professor Eamonn Ferguson, the study's lead author from the University of Nottingham, acknowledges potential drawbacks in either system due to their reliance on individual decision-making:
"People may refrain from action for numerous reasons, including loss aversion, inertia, and assuming policy makers have made the correct decision that they support."
In an opt-in system, inactivity may lead to individuals who would have chosen to donate failing to do so (a false negative). Meanwhile, in an opt-out system, inactivity could result in an individual who does not wish to donate becoming a donor (a false positive).
The United States employs an opt-in system, with 28,000 transplants made possible last year due to organ donors. Despite this, approximately 18 people die daily due to a scarcity of donated organs.
In the investigation, researchers from the University of Nottingham, University of Stirling, and Northumbria University compared the organ donation policies of 48 countries spanning a 13-year period—23 with opt-in systems and 25 with opt-out systems.
They discovered that countries adopting opt-out organ donation systems had higher totals of kidneys donated, the organ most in demand for transplantation. Opt-out systems also boasted a higher overall number of organ transplants.
Opt-in systems, however, demonstrated a higher rate of kidney donations from living donors. Prof. Ferguson noted that this influence on living donation rates was a novel finding that warrants attention.
The researchers acknowledge limitations in their study, as they did not account for varying degrees of opt-out legislation in countries, and other factors impacting organ donation remained unassessed.
The team's findings, published in BMC Medicine, indicate that opt-out consent might increase deceased donation but decrease living donation rates. They also suggest an increase in the total number of livers and kidneys transplanted.
Although their results offer insights for future policy decisions, they could benefit from further strengthening through the collation of international organ donation data, such as consent type, procurement procedures, and hospital bed availability, for public access.
Prof. Ferguson suggests that future research should delve into the perspectives of individuals making the opt-in/opt-out decision:
"Further research beyond this country-level epidemiological approach would involve examining issues from the perspective of the individual, exploring beliefs, wishes, and attitudes using a combination of survey and experimental methods."
The authors note that countries employing opt-out consent still experience organ donor shortages. Radical shifts in the system of consent are unlikely to resolve such issues, and they suggest studying changes to organ donation policy or adopting aspects of the "Spanish Model" as potential solutions.
Spain boasts the world's highest organ donation rate, with their success attributed to measures such as a transplant coordination network operating at both local and national levels, and the provision of high-quality public information about organ donation.
When considering potential solutions to the ongoing organ shortage, the question arises as to whether animal organs should be farmed for human transplantation. Could this be a viable solution or is it a problem better addressed through alterations in organ donation policy?
- In an opt-in system, inactivity may lead to individuals who would have chosen to donate failing to do so, creating a false negative.
- In an opt-out system, inactivity could result in an individual who does not wish to donate becoming a donor, resulting in a false positive.
- Researchers discovered that countries adopting opt-out organ donation systems had higher totals of kidneys donated, the organ most in demand for transplantation.
- The authors of the study note that radical shifts in the system of consent are unlikely to resolve organ donor shortages and suggest studying changes to organ donation policy or adopting aspects of the "Spanish Model" as potential solutions.
