Debate over Organ Donation Registration Systems: Opt-In vs. Opt-Out Approaches
In the diverse world we live in, organ donation policies wildly differ across countries. A burning question: Is it better to have a donation system where individuals need to opt in or opt out? To shed light on this, a gang of smarties from the UK delved into the organ donation protocols of 48 countries.
With an opt-in system, folks have to actively register to donate their organs posthumously. In contrast, opt-out systems automatically authorize organ donation unless the departed requests otherwise before kicking the bucket.
Prof. Eamonn Ferguson, the ringleader from the University of Nottingham, UK, acknowledges that due to the active decision required, both systems can face drawbacks:
"People might not act for various reasons, including aversion to loss, laziness, or thinking policy makers have made the right call, and they're good with it."
However, doing squat in an opt-in system can lead to individuals wanting to donate but not doing it (a boo-boo known as a false negative). Conversely, doing squat in an opt-out system could result in folks who don't wish to donate unintentionally becoming donors (a goof-up known as a false positive).
The United States sticks with an opt-in system. The US Department of Health & Human Services reports that 28,000 transplants were made feasible last year due to organ donors. Still, about 18 people die daily due to a deficit of donated organs.
In or Out?
Researchers from the University of Nottingham, the University of Stirling, and Northumbria University in the UK scrutinized the organ donation systems of 48 countries for 13 years - 23 using an opt-in system and 25 using an opt-out system.
The study heavyweights measured overall donor numbers, transplants per organ, and the total number of kidneys and livers transplanted from both deceased and living donors.
They discovered that countries using opt-out systems had higher overall kidney donation numbers - the organ that most folks waiting for a transplant are craving. Opt-out systems also garnered a greater overall number of organ transplants.
Opt-in systems, however, enjoyed a higher rate of kidney donations from living donors. The impact of policy on living donation rates, says Prof. Ferguson, appears to be uncharted territory:
"We've never noticed this effect before, and it's a subtlety that requires more attention."
The authors concede that their study was limited in that it didn't differentiate between the degrees of opt-out legislation, with some countries requiring next-of-kin permission for organs to be donated. The observational nature of the study means that other factors influencing organ donation remained overlooked.
Moving Forward
The researchers note that their results, 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."
They suggest that their results could be used to inform future policy decisions but could benefit further through the routine collection of international organ donation data, such as consent type, procurement procedures, and hospital bed availability, which should then be made public.
Prof. Ferguson proposes that future studies should observe the opinions of those who have to make the decision to opt in or opt out:
"It'd be helpful to study the beliefs, wishes, and attitudes of individuals from a different, more personal perspective."
"By blending these various research techniques, scientists can develop a deeper understanding of the influence of consent legislation on organ donation and transplantation rates," he says.
The researchers point out that countries using opt-out consent still experience organ donor shortages. A complete system overhaul is thus unlikely to solve this dilemma. They propose that consent legislation or adopting aspects of the "Spanish Model" could be ways to improve donor rates.
Spain boasts the highest organ donation rate globally. The Spaniards employ opt-out consent, yet their success is credited to measures such as a transplant coordination network that operates locally and nationally and improving the quality of public information available about organ donation.
Lately, Medical News Today ran a feature on the potential for animal organs to be farmed for human transplants. Could this be a cure for the organ shortage, or is it a problem to be tackled through changes to organ donation policy?
- In the study of 48 countries' organ donation systems, it was found that countries using opt-out systems had higher overall kidney donation numbers and a greater overall number of organ transplants.
- Opt-out systems, though leading to more deceased donations, result in lower rates of kidney donations from living donors, a subtlety that was found to require more attention.
- Researchers suggest that their findings could help inform future policy decisions but could benefit further through the collection of international organ donation data and public disclosure.
- Prof. Ferguson proposes that future studies should observe the beliefs, wishes, and attitudes of individuals from a more personal perspective, suggesting a blending of various research techniques to develop a deeper understanding of the influence of consent legislation on transplantation rates.
