Debate over Organ Donation: Should Opt-In or Opt-Out Method Be Implemented?
Globally, the practice of organ donation varies significantly between countries, with ongoing debate over the optimal approach: opt-in or opt-out. A team of researchers from the University of Nottingham, University of Stirling, and Northumbria University in the UK compared the organ donation protocols of 48 nations over a 13-year period.
In opt-in systems, individuals must actively sign up to a donor registry after death. On the other hand, opt-out systems automatically donate organs unless a specific request is made before death for organs not to be harvested. Prof. Eamonn Ferguson, the lead author from the University of Nottingham, acknowledges the potential drawbacks of both systems.
"People may postpone making a decision due to loss aversion, effort, or the belief that decision-makers have made the correct choice," said Prof. Ferguson. Inaction in an opt-in system can result in individuals who might have wanted to donate never doing so (a false negative). Conversely, inaction in an opt-out system could potentially lead to an individual who does not want to donate becoming a donor (a false positive).
The United States operates on an opt-in system, with 28,000 transplants facilitated last year due to organ donors. Unfortunately, around 18 people still die daily due to a shortage of donated organs.
The researchers' analysis showed that countries using opt-out systems had a higher number of overall kidney donations. These are the organs that the majority of people on organ transplant lists are waiting for. Additionally, opt-out systems had a greater overall number of organ transplants.
Opt-in systems, however, had a higher rate of kidney donations from living donors. This influence on living donation rates is a novel finding, according to Prof. Ferguson. The study was limited as it did not distinguish between different degrees of opt-out legislation, with some countries requiring permission from next-of-kin for organs to be donated. Furthermore, the observational nature of the study meant that other factors influencing organ donation remained unassessed.
Prof. Ferguson suggests that future research could examine the individual perspectives regarding beliefs, wishes, and attitudes towards consent legislation. This could help develop a greater understanding of the impact of consent legislation on organ donation and transplantation rates.
The researchers noted that countries using opt-out consent still experience organ donor shortages. While an outright change in the consent system may not solve such a problem, adopting aspects of the "Spanish Model" could potentially improve donor rates. Spain has the highest organ donation rate worldwide. Experts attribute their success not only to the opt-out system but also to a well-organized national transplant coordination network and improved public information about organ donation.
The study by researchers from the University of Nottingham, University of Stirling, and Northumbria University revealed a higher number of overall kidney donations and organ transplants in countries using opt-out systems. However, these nations still face organ donor shortages. The researchers suggest that future studies could examine individual perspectives towards consent legislation to understand its impact on organ donation rates. Additionally, adopting aspects of the "Spanish Model," which combines an opt-out system with a well-organized national transplant coordination network and improved public information, could potentially improve donor rates. Opt-in systems were found to have a higher rate of kidney donations from living donors, a novel finding in the context of science and medical-conditions related to health-and-wellness and organ transplantation.
