Organ Donation: A Comparison between Consent-Based and Presumed Consent Approaches
Organ Donation: To Opt-In or Opt-Out? Weighing the Pros and Cons
Buying a gallon of milk or signing up for a gym membership... these actions require an active decision. But when it comes to organ donation, should the choice be made active or default? Researchers from the UK have delved into organ donation protocols of 48 countries to find the best approach.
An opt-in system demands individuals to sign up on a registry to donate organs post mortem. On the other hand, in an opt-out system, organ donation occurs automatically unless a specific preference is expressed before death. However, both systems can encounter drawbacks:
"People may hesitate to act due to various reasons such as loss aversion, low effort, or trust in the government's decision-making," explains Prof. Eamonn Ferguson from the University of Nottingham, UK.
In an opt-in system, inaction can result in potential donors who wish to contribute not doing so (a false negative). Conversely, inaction in an opt-out system could lead to an individual who doesn't wish to donate becoming a donor (a false positive).
The United States adheres to an opt-in system, yet, roughly 18 people die daily due to a scarcity of donated organs. Last year, 28,000 transplants were made possible through organ donors.
To even the odds, researchers from the University of Nottingham, University of Stirling, and Northumbria University analyzed the organ donation systems of 48 countries over a 13-year span. They found that opt-out systems led to an increase in overall organ transplants, with a significant uptick in kidneys – the most sought-after organ in transplant lists.
Interestingly, opt-in systems boasted a higher rate of kidney donations from living donors. This influence of policy on living donation rates "has not been reported before," claims Prof. Ferguson. The researchers acknowledge some limitations, such as the lack of distinction among opt-out legislation degrees and unassessed factors.
The authors suggest that their findings could aid in future policy decisions and recommend data collection on international organ donation information, like consent type, procurement procedures, and hospital bed availability, to be made public. They also propose focusing on individuals' beliefs, wishes, and attitudes through surveys and experiments for future studies.
Opt-out consent might increase deceased donations while reducing living donation rates, as well as boosting the number of livers and kidneys transplanted. Countries using opt-out consent still face organ donor shortages; system changes alone may not solve the issue. The researchers suggest exploring consent legislation or adopting aspects of the "Spanish Model," which comprises an effective transplant coordination network and high-quality public information about organ donation.
Spain, with one of the world's highest organ donation rates, offers an example of successful strategies, including its opt-out system, the "40 Donors per population million (pmp) Plan," and a transplant coordination network. While animal organs for human transplants have sparked debate, could it be a solution to the organ shortage, or should the problem be addressed through improvements in organ donation policy?
- The contextual analysis of organ donation systems in 48 countries suggests that opt-out systems can increase overall organ transplants, particularly kidneys, due to more registrations.
- In the United States, which follows an opt-in system, there's a daily loss of 18 lives due to a scarcity of donated organs, despite annual transplants made possible through donors.
- Researchers have found that opt-in systems can lead to a higher rate of living kidney donations, although the reasons behind this are still under investigation.
- As opt-out consent might increase deceased donations while potentially reducing living donation rates, policymakers should consider data collection on international organ donation information for informed decision-making.
- To address the ongoing organ donor shortage, researchers have proposed exploring consensus legislation or adopting aspects of the "Spanish Model," which emphasizes an effective transplant coordination network and high-quality public information about organ donation.
- The debate continues about whether animal organs for human transplants can be a solution to the organ shortage, or if improvements in organ donation policy and reframing individual attitudes should be prioritized for a lasting solution.