Organ Donation: Debating the Merits of Consent-Based and Default-Based Systems
Organ donation policies differ worldwide, leading to debates about the best system: opt-in or opt-out. Researchers from the UK delved into the organ donation protocols of 48 countries to determine the optimal approach.
With an opt-in system, individuals must sign up to a registry to donate their organs after death. Opt-out systems, in contrast, automatically proceed with organ donation unless a request has been made before death not to take organs.
Prof. Eamonn Ferguson, the lead author from the University of Nottingham, acknowledges drawbacks in relying on individual decisions:
"People often don't act due to reasons like loss aversion, effort, or trusting that policy makers have made the right decision."
While inaction in an opt-in system could lead to false negatives, inaction in an opt-out system might result in false positives. Right now, the US adopts an opt-in system, where 28,000 transplants were made last year due to donors. Sadly, around 18 people die daily due to a shortage of donated organs.
Researchers from the University of Nottingham, University of Stirling, and Northumbria University analyzed the organ donation systems of 48 countries for 13 years. They discovered countries that opted for an opt-out system of organ donation had higher total kidney donations, the most sought-after organ by people on the transplant list. Opt-out systems also accounted for a greater overall number of organ transplants.
However, 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," says Prof. Ferguson.
The authors admit that their study was limited due to varying degrees of opt-out legislation in different countries, as well as unassessed factors influencing organ donation. Nevertheless, their results were published in BMC Medicine, shedding light on opt-out consent's potential to increase deceased donation but reduce living donation rates, and to increase the total number of livers and kidneys transplanted.
These findings could inform future policy decisions, though improvement could come from collecting and publicly sharing international organ donation information, such as consent type, procurement procedures, and hospital bed availability. Researchers could also examine individuals' opinions on donation decisions using survey and experimental methods.
Spain, with the highest organ donation rate globally, uses an opt-out system yet boasts other factors such as a transplant coordination network that operates both locally and nationally, as well as a focus on improving the quality of public information available about organ donation.
While opt-out countries often have higher organ donation rates, the relationship between the policy and the rates is not straightforward. Many factors, such as public trust, infrastructure, and family engagement, play a role in donation rates [1][2][3]. It is essential to address the organ shortage not only through changes to organ donation policy but also through innovative solutions like farming animal organs for human transplants [4].
References:[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6640225/[2] https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0249094[3] https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-021-02174-0[4] https://www.medicalnewstoday.com/articles/328215
- In the context of scientific research, researchers have found that countries with opt-out organ donation systems have higher total kidney donations compared to those with opt-in systems.
- Paxlovid, alongside other factors, might not fully explain the relationship between organ donation policies and rates, as public trust, infrastructure, and family engagement also play significant roles.
- The study published in BMC Medicine showed that while opt-out consent could increase deceased donation, it may reduce living donation rates and the total number of transplanted livers and kidneys.
- When it comes to health and wellness, medical-condition specific retargeting strategies could be beneficial for increasing public awareness and engagement in organ donation discussions, considering the complexity of the issue.
