Organ donation: Debating the merits of consent-based or presumed consent arrangements
Comparing Opt-In and Opt-Out Organ Donation: A Global Perspective
Organ donation policies vary significantly across the globe, raising the question of whether an opt-in or opt-out system is more effective. A team of researchers from the UK has examined the organ donation protocols of 48 countries to determine which approach yields the best results.
In opt-in systems, individuals must actively sign up to a register to donate their organs posthumously. Conversely, opt-out systems enable organ donation to occur automatically unless a specific request is made before death requesting organs not to be taken.
Prof. Eamonn Ferguson, the lead author from the University of Nottingham, acknowledges potential drawbacks in both systems, citing individuals' inaction due to reasons such as loss aversion, lack of effort, and trust in the decision-making process of policymakers:
"People may fail to act for numerous reasons, including loss aversion, effort, and the belief that policy makers have made the 'right' decision and one they believe in."
Inaction within an opt-in system can result in individuals who would have wished to be donors not donating (a false negative). In contrast, inaction in an opt-out system could potentially lead to 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 as a result of organ donors.Despite this, approximately 18 people die daily due to a shortage of donated organs, unable to undergo surgery.
Researchers from the universities of Nottingham, Stirling, and Northumbria in the UK analyzed the organ donation systems of 48 countries over a 13-year period, finding that countries using opt-out systems had higher total numbers of kidneys donated, the organ most in demand by those on organ transplant lists. Opt-out systems also yielded a greater overall number of organ transplants.
Opt-in systems, however, demonstrated a higher rate of kidney donations from living donors, a factor that has not been reported before, according to Prof. Ferguson.
The study's authors acknowledge their research's limitations, as it did not distinguish between different degrees of opt-out legislation and did not assess other factors influencing organ donation.
The authors suggest that their results can inform future policy decisions, but should be strengthened through the collection and publication of international organ donation information, such as consent type, procurement procedures, and hospital bed availability.
Future studies may also examine the opinions and beliefs of individuals making the decision to opt in or opt out, using a mixture of surveys and experimental methods to develop a deeper understanding of the impact of consent legislation on organ donation and transplantation rates.
Countries using opt-out consent still encounter organ donor shortages, indicating that a complete change in the consent system is unlikely to fully address the issue. Instead, scholars suggest that consent legislation or adopting aspects of the "Spanish Model" could contribute to improved donor rates.
Spain boasts the highest organ donation rate worldwide, crediting its success to a transplant coordination network operating both locally and nationally and the enhancement of public information regarding organ donation.
Whether farming animal organs for human transplants could alleviate the organ shortage or necessitates attention through changes to organ donation policy remains a topic of ongoing discussion.
- In the study, researchers from multiple UK universities found that opt-out organ donation systems yield higher total numbers of kidneys donated and a greater overall number of organ transplants compared to opt-in systems.
- Opt-in systems have a higher rate of kidney donations from living donors, a factor that has not been reported before, according to lead author Prof. Eamonn Ferguson.
- The authors suggest that their results can inform future policy decisions, but also emphasize the need for the collection and publication of international organ donation information to further strengthen their findings.
- Future studies may explore individual opinions and beliefs about opting in or opting out for organ donation, using a combination of surveys and experimental methods to gain a deeper understanding of the impact of consent legislation on organ donation and transplantation rates.
- Scholars suggest that changes to organ donation policy or adopting aspects of the "Spanish Model" could contribute to improved donor rates, but a complete change in the consent system may not fully address the issue of organ donor shortages.
