Organ donation: Should it be based on consent given or assumed?
Let's Dish: Opt-in or Opt-out - Which Organ Donation System Rocks?
Organ donation policies around the globe pale in comparison, giving rise to an intriguing debate: should people be expected to opt-in or opt-out? A team of UK researchers, hailing from University of Nottingham, University of Stirling, and Northumbria University, delved into the organ donation practices of 48 nations to assess which strategy is most effective.
When signing up to donate organs postmortem, folks need to actively enroll in an opt-in system. In contrast, opt-out systems grant coordinators the authority to proceed with donation unless a specific objection is made by the deceased before their demise.
Prof. Eamonn Ferguson, the study's ringleader from the University of Nottingham, acknowledged that the two strategies may suffer from pitfalls as they hinge on individual decisions:
"People may neglect acting for a multitude of reasons, such as loss aversion, lack of effort, and convinced that policy makers have made the 'right' call."
However, inaction in an opt-in system can lead to folks who'd wish to donate failing to do so (a false negative). In opposite tides, inaction in an opt-out system may result in an individual unwilling to donate becoming a donor (a false positive).
Currently, the United States operates on an opt-in system. The US Department of Health & Human Services reported that 28,000 transplants were made possible last year due to organ donors. Around 79 people receive organ transplants daily. Unfortunately, approximately 18 people die each day due to a shortage of donated organs.
Sign Here or Let's Go Organ Hunting?
The team of researchers scrutinized organ donation systems of 48 countries for a span of 13 years, 23 employing an opt-in system, and 25 turning to an opt-out system.
The researchers measured overall donor numbers, organ transplants per organ, and the total number of kidneys and livers transplanted from both deceased and living donors. They found that countries operating an opt-out system boasted a significantly higher number of kidneys donated - the organ most sought after by those on organ transplant lists. Opt-out systems also had the greatest overall count of organ transplants.
Opt-in systems, though, managed a higher rate of kidney donations from living donors. This influencing factor on living donation rates, according to Prof. Ferguson, is "subtle yet significant, warranting further exploration."
The authors conceded that their study had some limitations, primarily the absence of distinguishing between varying degrees of opt-out legislation, with some countries necessitating approval from next-of-kin for organs to be donated. The observational nature of the study also meant that additional factors potentially influencing organ donation went unassessed.
The Road Ahead
The researchers concluded, "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 suggested that these findings may aid future decisions on policy. However, they could be made stronger through the routine gathering and public disclosure of international organ donation information - such as consent type, procurement procedures, and hospital bed availability.
Prof. Ferguson pondered one more layer to the investigation:
"Further research should examine individuals' beliefs, wishes, and attitudes toward opting in or out. By combining survey and experimental methods, researchers could develop a greater understanding of the impact of consent legislation on donation and transplantation rates."
The authors noted that countries applying opt-out consent still face donor shortages. A complete overhaul of the system, therefore, is unlikely to solve such an issue. Instead, they propose that changes to consent legislation or incorporating elements of the "Spanish Model" could contribute to higher donor rates.
Spain currently boasts the world's highest organ donation rate, largely due to the Spanish's application of opt-out consent and additional measures like a transplant coordination network encompassing both local and national operations and improved public information about organ donation.
- Inaction in an opt-in system may lead to individuals who wish to donate failing to do so, creating a false negative scenario.
- Signing up for organ donation requires active enrollment in an opt-in system, while an opt-out system allows coordinators to proceed unless a specific objection is made.
- Science and health-and-wellness organizations, such as the US Department of Health & Human Services, report that a shortage of donated organs results in approximately 18 people dying each day.
- The study by UK researchers on global organ donation practices found that countries operating an opt-out system have a significantly higher number of kidney donations and overall organ transplants, but opt-in systems have a higher rate of kidney donations from living donors.
