Organ donation: Should the system be based on individuals explicitly opting in or automatically opting out?
Going with the Flow: Opt-In vs Opt-Out Organ Donation
The global landscape of organ donation reveals a fascinating contrast between opt-in and opt-out systems. A team of researchers from the UK took a deep dive into the donation protocols of 48 countries to uncover which approach works best.
In the opt-in scenario, individuals are required to actively sign up for the organ donor registry. Conversely, in opt-out systems, organ donation occurs automatically unless an explicit request is made to prevent it pre-death.
Prof. Eamonn Ferguson, lead author from the University of Nottingham, acknowledges that the reliance on active decisions from individuals can result in pitfalls:
"People might not act for various reasons, including loss aversion, effort, and believing that the policy makers have made the 'right' decision."
Inaction in an opt-in system can lead to false negatives, where individuals who wish to donate might fail to do so. While inaction in an opt-out system could lead to false positives, where individuals who don't wish to donate might still become donors.
The US, for instance, employs an opt-in system. According to the US Department of Health & Human Services, over 28,000 transplants were made possible last year due to organ donors. Despite this, approximately 18 people die every day due to a shortage of donated organs.
Making the Call
Researchers from the University of Nottingham, University of Stirling, and Northumbria University in the UK examined organ donation systems in 48 countries over a period of 13 years. The study found that countries using opt-out systems had higher total numbers of kidneys donated, the organ that the majority of people on organ transplant lists are eagerly waiting for. Opt-out systems also had the greater overall number of organ transplants.
However, opt-in systems had a higher rate of kidney donations from living donors. The influence that policy had on living donation rates is a new development that Prof. Ferguson highlights: "This subtlety hasn't been reported before."
The authors were mindful of the study's limitations, acknowledging that they didn't distinguish between different degrees of opt-out legislation and didn't assess other potential factors influencing organ donation.
Moving Ahead
The researchers published their findings in BMC Medicine, revealing that "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 recommend using these results to guide future policy decisions but also suggest strengthening the study further by collecting and publishing international organ donation data, such as consent type, procurement procedures, and hospital bed availability.
Further research should delve into the perspectives of individuals making the decision to opt-in or opt-out, using a combination of surveys and experimental methods.
The authors note that countries using opt-out consent still experience organ donor shortages. Changing the consent system alone might not solve such a problem. Instead, they suggest revisiting the consent legislation or adopting aspects of the "Spanish Model," which has been instrumental in Spain's high organ donation rate.
Spain's success is attributed to factors like a transplant coordination network that operates on both local and national levels, and improved public information about organ donation.
A recent spotlight feature by Medical News Today questions whether farming animal organs for human transplants could address the organ shortage. Could this be a viable solution, or should the focus be on altering organ donation policy instead?
Written by James McIntosh
Insights:Comparing opt-in and opt-out organ donation systems presents some intriguing findings:
Key Insights
- Default Bias: Opt-out systems leverage default bias, reducing friction associated with active registration found in opt-in systems.
- Family Involvement: In opt-in systems, family members can donate their relatives' organs even if no prior decision was registered. In contrast, opt-out systems can sometimes hinder family involvement if they're not aware of the deceased's wishes.
- Behavioral Barriers: Opt-in systems often face barriers like procrastination, mild friction (forms and websites), and emotional discomfort related to facing mortality. These barriers often disappear in opt-out systems.
Organ Donation Rates
- Opt-Out Systems: Experience higher organ donation rates due to reduced friction, increased donor registration, and default bias.
- Spain has achieved dramatic increases in donation rates by implementing opt-out policies combined with other strategies like early identification of potential donors.
- Opt-In Systems: Typically have lower donation rates due to the need for active registration and the presence of behavioral barriers.
Overall, opt-out systems tend to increase the total number of organs available for transplant by reducing friction and leveraging default bias. However, specific comparisons of total kidney donations under each system can vary based on additional factors.
- The study conducted by the University of Nottingham, University of Stirling, and Northumbria University implies that opt-out systems have higher organ donation rates due to the decreased friction associated with active registration.
- The authors of the study note that opt-in systems often face challenges such as procrastination, mild friction, and emotional discomfort, which can be alleviated in opt-out systems.
- In opt-out systems, there can occasionally be a hindrance in family involvement if they are unaware of the deceased's wishes, in contrast to opt-in systems where family members can donate even without prior registration.
- The research suggests that opt-out consent may lead to an increase in deceased donation but a reduction in living donation rates, and also associates opt-out consent with an increase in the total number of livers and kidneys transplanted.
- In a span of 13 years, researchers examined organ donation systems in 48 countries and found that countries using opt-out systems had higher total numbers of kidneys donated.
- The study calls for further research to delve into individual perspectives on organ donation, using a combination of surveys and experimental methods. The authors also recommend collecting and publishing international organ donation data to strengthen the study further.
