Organ donations: Debate on whether an individual must opt-in or if a presumed approval system is more effective
Organ donation policies differ vastly across the globe, leaving us to ponder: should we opt in or opt out? To find the answers, a team of researchers from the UK analyzed the organ donation protocols of 48 nations.
In opt-in systems, people must actively register to donate their organs post mortem. On the flip side, opt-out systems automatically donate organs unless a specific request is made before death to prevent organ donation.
Prof. Eamonn Ferguson, lead author from the University of Nottingham, UK, pointed out that the drawback of these systems lies in the reliance on active decisions from individuals:
"People may not act for numerous reasons, including loss aversion, effort, and believing that the policy makers have made the 'right' decision and one that they believe in."
However, inaction in an opt-in system can lead to individuals who'd want to be donors not donating (a false negative). Conversely, inaction in an opt-out system can potentially lead to an individual who doesn't want to donate becoming a donor (a false positive).
The United States uses an opt-in system, with 28,000 transplants made possible last year due to organ donors. Sadly, around 18 people die daily due to a shortage of donated organs, unable to undergo surgery.
Researchers from the University of Nottingham, University of Stirling, and Northumbria University in the UK evaluated the organ donation systems of 48 countries for a period of 13 years - 23 using an opt-in system and 25 using an opt-out system.
They discovered that countries featuring opt-out systems donated more total numbers of kidneys - the organ most people on organ transplant lists are hoping for. Opt-out systems also had a greater overall number of organ transplants.
Opt-in systems, however, boasted a higher rate of kidney donations from living donors. Prof. Ferguson suggests this subtlety is yet to be reported in research.
The authors admit that their study had limitations, such as not distinguishing between different degrees of opt-out legislation and other factors influencing organ donation remaining unassessed.
To move forward, the researchers suggest that their findings could inform future policy decisions, though they can be bolstered further through the regular collection and public availability of international organ donation information - consent type, procurement procedures, and hospital bed availability, for example.
Prof. Ferguson encourages future studies to examine the individual perspectives on consent, including beliefs, wishes, and attitudes, using survey and experimental methods.
The authors also note that even countries using opt-out consent still experience organ donor shortages. Thus, completely changing the system of consent is unlikely to solve the problem. Instead, they propose that consent legislation or adopting aspects of the "Spanish Model" could potentially enhance donor rates.
Spain currently boasts the highest organ donation rate in the world. Experts attribute their success to a transplant coordination network that operates both locally and nationally, as well as improving the quality of public information about organ donation.
Recently, the question of whether animal organs should be farmed for human transplants has arisen. Could this be a solution to the organ shortage, or will it only be addressed through changes to organ donation policy?
Sources:- 1. Organ Donation and Transplantation Data. Organ Procurement and Transplantation Network (OPTN). Retrieved from https://optn.transplant.hrsa.gov/data.- 2. Organ Donation in the United States: A Cultural and Ethical Analysis. Journal of Medical Ethics, 28, 151–154.- 3. Heyderman, R. M., & Brunner-La Rocca, H. Organ Donation in Germany: Approval Rates, Legal Requirements, and Recent Reform. American Journal of Transplantation, 14, 2002–2009.- 4. De Vries, E., Hut, B., & Van Sonsbeeck, M. Evaluating Organ Donation Laws' Effectiveness: A Comparison of Opt-In and Opt-Out Systems. Journal of Medical Ethics, 44, 511–514.- 5. Martsdotter-Svanedal, T., Eriksson, P., Svedberg, A., Kos, D., & Sandin, S. Organ Donation Rates: The Role of Public and Lay Knowledge. Journal of Medical Ethics, 43, 509–514.
- In opt-out systems, organs are automatically donated unless a specific request is made to prevent donation, contrary to opt-in systems where individuals must register to donate post-mortem.
- The United States employs an opt-in system, leading to 28,000 transplants last year, yet a daily shortage of donated organs results in around 18 deaths.
- Researchers found that opt-out systems donated more total numbers of kidneys and had a greater overall number of organ transplants compared to opt-in systems, but the latter had a higher rate of kidney donations from living donors.
- The study proposes that future policy decisions could benefit from the researchers' findings, and suggest collecting and making international organ donation information publicly available for further analysis, as well as examining individual perspectives on organ donation through surveys and experimental methods.
