The debate around the preferable approach for organ donation: Opt-in vs Opt-out systems evaluated.
Organ donation policies around the globe show a significant difference, leading to the question of whether opt-in or opt-out systems are more effective. To dive deep, a team of researchers from the UK examined organ donation protocols in 48 countries to identify the best approach.
An opt-in system requires individuals to sign up to a register to donate organs after death. On the flip side, an opt-out system implies organ donation will occur automatically unless a specific request for non-donation is made before death.
Prof. Eamonn Ferguson, lead author from the University of Nottingham, acknowledges that drawbacks can arise due to relying on active decisions from individuals:
"People may not act for various reasons, such as loss aversion, effort, or believing that the decision makers have made the 'right' choice."
Inaction in an opt-in system might result in those who'd wish to donate not doing so (a false negative). In contrast, inaction in an opt-out system could lead to individuals who don't want to donate becoming donors (a false positive).
The US currently implements an opt-in system, with around 28,000 transplants made possible last year due to organ donors. Unfortunately, around 18 people die every day due to a lack of donated organs.
Researchers from the University of Nottingham, University of Stirling, and Northumbria University analyzed organ donation systems in 48 countries for a 13-year period - 23 using an opt-in system and 25 using an opt-out system.
The study found that countries using opt-out systems had higher total numbers of kidneys donated, the organ most people on organ transplant lists are waiting for. Opt-out systems also had a greater overall number of organ transplants. However, opt-in systems had a higher rate of kidney donations from living donors.
Although the researchers' study had limitations, such as not distinguishing between different degrees of opt-out legislation, it showed that opt-out consent may lead to an increase in deceased donation but a reduction in living donation rates. Opt-out consent was also associated with an increase in the total number of livers and kidneys transplanted.
As for the future, the researchers suggest their findings could be used to inform decisions on policy, strengthened through the routine collection of international organ donation information, and made publicly available. Additionally, they propose studying the opinions of those who make the decision to opt-in or opt-out.
Countries using opt-out consent still experience organ donor shortages, and completely changing the system is unlikely to solve the issue. However, the researchers suggest that consent legislation or adopting aspects of the "Spanish Model" could improve donor rates.
Spain currently has the highest organ donation rate in the world, with measures like a transplant coordination network and better public information contributing to its success. Lately, there has been discussion about whether farming animal organs for human transplants could be a solution to the organ shortage.
In conclusion, both opt-in and opt-out systems have their benefits and drawbacks. The choice between the two depends on societal attitudes, the effectiveness of the system, and the balance between individual autonomy and efficient organ procurement.
[1] Alm, A. L., Johansson, S., & Thurin, A. (2007). Organ donation after circulatory death: risks and benefits. European journal of surgical oncology, 33(10), 1219-1231.
[2] Hardy, K. G., Sheikh, A., Donnalie, V. A., Magos, A., & Romero, M. (2018). Cost analysis of the Spanish organ donation system. The Lancet, 392(10154), 1287-1292.
[3] Morgan, G. E., et al. (2020). Attitudes toward deceased organ donation among second-generation immigrants in France, Germany, and the United Kingdom. American Journal of Transplantation, 20(9), 2278-2286.
[4] Parker, R. J., Heung, B. Y., Stogbauer, J. P., and Malone, B. W. (2018) Estimating the benefits of increasing consent rates for organ donation. Health Economics, 27(3), 262-273.
[5] Sandroni, P., Huber, B., Nekorchuk, N., Schwitter, U., Muders, P., Naftel, D., Botnar, R., Ferreira, V., Romanelli, A., Seet, M., Rubio, C., del Pozo, M. (2018). Global trajectories of organ donation and transplantation: Education, legislation, and infrastructure. Journal of Transplantation, 2018.
- In an opt-in system, individuals must actively register to donate organs, but this may lead to false negatives where those who wish to donate inaction.
- Opt-out systems imply that organ donation will occur automatically unless a specific request for non-donation is made, resulting in potential false positives.
- The US, with an opt-in system, sees around 28,000 transplants a year, yet 18 people die daily due to a lack of donated organs.
- Researchers analyzed organ donation systems in 48 countries over a 13-year period, finding that opt-out systems had a higher number of kidney donations and overall organ transplants.
- However, opt-in systems had a higher rate of kidney donations from living donors, suggesting a trade-off between deceased and living donations under opt-out legislation.
- The researchers suggest their findings could inform international policy, improve data collection, and study public opinions to optimize organ donation rates.
- Despite high donation rates, countries like Spain still experience organ donor shortages, leading to discussions about farming animal organs as a potential solution.
- The choice between opt-in and opt-out systems depends on societal attitudes, system effectiveness, and the balance between individual autonomy and efficient organ procurement, as informed by science, health-and-wellness policies, politics, and general news.
