Where shouldn't we leave organ donation choices - opt-in or opt-out? A debate persists on the most effective strategy for ensuring proper organ donations.
In a world where organ donation policies are as diverse as the nations themselves, the question remains: is it better to have an opt-in or an opt-out system? A team of researchers from the UK decided to dig deep and examine the organ donation protocols of 48 countries to find the answer.
The opt-in system is the one where people need to actively sign up to a registry to donate their organs after death. On the other hand, in an opt-out system, organ donation occurs automatically unless a specific request is made before death for organs not to be taken.
Prof. Eamonn Ferguson, the lead author from the University of Nottingham, UK, recognizes the challenges of relying on individual decisions:
"People may not act for a myriad of reasons, including loss aversion, effort, and believing that the policy makers have made the right decision and one they believe in."
The US follows the opt-in system. Last year, 28,000 transplants were made possible due to organ donors. Unfortunately, around 18 people die every day due to a shortage of donated organs.
Researchers from the University of Nottingham, University of Stirling, and Northumbria University in the UK analyzed 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 found that countries using opt-out systems of organ donation had higher total numbers of kidneys donated - the organ that most people on the organ transplant list are waiting for. Opt-out systems also had the greater overall number of organ transplants.
Opt-in systems did, however, have a higher rate of kidney donations from living donors. The influence that policy had on living donation rates, as highlighted by Prof. Ferguson, is a subtlety that has not been reported before.
The study, published in BMC Medicine, shows 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.
The authors acknowledge that their study was limited by not distinguishing between different degrees of opt-out legislation and did not assess other factors that may influence organ donation. The researchers suggest that future studies could analyze the opinions of those who have to make the decision to opt in or opt out from various perspectives.
Countries using opt-out consent still experience organ donor shortages. Completely changing the system of consent is unlikely to solve the problem, according to the authors. They suggest that consent legislation or adopting aspects of the "Spanish Model" could be ways to improve donor rates. Spain currently has the highest organ donation rate in the world. The Spanish utilize opt-out consent, but their success is credited by experts to a transplant coordination network that works both locally and nationally, as well as the improved quality of public information available about organ donation.
As for the future, should we consider farming animal organs for human transplants to address the organ shortage, or is this a problem to be addressed through changes to organ donation policy? That remains a topic for debate.
- The research team from the University of Nottingham, University of Stirling, and Northumbria University analyzed the organ donation systems of 48 countries over a 13-year period.
- Countries using opt-out systems of organ donation had higher total numbers of kidneys donated compared to those using opt-in systems.
- Opt-out systems also had the greater overall number of organ transplants.
- In contrast, opt-in systems had a higher rate of kidney donations from living donors.
- The study, published in BMC Medicine, suggests that opt-out consent may lead to an increase in deceased donation but a reduction in living donation rates.
- As for address the organ shortage, researchers suggest considering changes to organ donation policy, such as adopting aspects of the "Spanish Model," or debating the ethics of farming animal organs for human transplants.
