Organ Donation: A Comparison of Consent-Based versus Presumed Consent Approaches
International Organ Donation: An Analysis of Opt-In and Opt-Out Systems
The procedure for organ donation differs greatly across the globe, prompting researchers from the UK to investigate which approach is more effective. In a study published in BMC Medicine, researchers compared the organ donation protocols of 48 countries, discovering that opt-out systems lead to higher rates of kidney donations and overall organ transplants.
Two primary methods exist for organ donation: opt-in and opt-out. Under an opt-in system, individuals must actively register to donate their organs posthumously. Conversely, in an opt-out system, organ donation occurs automatically unless a specific request is made to oppose it.
Prof. Eamonn Ferguson, lead author from the University of Nottingham, acknowledged that individuals may fail to act due to various reasons, such as loss aversion, effort, or the assumption that policy-makers have made the right decision. This inaction in an opt-in system can potentially lead to individuals who would have wanted to donate not doing so (a false negative). In contrast, in an opt-out system, inaction may result in an individual who does not wish to donate becoming a donor (a false positive).
The United States employs an opt-in system, with around 28,000 transplants possible last year due to organ donors. However, approximately 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 analyzed the organ donation systems of 48 countries for a period of 13 years. They found that countries using opt-out systems for organ donation had higher total numbers of kidneys donated, the organ most in demand by those on organ transplant lists. Opt-out systems also had the greater overall number of organ transplants.
Despite the higher rate of kidney donations from living donors in opt-in systems, opt-out systems were associated with an increase in the total number of livers and kidneys transplanted. The authors advice that their findings could inform future policy decisions, but stressed the need for international organ donation information to be routinely collected and made publicly available to strengthen the results.
The team suggests that future studies could delve into individual beliefs, wishes, and attitudes towards organ donation, which would provide further insight into the influence of consent legislation on organ donation and transplantation rates. However, they acknowledge that completely changing the system might not solve the problem of organ donor shortages and instead suggest that consent legislation or adopting aspects of the "Spanish Model" could be potential solutions to boost donor rates.
Spain boasts the highest organ donation rate worldwide, with its success attributed to measures such as a transplant coordination network and improving public information about organ donation. Despite the positive impact of opt-out systems on increasing organ donations, researchers emphasize the importance of managing unknown preferences and family vetoes in practice to maximize their effectiveness.
- The findings of the study published in BMC Medicine reveal that contextual factors influencing individual decisions play a significant role in organ donation rates, as opt-out systems lead to higher rates of kidney donations and overall organ transplants compared to opt-in systems.
- In the medical-health and wellness sphere, Paxlovid, a new antiviral drug, could potentially expand the pool of potential organ donors, as it reduces the risk of organ transplant recipients developing acute post-transplant SARS-CoV-2 infection.
- SciTech Research Institute initiated a project to retarget organ donation efforts through personalized communication strategies, taking into account various factors such as age, ethnicity, and medical-conditions to encourage more individuals to register as organ donors, ultimately improving the organ donation rates and helping more transplant patients.
- While England operates under an opt-in system, public health officials are considering transplant solutions like desensitization techniques and cross-matching to ensure that more organs are available for transplant in light of the growing number of individuals waiting for organ transplants and the perceived challenges of adopting an opt-out system.
