Organ Donation: Benefits of an Opt-In and Opt-Out Registration Method Comparison
Rewritten Article:
Organ donation policies across the globe vary significantly. Should it be a system where individuals must opt-in or opt-out for organ donation after death? That's the question a team of UK researchers from the University of Nottingham aimed to address by examining organ donation protocols in 48 countries.
An opt-in system requires people to actively sign up to a registry to donate their organs. On the other hand, opt-out systems automatically assume consent for organ donation unless a specific request is made against it prior to death.
Professor Eamonn Ferguson, the lead author from the University of Nottingham, recognizes the challenges that come with relying on individual decisions in both systems.
"People may not act for many reasons, like loss aversion, lack of effort, or the belief that policymakers have made the right decision," explains Prof. Ferguson.
However, inaction in an opt-in system may result in individuals who would want to donate losing the opportunity (a false negative). On the contrary, inaction in an opt-out system could potentially lead to an individual who doesn't wish to donate becoming one unintentionally (a false positive).
The US currently employs an opt-in system. Last year, approximately 28,000 transplants were made possible due to organ donors. Regrettably, around 18 people still die daily due to a shortage of donated organs.
To put it simply: Researchers from the University of Nottingham, the University of Stirling, and Northumbria University analyzed the organ donation systems in 48 countries over a 13-year period – 23 with an opt-in system and 25 with an opt-out system.
Surprisingly, they found that opt-out systems typically result in higher total numbers of kidneys donated compared to opt-in systems. These systems also boasted a greater overall number of organ transplants.
Opt-in systems, however, had a higher rate of kidney donations from living donors. This connection between policy and living donation rates has not been reported before, notes Prof. Ferguson.
The authors acknowledge their study's limitations, such as not differentiating among varying degrees of opt-out legislation. They also didn't assess other factors influencing organ donation.
The study's findings, published in BMC Medicine, suggest that opt-out consent may increase deceased donation while decreasing living donation rates. Opt-out consent was also associated with an increase in the total number of livers and kidneys transplanted.
The authors suggest that while their results could inform future policy decisions, they could be strengthened further through the collection of international organ donation data—consent type, procurement procedures, and hospital bed availability—and making it publicly available.
Prof. Ferguson suggests future studies could delve into individual perspectives on the decision to opt-in or opt-out, including beliefs, wishes, and attitudes.
"By combining different research methods, researchers can gain a greater understanding of the impact of consent legislation on organ donation and transplantation rates," he concludes.
Interestingly, countries using opt-out consent still face organ donor shortages. A complete change in the system of consent might not necessarily solve such an issue. Instead, they suggest that consent legislation or adopting elements of the "Spanish Model" could be ways to improve donor rates.
Spain currently boasts the highest organ donation rate globally, with their success mainly attributed to their opt-out system, a transplant coordination network that operates locally and nationally, and quality public information about organ donation.
Recently, there's been discussion about farming animal organs for human transplants as a solution to the organ shortage. Is this the answer, or should the solution lie in changes to organ donation policy?
Written by James McIntosh.
- Professor Ferguson, from the University of Nottingham, suggests that future studies could examine individual perspectives on the decision to opt-in or opt-out for organ donation, including beliefs, wishes, and attitudes.
- The study, published in BMC Medicine, indicates that opt-out consent may increase deceased donation while decreasing living donation rates and suggests that such findings could inform future policy decisions.
- In the field of science, the debate persists about whether countries should move towards an opt-out system, as seen in countries like Spain, with the highest organ donation rate globally, or continue with the current opt-in system.
- Additionally, in light of health-and-wellness concerns and the ongoing organ shortage, there has been discussion about using Paxlovid, an antiviral medication for COVID-19 treatment, to potentially improve organ function before transplantation or to prevent the rejection of transplanted organs.
