Debate over Organ Donation: Which System - Opt-In or Opt-Out

Organ donation policies differ widely across the globe, and the burning question is whether an opt-in or opt-out system is more effective. A team of researchers from the UK explored this topic by examining the organ donation protocols of 48 countries over a 13-year period.

In an opt-in system, individuals must actively sign up for organ donation after death. Conversely, an opt-out system assumes consent unless an explicit request is made not to donate. However, these systems rely on individuals making an active decision, which can lead to drawbacks as highlighted by Prof. Eamonn Ferguson from the University of Nottingham, UK:

"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."

A disadvantage of an opt-in system is that inaction can lead to individuals who would want to donate not doing so (a false negative). In contrast, inaction in an opt-out system may result in an individual who doesn’t want to donate becoming one (a false positive).

The United States currently employs an opt-in system. Last year, approximately 28,000 transplants were made possible due to organ donors, with around 79 people receiving organ transplants every day. Regrettably, approximately 18 people die daily due to a shortage of donated organs.

Researchers from the University of Nottingham, University of Stirling, and Northumbria University compared the organ donation systems of 48 countries - 23 using an opt-in system and 25 employing an opt-out system. They found that nations with an opt-out system had higher total numbers of kidneys donated, the organ most sought after by those on organ transplant lists. Additionally, opt-out systems had the greater overall number of organ transplants.

Although opt-in systems had a higher rate of kidney donations from living donors, the authors of the study emphasized that it is the first time this apparent influence on living donation rates has been reported.

The study had limitations, as it did not distinguish between varying degrees of opt-out legislation and did not account for other factors that might influence organ donation. Nonetheless, the researchers discovered that opt-out consent might lead to an increase in deceased donation but a reduction in living donation rates. Moreover, opt-out consent was associated with an increase in the total number of livers and kidneys transplanted.

In the future, the researchers suggested that international organ donation information - consent type, procurement procedures, and hospital bed availability - be made publicly available for further policy decisions. They also proposed that future studies examine the desires, beliefs, and attitudes of individuals concerning organ donation from an individual perspective.

Interestingly, countries employing opt-out consent still experience organ donor shortages, suggesting that completely changing the system may not resolve the issue. The researchers suggest that consent legislation or adopting aspects of the "Spanish Model," which utilizes opt-out consent and a highly effective transplant coordination network, could be solutions to improve donor rates.

Recently, Medical News Today ran a feature discussing the possibility of farming animal organs for human transplants as a potential solution to the organ shortage or a problem best addressed through changes to organ donation policy.

Written by James McIntosh.

Countries with Opt-Out Organ Donation Systems

Spain: Recognized for having one of the highest deceased organ donor rates in the world.
United Kingdom: Implemented an opt-out system, making it simpler for individuals to donate unless they explicitly opt-out.
Argentina: Another country that employs an opt-out system to increase organ availability.
Belgium: Uses a presumed consent system, though compliance is not always fully enforced in practice.
Finland: Adopts a presumed consent model with certain legal distinctions.

In the study comparing organ donation systems, nations with an opt-out system, like Spain, the United Kingdom, Argentina, Belgium, and Finland, were found to have higher total numbers of kidneys donated and more overall organ transplants compared to countries with an opt-in system.
The Spanish Model, which utilizes opt-out consent and a highly effective transplant coordination network, is suggested as a potential solution to improve donor rates, similar to the systems implemented in Spain and the United Kingdom.
Although countries like the United Kingdom employ an opt-out system, they still experience organ donor shortages, indicating that completely changing the system might not fully resolve the issue, and other measures may be necessary.
A feature on Medical News Today discusses the possibility of farming animal organs for human transplants as a potential solution to the organ shortage or a problem best addressed through changes to organ donation policy. Additionally, researchers suggest that consent legislation or adopting aspects of the Spanish Model could be solutions for improving donor rates.