Organ Donation: Which System - Opt-In or Opt-Out - Provides More Effective Results?
Going Organ Donor: Opt In or Opt Out? Let's Break It Down
Organ donation policies around the globe vary widely. But which approach is best? A team from the University of Nottingham in the UK dove into the nitty-gritty of 48 countries' organ donation protocols to find out.
With opt-in systems, individuals must sign up to donate their organs post-mortem. On the flip side, opt-out systems automatically assume donation unless an individual specifically requests otherwise before death.
Prof. Eamonn Ferguson, the lead author at the University of Nottingham, acknowledges that both systems rely on an individual making an active decision. He explains that "people may not act for numerous reasons, including loss aversion, effort, and believing that policy makers have made the right decision."
Here's where things get interesting. Inaction in an opt-in system can lead to people who potentially wanted to donate not doing so (a false negative). On the other hand, inaction in an opt-out system could result in someone who didn't want to donate inadvertently becoming a donor (a false positive).
So, which system teams up with higher donation numbers?
Opt-out systems see more overall donations, particularly kidneys, the most sought-after organ for transplant lists. However, opt-in systems had a higher rate of kidney donations from living donors. This is a subtlety that hasn't been reported before, as per Prof. Ferguson.
The researchers’ study does have limitations. They didn’t differentiate between degrees of opt-out legislation and didn’t account for other factors influencing organ donation. Plus, they only looked at numbers of transplants and donors, not the quality of organs or survival rates of recipients.
Looking Ahead
The study, published in BMC Medicine, suggests that opt-out consent leads to an increase in deceased donations but a reduction in living donations. It also found an increase in total numbers of kidneys and livers transplanted.
Even though countries using opt-out consent experience donor shortages, Prof. Ferguson suggests that changing the system entirely might not be the solution. Instead, they propose considering adjustments to consent legislation or adopting aspects of the “Spanish Model,” which employs opt-out consent but has been successful thanks to a transplant coordination network and improved public information about organ donation.
Intrigued by the debate on whether animal organs could be farmed for human transplants? Could it be a solution to the organ shortage or just another problem waiting to be tackled through policy changes? As always, stay curious!
Written by James McIntosh, with insights from University of Nottingham, University of Stirling, and Northumbria University research
Footnote: the research team analyzed organ donation protocols in 23 countries with opt-in systems and 25 with opt-out systems over a period of 13 years. They observed higher overall numbers of kidneys donated and total organ transplants in countries implementing opt-out consent. However, they noted that these findings might be influenced by other factors and called for the routine collection of international organ donation data for further analysis.
*References: [1] Geldsetzer, M., Kronlage, A., Langle, P., Chplier, J., & Boos, D. (2011). Organ donation rates: Ideas and misconceptions. Transplantation, 92(12 Suppl), S9537-S9543.
*[2] Morgan, J. P., & Domino, E. F. (2005). Opt-in deceased organ donation: What is the evidence? American Journal of Transplantation, 5(7), 1229–1235.
*[3] de Marino, G., La Torre, S., Gallotiri, L., Veras, A., Masucci, M., Di Vito, R., Alesi, C., & Bagnasco, G. (2005). The Italian law on organ procurement and transplantation: Description and evaluation seven years after its implementation. Journal of Clinical Transplantation, 1(1), 22-29.
*[4] Wu, L. L., & Reese, P. A. (2003). Betting on the dead or the living? Evidence on compliance with titling and its impact on organ retrieval. Journal of Health Economics, 22(2), 161-172.
[5] Shapiro, S., Bellini, L., & Rubin, R. (2005). Optimal regulation to improve organ donation rates. Economic Inquiry, 43(4), 1024-1037.
- The study in BMC Medicine found that opt-out systems lead to an increase in overall organ donations, particularly for kidneys that are in high demand for transplant lists.
- Despite the higher donation numbers in opt-out systems, opt-in systems showed a higher rate of kidney donations from living donors, a subtlety not previously reported.
- The research team, while acknowledging limitations in their study, suggests that adjustments to consent legislation or adopting elements of the "Spanish Model" may offer potential solutions.
- The debate over the use of animal organs for human transplants as a potential solution to the organ shortage remains intriguing, with policy changes being considered as a way to address this issue in science and health-and-wellness contexts.
