A recent study by the Max Planck Institute for Human Development, in collaboration with the MSB Medical School Berlin and the Max Planck UCL Centre for Computational Psychiatry and Ageing Research, has found that switching to an opt-out organ donation policy, where all adults are presumed organ donors unless they explicitly opt out, does not result in an increase in donations from deceased donors. The results of the study have been published in the journal Public Health. With the demand for donor organs exceeding the supply, there is growing pressure for changes in public policy to increase organ donations. An opt-out default policy, also known as presumed consent, is often considered a viable option, where all adults are automatically considered potential organ donors unless they choose to withdraw their consent during their lifetime.
In contrast to the opt-in system, where potential donors must actively consent to donating their organs after they pass away, the opt-out policy presents individuals as potential donors by default unless they opt out. Previous analyses of member countries of the Organisation for Economic Co-operation and Development (OECD) found no significant difference in deceased donor rates between opt-in and opt-out countries, but opt-out countries had significantly fewer living donors. However, these cross-sectional analyses could not account for country-specific factors such as health infrastructure, culture, and religious beliefs that may influence donation rates.
To address the limitations of previous research, the current study used a longitudinal approach to analyze changes in deceased donor rates over time in five countries that had switched from opt-in to opt-out default policies. By assessing changes in donation rates over time in Argentina, Chile, Sweden, Uruguay, and Wales, the study aimed to provide a more reliable assessment of the impact of opt-out policies while controlling for long-term trends and country-specific factors. Data was collected from international databases such as the International Registry in Organ Donation and Transplantation (IRODaT) and the Global Observatory on Donation and Transplantation (GODT).
The study found that switching from an opt-in to an opt-out system did not lead to an increase in organ donation rates in the five countries analyzed. Despite the change in policy, there was no significant change in deceased donor rates, indicating that the opt-out default did not result in an increase in organ donations. The onset of the COVID-19 pandemic also led to a reduction in donations, with a slow recovery observed by 2022. Author Mattea Dallacker emphasizes that transitioning to an opt-out system alone is unlikely to increase organ donation rates without accompanying measures such as investments in healthcare systems and public awareness campaigns.
The study highlights the crucial role of relatives in organ donation decisions, even in presumed consent systems. Families are often consulted and can override presumed consent, leading to uncertainty and potential refusals when individuals do not discuss their donation wishes with loved ones. Ralph Hertwig suggests a potential alternative to the opt-out system is a mandatory choice system, where citizens can explicitly register their consent or objection to organ donation when applying for a driver’s license or ID card. This active choice system could prompt individuals to make informed decisions, reducing ambiguity and potentially leading to higher donation rates. Good and accessible information about organ donation is essential for promoting informed choices.
