A recent study indicates that implementing an opt-out organ donation policy, where adults are presumed to be organ donors unless they choose not to participate, does not result in an increase in deceased organ donations.
According to a new study conducted by the Max Planck Institute for Human Development, in collaboration with MSB Medical School Berlin and the Max Planck UCL Centre for Computational Psychiatry and Ageing Research, transitioning to an opt-out organ donation system does not enhance the number of organ donations from deceased individuals. The findings have been published in the journal Public Health.
The demand for organ donations significantly exceeds the available supply, prompting growing calls for a change in public policy. The opt-out default policy, also known as ‘presumed consent,’ is often viewed as a potential solution. This approach automatically classifies all adults as organ donors posthumously unless they express their unwillingness to participate while alive. On the other hand, the opt-in model requires individuals to proactively agree to donate their organs after death. Recently, discussions about adopting an opt-out policy have resurfaced in Germany, raising the inquiry of whether such a shift would actually result in more deceased organ donors.
An analysis examining all member nations of the Organisation for Economic Co-operation and Development (OECD) revealed no substantial difference in deceased donor rates between opt-in and opt-out nations, though it noted fewer living donors in opt-out countries—those who donate organs, such as kidneys, while still alive. However, these widespread analyses do not account for country-specific factors like healthcare infrastructure, societal culture, and religious beliefs, all of which can affect donation rates.
To overcome the shortcomings of earlier research, the present study adopted a longitudinal approach, investigating the changes in deceased donor rates over time in five countries—Argentina, Chile, Sweden, Uruguay, and Wales—that transitioned from an opt-in to an opt-out policy. This method offered a more trustworthy evaluation of the effects of opt-out policies by accounting for long-term trends and specific national factors.
Data was gathered from international repositories, including the International Registry in Organ Donation and Transplantation (IRODaT) and the Global Observatory on Donation and Transplantation (GODT). Among the 39 countries that had switched from explicit consent to presumed consent by the end of 2019, only five could be included in the analysis due to insufficient historical data for changes prior to the launch of the IRODaT database in 1996, along with the prevalence of informal presumed consent practices before formal legislation.
In line with previous cross-sectional studies, the current research found that changing the policy from opt-in to opt-out did not improve organ donation rates in the selected five countries. Additionally, the findings showed that the switch to an opt-out system did not lead to even a marginal increase in organ donations, as the long-term trend remained consistent with no change following the policy shift. Unsurprisingly, a decline in deceased donations occurred at the beginning of the COVID-19 pandemic, with only a gradual recovery noted by 2022.
“A mere transition to an opt-out model does not automatically result in more organ donations,” states Mattea Dallacker, the lead author of the study at the Center for Adaptive Rationality at the Max Planck Institute for Human Development. “Unless complementary measures, such as enhancements to the healthcare system and public awareness campaigns, are implemented, shifting to an opt-out system is unlikely to boost organ donations. The challenge of increasing organ donation rates is complex and does not have a straightforward solution,” she continues.
The study emphasizes the significant role that family members play in organ donation decisions. Even in presumed consent systems, where individuals are assumed to be donors unless they opt out, families are often consulted and can override this presumed consent. Since many individuals do not communicate their organ donation preferences to their loved ones, presumed consent can create uncertainty and reluctance among families, leading to potential refusals.
“One alternative to the opt-out system could be a mandatory choice approach,” suggests Ralph Hertwig, Director at the Center for Adaptive Rationality at the Max Planck Institute for Human Development. “This would let individuals explicitly express their consent or objection to organ donation when applying for a driver’s license or ID card, for instance. Such an active choice system could encourage people to make informed decisions and alleviate the ambiguity concerning their preferences, which seems to contribute to increased family refusal rates. Accessible and informative resources about organ donation are crucial for facilitating informed choices,” Hertwig elaborates.
