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Are you in or out? What is best for organ donation?

There has been much discussion around the world about whether or not organ donation should be opt-in, where people actively sign-up to donate their organs after death, or opt-out, where organ donation automatically occurs unless a person has specifically requested not to before death. Despite the debate on this subject there has been little evidence to suggest which policy works best. To address this an analysis of the organ donation protocols of 48 countries has been published in the open access journal BMC Medicine.

Researchers from the University of Nottingham, the University of Stirling and Northumbria University set out to answer some of the questions about both policies. They compared 23 countries that used the opt-in system with 25 that used opt-out over a 13 year period (a full list of the countries is in Table 1 of the paper). They found that countries with an opt-out system had a higher total number of kidneys transplanted, which the majority of people on transplant lists are waiting for.

The analysis found that opt-in organ donation systems may have a higher rate of kidney donations from living donors, but opt-out systems have a greater overall quantity of organ transplants.

Organs from deceased donors are not the only source of organs; there are also living donors, which sometimes include relatives wanting to help ill members of their family. The scientists have shown for the first time that that the type of consent can affect deceased and living donation rates - living donations are higher in opt-in systems compared with opt-out.

Eamonn Ferguson, lead author from the University of Nottingham, says: “The idea for this research came from the observation that previous work on opt-in versus opt-out consent had focused mainly on deceased donation and not living donation. This is because these two consent policies target deceased donation. We were interested if these policies also influence living donation, which is a major source of kidneys.”

The researchers say that the results of this study could be used to inform policy decisions but that this could be greatly enhanced by routinely collecting and making available data about organ donation. The authors also believe that it is also important to look at other factors that may influence organ donation rates, such as adopting elements of the Spanish model. This includes a transplant coordination network on hospital, regional and national levels; transplant coordinators at each organ procurement hospital; and improving the quality of public information messages about organ donation. Some aspects of this model have been applied in the UK.

Eamonn Ferguson says: “We hope policy makers will use our set of analyses to consider policy decisions within the context of their own organ donation needs. One of our main recommendations is that it is imperative for international transplant organizations to routinely collect data on important organ donation indices, such as, consent type, procurement procedure, number intensive care beds and trained surgeons. These data should be on a publically available database to inform future research and policy recommendations in this area based on an individual country’s needs and consent system.”


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Notes to editor:
1. Research article
An international comparison of deceased and living organ donation/transplant rates in opt-in and opt-out systems: a panel study
Lee Shepherd, Ronan E O'Carroll and Eamonn Ferguson
BMC Medicine 2014, 12:131

Article available at journal website here.

Please name the journal in any story you write. If you are writing for the web, please link to the article. All articles are available free of charge, according to BioMed Central's open access policy.

2. The lead author of the study, Eamonn Ferguson, has conducted an interview with BioMed Central’s online magazine Biome.

3. BMC Medicine is the flagship medical journal of the BMC series, publishing original research, commentaries and reviews that are either of significant interest to all areas of medicine and clinical practice, or provide key translational or clinical advances in a specific field.

4. BioMed Central is an STM (Science, Technology and Medicine) publisher which has pioneered the open access publishing model. All peer-reviewed research articles published by BioMed Central are made immediately and freely accessible online, and are licensed to allow redistribution and reuse. BioMed Central is part of Springer Science+Business Media, a leading global publisher in the STM sector.