Organ Donation: opt-in vs. -out

Author: Ashanthi Snell

In the United States, 18 people die everyday waiting for an organ transplant and over 100,00 people are still on the transplant list today. Organ donation is the process of transplanting a healthy organ from either a living or deceased donor into someone who is experiencing organ failure.

In the United States, 18 people die everyday waiting for an organ transplant and over 100,00 people are still on the transplant list today. Organ donation is the process of transplanting a healthy organ from either a living or deceased donor into someone who is experiencing organ failure. This process is one of the remarkable procedures that can be used to save lives on a daily basis and highlights just how much medicine has advanced. But, we are currently experiencing an organ shortage. Individuals who are on the waiting list for a transplant are unable to get one immediately and often pass away or become too ill to accept an organ before one becomes available. 

In the United States, we currently operate under an opt-in system for donation. This means that people have to actively consent to donating their organs while they are still alive or the next of kin must consent to the donation process after death. An alternative to this system is an opt-out policy meaning that individual organs are automatically donated when they pass away unless they remove themselves from the registry before death. In theory, the opt-out policy would allow more organs to be donated and help to improve the quality of life of many more people.

Although these systems may sound similar they have fundamental differences in their outcomes and psychological mindsets. In the United States, an opt-in country, people view organ donation as an extraordinary behavior that is both ethically meaningful but also costly. On the other hand in opt-out countries, such as Austria or Spain, organ donation is viewed as an ordinary behavior that is ethically trivial and inconsequential. Due to the vast differences in mindset, a policy change in the United States would not only increase the number of organs donated but also the outlook individuals have on this behavior.

If the United States were to change its organ donation policy to an opt-out system it would impact the lives of thousands of patients awaiting transplantation. The number of people taken off the waitlist due to illness or death would decrease by between 3-10% and waitlist removals would decrease by 52%. In addition, an opt-out system in the United States could lead to an organ donation increase of between 5-25%. Further, an opt-in policy would increase the deceased donation rate by 21-76% over 5-14 years meaning that about 4753-17,201 additional transplants would occur annually. Although these numbers are significant, a policy change would only affect the United States marginally and would not provide a solution to the organ shortage. 

Where does this leave us today? Currently, the United States has one of the highest organ donation rates in the world with over 50% of American adults registered. When surveyed about 93% of American adults stated that they support organ donation so a policy change would help the 40% of people who would otherwise not be eligible to donate their organs. In addition to donation policies, many other factors affect this process such as organ location, the viability of the organ, clinician judgment, and religious or cultural beliefs that may prevent someone from donating their organs or receiving a transplant. All of these additional factors are present not only in the United States but worldwide and it is important to remember this when further exploring whether a policy change should be made.

In addition to policy changes, there are two other ways that we can work to help the thousands of people still waiting for a transplant today. First, aging and the increased prevalence of comorbidities in the United States are negatively affecting the pool of eligible organ donors. Currently, only 1-2% of deceased individuals are eligible to donate their organs with a fraction of those people actually doing it. By working to improve the overall health of our population we would be able to increase the number of organs eligible for donation. Second, there are both organ and tissue donations that are possible with living donors. For example, kidney, liver, or bone marrow donations among others are organs/tissues that we can donate during our lifetime without dramatically impacting the living donor’s health, yet this is something that is not very common today. Working to reduce the stigma behind living organ donation and further removing barriers surrounding this topic would also help to provide more organs to those who need them.

All in all, there are many factors that are contributing to the organ shortage, yet one of the more tangible factors is our legislative policy. Should we work to change the United States into an opt-out system, or do you think this change would only have marginal impacts?

Sources

• https://sparq.stanford.edu/solutions/opt-out-policies-increase-organ-donation

• https://labblog.uofmhealth.org/industry-dx/how-opt-out-donation-could-affect-us-waiting-lists

• https://link.springer.com/article/10.1007/s00268-019-05118-4

Check out these great resources if you are willing to take action or want to get involved!

• Sign up to be an organ donor in your state

  • https://www.organdonor.gov/sign-up

• Be the Match- Learn more about the bone marrow transplant

  • https://my.bethematch.org/s/join?language=en_US&joinCode=marrow17&gclid=CjwKCAiAvriMBhAuEiwA8Cs5lWMNps2jy1_HdF9mT4VJhPYkqofQXncU_CcbSHcWlhYXT-mPHSM4cRoCPTUQAvD_BwE

• Be a Wonder Foundation

  • https://www.beawonder.org/