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Organ Donation: Opt-Out Defaults Don’t Increase Donation Rates, Study Finds

A recent study by the Max Planck Institute for Human Development, in collaboration with the MSB Berlin School of Medicine and the UCL Max Planck Center for Computational Psychiatry and Aging Research, shows that switching to an opt-out policy organ donation, in which all adult organ donors, unless they explicitly opt out, are presumed not to increase donations from deceased donors. The results of the study have been published in the journal Public health.

As demand for donor organs far outstrips supply, calls for changes in public policy are growing. A default opt-out policy (‘presumptive consent’) is often seen as a promising approach. This policy stipulates that all adults are automatically considered potential organ donors after their death, unless they explicitly withdraw their consent during their lifetime. In contrast, the opt-in system (‘explicit consent’) requires potential donors to give active consent to donate their organs after their death. Discussion about implementing an opt-out policy has recently gained momentum again in Germany, raising the question of whether such a change in policy would actually lead to an increase in the number of deceased organ donors.

A recent analysis of all member countries of the Organization for Economic Co-operation and Development (OECD) found no significant differences in deceased donor rates between countries that choose to participate and countries that choose not to, but a significantly smaller number of living donors (individuals who voluntarily donate organs). , like a kidney, in life, in voluntary exclusion countries. However, these cross-sectional analyzes cannot control for all country-specific factors, such as healthcare infrastructure, culture, and religious issues, all of which can influence donation rates.

To address the limitations of previous research, the current study used a longitudinal approach, analyzing changes in deceased donor rates over time in five countries (Argentina, Chile, Sweden, Uruguay and Wales) that had transitioned from a donor modality. from voluntary donation to one of voluntary donation. a default opt-out policy. This method provided a more reliable assessment of the impact of opt-out policies by controlling for long-term trends and country-specific factors.

Data were collected from international databases, including the International Registry on Organ Donation and Transplantation (IRODaT) and the Global Observatory on Donation and Transplantation (GODT). Of the 39 countries that had switched from explicit consent to presumed consent by December 2019, only five could be included in the analysis due to a lack of historical data on changes made before the IRODaT database was launched in 1996 and because Presumed consent practices often existed informally. before formal legislation.

Consistent with previous cross-sectional analyses, the study found that changing the default option from opt-in to opt-out did not lead to any increase in organ donation rates in the five countries considered. Furthermore, the results indicated that the opt-out did not cause even a slight upward curve in organ donations: the long-term trend remained the same, showing no change in the rate after the change. As expected, the results showed a reduction in deceased donations with the start of the COVID-19 pandemic, with only a slow recovery observed in 2022.

“Simply switching to an opt-out system does not automatically lead to more organ donations,” says author Mattea Dallacker, who led the project at the Center for Adaptive Rationality at the Max Planck Institute for Human Development. “Without accompanying measures, such as investments in the health system and public awareness campaigns, a shift towards an opt-out option is unlikely to increase organ donations. There is no easy solution to the complex challenge of increasing organ donation rates. organ donation,” he continues. .

The study also highlights the crucial role of family members in decisions about organ donation. Even in presumed consent systems, where individuals are considered donors unless they choose not to, families are often consulted and can override presumed consent. Because many people do not discuss their donation wishes with their loved ones, presumed consent can create uncertainty and hesitation among families, which could lead to refusals.

“A possible alternative to the opt-out system is a mandatory choice system,” says Ralph Hertwig, director of the Center for Adaptive Rationality at the Max Planck Institute for Human Development. “This would allow citizens to explicitly register their consent or opposition to organ donation, for example when applying for a driving license or ID card. This active choice system could encourage people to make an informed decision, thereby that would eliminate the perceived ambiguity about their preference that appears to lead to higher rates of family rejection. Good, accessible information about organ donation is essential for an informed choice,” Hertwig continues.

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