Will the opt-out organ donation register increase numbers?

Will the opt-out organ donation register increase numbers?
NHS Organ Donor Register © Magnus D CC BY 2.0 via flickr

According to a new study by Queen Mary University of London, UK, an opt-out organ donation register is unlikely to increase the number of organ donations.

Researchers from the university say donors should actively choose to be on the organ donation register by opting in to ensure they genuinely want to donate their organs, and to limit families from refusing the donation of their deceased relatives’ organs.

How does the system work?

An opt-out system automatically registers everyone and presumes consent to donate, so if you do not want to donate, you must take yourself off the register. However, an opt-in system requires explicit consent to donate and indicates willingness.

Most organ donation legislative systems, however, include a clause that allows the final decision to donate to be made by family members. In 2016, NHS Blood and Transplant reported that more than 500 families have vetoed organ donations since April 2010, despite being informed that their relative was on the opt-in NHS Organ Donation Register, which translated into an estimated 1,200 people missing out on life-saving transplants.

Introducing the opt-out organ donation register

Plans to introduce an opt-out system in England by 2020 have recently been announced by the government, but researchers suggest that this will create ambiguity and will not reduce veto rates.

Lead author Dr Magda Osman, from Queen Mary University of London, said: “We show it’s harder to judge the underlying wishes of the deceased if they were on an opt-out and mandatory donation register. Why? Because making a free choice indicates what your preference is. If you don’t actively choose and you are listed as a donor on the register, then it isn’t clear if you really wanted to donate your organs. This matters because if in the event of death your relatives have to decide what to do, they may veto the organ donation if they can’t tell for sure what your underlying wishes were.”

As reported by EurekAlert, in 2017/18 there were 6,044 people in the UK waiting for a transplant; 411 patients died while waiting on this list. Similarly, this year in the US there are 114,000 people on the waiting list to receive an organ and it is estimated that 20 people die each day while waiting on the list.

To address problems like these, behavioural interventions, such as nudges, have been used to provide practical solutions that are based on psychological and behavioural economic research.

A nudge is an automatic default, such as the ones often used in organ donation legislative systems. The rationale behind an automatic default is that it can bridge the gap between a good intention and the effort needed to implement that intention into practice.

Osman concluded: “Our findings are important because they challenge the efforts of many nudge enthusiasts to promote the use of opt-out defaults in organ donation.

“To help increase actual rates of organ donation, we need more transplant co-ordinators working with families to help them understand the issues before being faced with a monumental and distressing decision.”

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