In the future, new organs will be created from a patient's own stem cells and they will require no waiting lists, no immunosuppressive drugs, and no stickers on drivers licenses making people available for organ donations.

Currently, organ transplantation is "opt in" - you have a choice. A new paper by psychologists examines whether it might be better to have organ donation be opt-out.

If most people have a choice, they want to keep it. The developed world is increasingly monitored and controlled by government and freedoms are being limited in everything from food to behavior. The scholars from The University of Nottingham, the University of Stirling and Northumbria University want to create another government database, an international one, and believe it would lead to an 'opt out' system and provide a greater number of organs for transplant.

The paper in BMC Medicine says it is the first international comparison that examines both deceased as well as living organ/transplant rates in opt-in and opt-out systems. 

Professor Eamonn Ferguson, a psychologist at The University of Nottingham, said, "Until now decisions have been based on limited evidence. This important health policy question generates strong opinions but the evidence is weak and the subject is complex. Our main aim is to increase the number of organs available for donation and transplantation but this research has revealed subtleties that weren't known before concerning the effects of consent of both deceased and living organ donations, with previous work focusing primarily on deceased donations."

No Easy Answers

Organ donations have basically been level for a while. The people who want to opt in have do it and the people who don't, don't. There are calls to increase opt outs because if someone does not do so, their organs can be harvested without permissions from the family and that would lead to more organs available.

The new paper says an opt-in system can increase the number of living donors for kidneys and liver. "We wanted to find out if opt-out versus opt-in policies influence not just deceased donations but also living donations - which are a major source of kidneys. We also wanted to extend previous work by examining the effects of these policies for different types of organs. The aim is to develop a more comprehensive dataset on organ donation by combining sources of data from 48 counties over a 13 year period," Ferguson said.  

The research looked at the number of organ donations in 48 countries world-wide. Twenty-three of these countries use the opt-in system, twenty-five of them have an opt-out system. Using statistics going back 13 years the study found that for every million people in the population:

• There were more deceased donors in countries using the opt-out system than those using the opt-in system.
• There were more living donations in countries using the opt-in system than those with an opt-out.
• Taking the overall number of kidney and liver donations - from both living and deceased donors – the figure was higher in countries using the opt-out system.

So Is Opt-Out the Best Way Forward?

With advances in medical treatments the demand for organ transplantation is growing. In Wales they have moved to an opt-out system while England has kept the opt-in system. The Spanish Model which has an opt-out system has resulted in a notable increase in donors but the whole health system underwent a transformation to achieve that.

Ferguson says, "Although we support previous research in demonstrating greater deceased donor rates in opt-out countries compared with countries using the opt-in system it isn't as simple as that."

The researchers point to other factors that can influence the donation rates other than the type of consent system. For instance:

• The critical care systems: how many critical hospital beds are there?
• The gross domestic product.

Fergusson argues that it is imperative for transplant organizations to routinely collect data on important organ donation indices - consent type, procurement procedure, number of intensive care beds and trained surgeons - and make this publicly available to inform future research and policy recommendations.