When it comes to organ donation policies, different countries adopt different policies within its borders. Mainly there are four types of policies — Soft opt-in, Hard Opt-in, Soft Opt-out and Hard Opt-out.
Opt-in policy means one has to register as an organ donor with the national registry.
If one registers at the registry, in the incidence of his/her death the authority already considers him/her as a potential donor, him/her as a potential donor. The family has the last say on whether the organs are to be donated or not. In case of hard Opt-in, the family members have no say in the process if so it is only for formality since the deceased has made it clear before his death that his organs are to be donated after death.
An opt-out policy means that registration has to be carried out in case one is not interested in organ donation post-death.
Until and unless this is done, the person will be treated as a potential donor after death. In the case of soft opt-out, one’s family members can still decide on one’s behalf to donate the organs, but in case of hard opt-out, one’s organs would not be donated even if the family members insist otherwise.
Although when considering the influence of policy on organ donation rates, based on current research the opt-out policy is considered most effective. A study that happened in Wales after their change of policy from Opt-in to Opt-out has shown encouraging proof of the increase in organ transplantation rate after policy change. This being said, not all countries with opt-out policies have seen this exponential increase of donation rates like others.
Many times, what works in favour of Opt-out policy is that people are unaware or unmotivated to take actions regarding the topic, which results in more number of potential donors, and more number of postive family consents. For Opt-in, this attitude results in less number of people signing up and thus indicating their wishes.
As mentioned by Prof. Eamonn Ferguson in one of his publication, inaction in an opt-in system can lead to individuals who would want to be a donor not donating (a false negative). In contrast, inaction in an opt-out system can potentially lead to an individual that does not want to donate becoming a donor (a false positive).
The studies published in BMC Medicine, show that “opt-out consent may lead to an increase in deceased donation but a reduction in living donation rates.”
Looking at the world leader of organ donation and transplantation rates, Spain, makes it clear that the increase in rate is possible in case of Opt-out policy in the short term but in order to keep this rate up for long, one has to have a system which maintains, facilitates and improves the processing time to time. Spain utilises the Opt-out system, but if one goes more in-depth in understanding what they are doing differently, the team credits it to the measures they have taken with the policy change. The network of local and national transplant coordinators, their training and onboarding, with the quality of information available to the public all the time at one place is what makes them different.
The opt-out policy is said to increase the deceased organ donations, but in opt-out policies, the number of living donations is higher. Which is one more factor one should consider while evaluating the impact of those policies on public attitude.
This article was written in order to introduce the types of organ donation policies that are adopted around the world. In the next article, which will come out on next Saturday, we will discuss more the Opt-in policy with a focus on Indian organ donation & transplantation system with the governing legislation.
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