Organ Donation - Opt in / Opt Out ?

Dr. Abhishek Garg
UCMS, Delhi

Although organ donation is vital to our health care system, many individuals still feel unnerved when they first receive the organ donation form. Most individuals are not properly educated on how organ donation works, whom it benefits, what the benefits are, and what the negatives are, so many don’t opt-in.

Rather, the form often elicits a passive response of consideration but then gets tossed aside and often forgotten. Namely, this is due to the topic being a tricky one to talk about and due to lack of knowledge, there are many myths and disbeliefs about organ donation in the society.

Almost anyone can become an organ donor, but for those who are under the age of eighteen, must have a parent present when giving their permission or else they must have guardian consent. Generally, anyone is a good candidate, permitting that he or she does not have actively spreading cancer, a severe infection, or HIV/AIDS. When going to donate an organ, one must go through a testing and evaluation before getting the green light.

Typically, the donor should have a similar blood type and tissue type, and when possible be an exact match. However, most recipients will receive a special treatment to prevent their body from rejecting the organ, tissue, or donated blood. Organs and tissues that can be donated include the liver, kidney, skin, bone marrow, bone, lungs, intestines, heart, pancreas, heart valves, middle ear, cornea, and connective tissue.

Moving further; there are two systems of organ donation around the world namely: Opt-in and Opt-out system. With an opt-in system, people have to actively sign up to a register to donate their organs after death. In opt-out systems, organ donation will occur automatically unless a specific request is made before death for organs not to be taken.

Researchers from the University of Nottingham, University of Stirling and Northumbria University in the UK analysed the organ donation systems of 48 countries for a period of 13 years - 23 using an opt-in system and 25 using an opt-out system.

The study authors measured overall donor numbers, numbers of transplant per organ and the total number of kidneys and livers transplanted from both deceased and living donors.

They found that countries using opt-out systems of organ donation had higher total numbers of kidneys donated - the organ that the majority of people on organ transplant lists are waiting for. Opt-out systems also had the greater overall number of organ transplants.

Opt-in systems did, however, have a higher rate of kidney donations from living donors.

For example, Germany, which uses an opt-in system, has an organ donation consent rate of 12% among its population, while Austria, a country with a very similar culture and economic development, but which uses an opt-out system, has a consent rate of 99.98%.

Now it would appear that implementing the opt-out system in India would be the ideal solution to solve the problem of organ donation deficit, but let’s first look at both sides of the coin before making a decision.

Arguments for automatic organ donation:

  • More than 6,500 people in the UK need a transplant, but a shortage of donors means that around 3,500 transplants are carried out annually.
  • Advances in medical science mean that the number of people whose lives could be saved by a transplant is rising more rapidly than the number of willing donors.
  • The law as it stands condemns many, some of them children, to an unnecessary death, simply because of the shortage of willing donors while, as the BMA puts it, 'bodies are buried or cremated complete with organs that could have been used to save lives'.
  • Doctors and surgeons can be trusted not to abuse the licence which a change of the law would grant them.
  • Objections to a change in the law are sheer sentimentality. A dead body is an inanimate object, incapable of feeling.

Arguments against automatic organ donation:

  • Few question the value of transplant operations or the need for more donors. But a programme designed to recruit more donors is preferable to a change in the law.
  • The proposed change implies that our bodies belong to the State as soon as we are dead. The assumption is offensive.
  • Organ removal without the expressed wish of the deceased could be distressing for his or her family.
  • The proposed change in the law is open to abuse, with the possibility of death being hastened to secure an organ needed by some other patient.
  • The safeguard - that is, the right to refuse permission for your organs to be removed - is inadequate. A terminally ill patient or his/her relatives would be made to feel selfish if permission was withheld.
  • Families may feel the wishes of their loved ones are more ambiguous compared to opt-in systems, leading to higher risk of family refusal.