A Systematic Review of Opt‐out Versus Opt‐in Consent on Deceased Organ Donation and Transplantation (2006–2016)

Abstract

Background Significant numbers of patients in the USA and UK die while waiting for solid organ transplant. Only 1–2% of deaths are eligible as donors with a fraction of the deceased donating organs. The form of consent to donation may affect the organs available. Forms of consent include: opt‐in, mandated choice, opt‐out, and organ conscription. Opt‐in and opt‐out are commonly practiced. A systematic review was conducted to determine the effect of opt‐in versus opt‐out consent on the deceased donation rate (DDR) and deceased transplantation rate (DTR). Methods Literature searches of PubMed and EMBASE between 2006 and 2016 were performed. Research studies were selected based on certain inclusion criteria which include USA, UK, and Spain; compare opt‐in versus opt‐out; primary data analysis; and reported DDR or DTR. Modeled effect on US transplant activity was conducted using public data from Organ Procurement and Transplantation Network and Centers for Disease Control WONDER from 2006 to 2015. Results A total of 2400 studies were screened and six studies were included. Four studies reported opt‐out consent increases DDR by 21–76% over 5–14 years. These studies compared 13–25 opt‐out countries versus 9–23 opt‐in countries. Three studies reported opt‐out consent increases DTR by 38–83% over 11–13 years. These studies compared 22–25 opt‐out versus 22–28 opt‐in countries. Modeled opt‐out activity on the USA resulted in 4753–17,201 additional transplants annually. Conclusion Opt‐out consent increases DDR and DTR and may be useful in decreasing deaths on the waiting list in the USA and other countries. Registration number PROSPERO CRD42019098759.

Family discussions and demographic factors influence adolescent’s knowledge and attitude towards organ donation after brain death: a questionnaire study

“…Due to the diversity of the systems and the complexity of the organ donation process, the legal situation and the potential burden of decision for families are not the sole factors explaining varying organ donation rates. Systematic reviews suggest that countries with opt-out systems have higher rates of organ donations after brain death [18], but others showed that there are no differences between opt-in and opt-out systems [19,20] depending on the studies and countries included in the analysis. There are indeed examples of highly successful countries with an opt-in system, such as the USA; however, switching from opt-out to opt-in does not necessarily result in a sustainable increase of organ donation rate [21,22].…”

Impact of the revision of the law on pancreatic transplants in Japan—An analysis of the Japanese Pancreas Transplants Registry

“…The development of a legally based social infrastructure clearly affects the increase in organ donation. In particular, the opt‐out systems led to an increase in deceased organ donation 14‐16 . Although no opt‐out system has been introduced, the revision of the law on donating brain‐dead organs in 2010 increased the number of donations from brain‐dead patients, which resulted in an increase in the number of pancreas transplantation procedures, as well as heart 11,17 and lung 18,19 transplantation procedures, in Japan.…”

Evaluation of Junior Doctors’ Knowledge of Corneal Donation and the New Opt-Out System in England

“…Therefore, the implementation of an opt-out system may not automatically translate to an improvement in organ and tissue donations. 32 A systematic review conducted by Ahmad et al 20 showed that opt-out systems increase the donation rate by 21-76% over 5-14 years. However, another review demonstrated a conflicting finding whereby the donation rate was similar between opt-out and opt-in systems, highlighting the need for addressing other barriers to organ donation.…”

“…On 20 th May 2020, England has implemented an opt-out system, also known as the Max and Keira’s Law, with an aim to improve the rate of organ and tissue donation, 19, 20 joining countries such as Spain, France and Italy, and many others. Under the new, soft opt-out system, all adults in England are now assumed to be willing organ and tissue donors unless they have registered their intent otherwise.…”