Organ Donation: Opt-out or Opt-in?

To understand why an opt-out system of organ donation makes so much sense, we first need to understand how the current opt-in system actually works. It sounds so wonderful, for example, 125,000 people have registered to be organ donors in the United States.

The reality is that upon their death, only 3 in every 1000 who are registered in the US as donors, will have their organs transplanted to improve or save another life.

So, we begin to see why people stay on transplant lists for long periods of time. Too many of these people never have the opportunity to have their transplant’s needs met. Most of us go about our daily lives without giving the national transplant list a second thought, or any thought at all for that matter.

The donor process begins for most people by registering to donate with the state in which they reside. This is often taken care of by the state’s department of motor vehicle. The actual process of registering as an organ donor, the “opt-in” system, does not guarantee that their organs or tissues will actually be used for transplantation. Also, the “opt-in” registration process usually takes place many years before a donation is even possible.

The registered donor goes about living their lives, spending little or no time thinking about the fact that they ever even registered as an organ donor. The problem is not that people are unwilling to register as organ donors. The problem is that even though the United States has over 125,000 registered donors, most times an actual organ or tissue transplant will not take place upon their passing. For this to happen the registered donor in the “opt-in” system, will have to die in very specific circumstances.

Those individuals who eventually may have their organs or tissues utilized for transplantation will have died at a hospital. Not out of the country on vacation, at work or at home. They must not have any systemic (body wide) infections. They may have been injured in a traumatic accident causing head trauma or they may have had a stroke or an aneurysm. They would have gotten the best care the hospital had to offer in order to save their lives. The majority of viable tissue or organs come from individuals who were on life support systems when they are eventually declared brain dead.

Federal regulations dictate that the local Organ Procurement Organization must be notified if an organ donor has died or is nearing death. The local Organ Procurement Organization is usually efficient at taking advantage of an organ donors passing. But, the “opt-in” system works only when the medical staff is actually aware of the patients’ organ donor status and has the time to confirm this status.

If the Organ Procurement Organization is able to confirm the deceased individuals’ organ donor status, they will serve as legal consent for the organ donation. If an individual dies in a manner that makes them eligible to donate their organs and they are not listed as an organ donor, the medical stay will often make a donation request from the deceased family. Off course at this time, the family may not be able to agree to the request, as they are already under extreme emotional distress.

So, what happens next? When pre registration organ donor status has been confirmed or the next of kin has authorized a donation (opt-in system), the local OPO will then notify the Organ Procurement and Transplant Network. It is important to point out that the time line is very important. The organs and tissues of a deceased donor are only viable for a limited period.

The Organ Procurement and Transplant Network is responsible for overseeing the national transplant database of all patients waiting for a tissue or organ transplant. The donors’ medical records are uploaded to the database and a search for matching patients begins. This computerized system produces a list of local patients waiting for organ or tissue transplants that match the deceased donor. If a local patient is not available or healthy enough to receive a transplant on that day, the OPTN moves on to the next patient on the list. On the occasion that a local match is not found the OPTN will reach out to a regional or national search base.

While this search is being carried out the organs and tissues are being maintained by artificial support. Remember that the time line is important and every organ that may be viable does not necessarily find its way to a matching patient. The condition of each of the organs tagged for transplant is watched over by the local medical staff and the local Organ Procurement Organization coordinator.

The medical team that treated the organ donor is relieved by the incoming transplant team chosen by the Organ Procurement Organization. This team of medical professionals removes the organs and tissues to be transplanted in an operating room. The process also includes closing any incisions made, to ensure that an open casket ceremony is possible.

Some organs can survive outside the body longer than others. As a result, this is one of the major factors that determine how far it can travel to a recipient. Now that we have a better understanding of how the current “opt-in” system of organ donation works, it is time to think about how an “opt-out” system can save more lives every day.

The concept of legalizing an “opt-out” system is a worldwide concern of all developed countries. Is it something that humanity is ready for, or is it too big of a human rights issue? Many lives are lost with the current “opt-in” system. When we turn the tables on volunteering, we would now assume that everyone is a potential organ donor. Unless they register to opt out before their death.

In this scenario, the legal system would presume that consent has been given for organ or tissue removal upon death. The legal path to indicate your disapproval would be to register as a non-organ donor. This would mean that all viable organs and tissues could be used routinely to save lives. The problem in approving any legislation to this effect comes, when one considers religion and cultural death rituals.

As it stands now there are major organ shortages. As of July 2017, there are 117,000 individuals on the national organ transplant list. This figure is made up of men, women, and children. Last year in 2016 a total of 33,611 actual organ transplant surgeries were performed. Can you see how much the “opt-in” system of organ donation falls short?

Every day a minimum of 22 people dies in the US while waiting for a transplant. While most people would agree that organ donations should be made available to those in need to save or improve life, only 54% of the US population has actually taken the steps to register as donors. While 22 people a day are dropping off the list, another person is added every ten minutes.

Each viable donor can save 8 lives and improve the lives of several others. Each approved donor can donate one heart, two lungs, two kidneys, one liver, one pancreas and their intestines. In the US last year, 62% of organ transplant were male and 38% were female. In addition 82,000 corneal transplants were performed and more than 1 million tissue transplants.

In the US during the year 2016, 41,335 organs were donated. More than 4 out of 5 donations came from deceased donors. More importantly, because the US uses an opt-in system of donation, 33% of deceased donors were over the age of 50.

Australia currently has an opt-out system of donation. When an individual dies, the medical team assumes that they can approve the use of viable organs or tissue for transplant, unless there is a standing opt-out order in their medical records. Statistically, 90% of the population remain eligible organ donors.

How does the average American see organ donation? In 2012 three Social Psychologists conducted a study in the US and other opt-in country’s perception of volunteer organ donation. They also, questioned citizens in countries with an opt-out system, how they felt about organ donation.

Shai Davidai, Tom Gilovich, and Lee Ross made some very interesting observations. They asked Americans what it would mean to donate their organs in an opt-in system versus what it would mean to donate their organs in an opt-out system. They found that Americans viewed organ donation in the US as a sign of altruism.

When they answered the other side of the question, Americans said that they viewed organ donation in an opt-out country like missing a kid’s graduation or game. They also associated the act of organ donation in opt-in countries to costly acts like going on a hunger strike. Oddly enough, they likened organ donation in opt-out countries to a less costly act, like letting someone go ahead of you in line.

They found that in Germany another opt-in country that they associated the act of organ donation to an ethnically more, yet costly act. Where as, in Australia and the opt-out countries, they associated the act of donation as ethically meaningless and inconsequential. They concluded that changing the system in the US from an opt-in system to an opt-out system would simply change the perception of organ donation form meaningful and costly to meaningless and inconsequential.

Imagine what this kind of change in perception could do for the 117,000 individuals on the national transplant list. What did this study reveal? It confirmed that as human beings we are creatures of public opinion or the status quo. What does the community in which I live define as usual and customary?

It is not hard to imagine that a simple change in legislation would accomplish this enormous change in perception. Resulting in as much more people receiving transplant organs and tissues. Saving thousands of lives and improving the lives of millions.

How do you feel about a change in the US from an opt-in system of organ donation to an opt-out system of organ donation? Keep in mind those with ethical or religious concerns could register to opt-out. Opting-out would be seen as inconsequential by the majority of the population. It would appear to be a fair choice based on the individual’s personal concerns.

Survival rates would improve, because death that resulted in viable organs and tissues would not go to waste, by a system that is handicapped by numbers of volunteers and too much time consuming red tape. Would you not vote for a system that improved your own chances of living longer, as well as friends and family? How could you vote no, when you could simply opt-out if you personally did not want your organs or tissues used to save another person’s life.