Opt-Out Organ Donation Laws Do Not Guarantee Increase in Donor Organs
Recent research from a team at the Vienna University of Economics and Business has found that the introduction of 'opt-out' policies for organ donation--where individuals are considered potential donors unless they have explicitly declined--does not necessarily translate into a significant rise in available donor organs for transplantation. The study, published in a reputable scientific journal, examined the impact of switching from an 'opt-in' system, which requires explicit consent, to an 'opt-out' system in several countries over the past two decades.
The 'opt-out' model was originally implemented with the aim of increasing the number of organs available for transplant by presuming consent among the population. In Austria, for instance, this approach means that more than 99 percent of the population is automatically considered potential donors. However, the findings suggest that medical and psychological factors, as well as family involvement in the decision-making process, play significant roles in limiting the expected increase in organ donations.
According to the study, following the adoption of the opt-out policy, there was an average decrease of 29 percent in living organ donations, while donations from deceased individuals increased by only around 7 percent. The researchers attribute this marginal increase to stringent medical criteria, which restrict the pool of viable organ donors, regardless of consent status. Additionally, in many countries, relatives of the deceased are still consulted and can prevent organ retrieval, further reducing the number of donations.
Data gathered from surveys involving over 5,000 participants indicated a psychological effect known as the substitution effect. The introduction of the opt-out system often leads to the public perception that there is now an adequate supply of donor organs, which in turn decreases the willingness of individuals to consider living donation. However, this effect is less pronounced among immediate family members, where the willingness to donate a kidney or other organ remains high irrespective of the broader legal framework. For more distant relatives or acquaintances, the opt-out policy appears to have a stronger impact on reducing living donation rates.
Experts recommend implementing supplementary measures alongside the adoption of opt-out organ donation policies to address these unintended consequences. Public awareness campaigns and ongoing education are suggested as means to encourage living donations where appropriate and to ensure families remain well-informed about the importance of both deceased and living organ donation.
Austria serves as a prominent example of the opt-out principle in action, contrasting with countries such as Germany, where explicit consent is required for organ donation. In the previous year, Austria reported 579 organ transplants from deceased donors, while 58 organs came from living donors. At the end of 2024, over 66,000 individuals had registered their objection to organ donation in the national opt-out register.
The study underscores that while opt-out policies can contribute to modest increases in post-mortem organ donation, they should not be viewed as a standalone solution. A comprehensive approach that considers medical eligibility, family involvement, and public perception is essential for effectively addressing organ shortages and supporting both living and deceased organ donation.