The opt-out strategy backfires unintended consequences on vital organ supply via crowding out effect of donors.
Recent research on organ supply and organ donation (on analyzing 24 countries from 2000 to 2023) revealed that the opt-out policies in organ donation have reduced the number of living organ donors by 29%.
This negative crowding out effect resulted in no added advantage in total organ supply. Also, these policies caused non-significant 7% increase in deceased donors. (1✔ ✔Trusted Source
Crowding-out effects of opt-out defaults: Evidence from organ donation policies
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The study was done by researchers from the University of Nottingham, and the outcomes were published in the journal PNAS Nexus.
The researchers suggest this effect occurs because the transition to an opt-out system alters the way people perceive the supply of organs, leading them to believe the move to an opt-out system solves the supply shortage.
Crowding-Out Confirmed: Evidence from Germany and Austria
The study confirmed this across a number of experiments on over 5,000 participants in Germany (opt-in) and Austria (opt-out), demonstrating that there is a crowding-out effect that primarily affects so-called “altruistic donations” to acquaintances and strangers, rather than donations to family members.
The most needed organ for transplant in the UK is the kidney, with over 5,500 people currently on the waiting list, and they are the most transplanted organ, especially from living donors. Living donors account for more than 40% of all organ donations in England so the significant reduction in living donors is a major concern.
Living organ donations, particularly for kidneys, are also generally more successful, with an average 10-year survival rate of 90%, compared with 75% after a deceased donor transplant.
Risks of Crowding-Out effect in Other Health Policies
Professor Eamonn Ferguson from the University of Nottingham’s School of Psychology led the UK research and is an expert in donation behavior, he explains: “We found a hidden negative effect of opt-out policies that changes people’s perception of the supply of organs, as they believe this solves the problem and the demand for organs will be met.”
“This has the knock-on effect of reducing the number of people willing to be living donors, as they believe the need is no longer there. This could have a particular impact on kidney donations, which we know are in high demand and are more successful from living donors.”
“Opt-out policies are proposed for use in other areas of health-care provision like vaccination, and as such, potential crowding-out effects need to be considered in these areas as well.”
The Path Forward: School-Based Organ Donation Education
“In England, the opt-out system was introduced by the Organ Donation (Deemed Consent) Act 2019 and officially came into force on 20 May 2020. The findings reveal the unintended consequences of a public policy nudge and suggest that policymakers should consider potential crowding-out effects when implementing opt-out organ donation systems.
“Changing to the opt-out system isn’t having the intended effect of dramatically increasing the number of organ donors that was hoped for,” adds Professor Ferguson. “What is really needed is investment in education and awareness around organ donation, starting with children in school.”
“As a society, we need to discuss it more so that people can make informed choices about becoming a donor. One way, for example, to trigger discussions about organ would be with pieces of public art.”
Reference:
- Crowding-out effects of opt-out defaults: Evidence from organ donation policies – (https://academic.oup.com/pnasnexus/article/4/10/pgaf311/8303887)
Source-Eurekalert