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Organ Donors By Default System Would Save Lives

Study says it would make many more organs available

THURSDAY, Nov. 20, 2003 (HealthDayNews) -- Changing the organ donation system so that people are automatically donors unless they specifically indicate otherwise would make more organs available and save thousands of lives each year.

That's the conclusion of an article appearing in the Nov. 21 issue of Science.

There has been a debate about whether defaults, which are the automatic selections made when a person fails to signal a preference, actually make a difference.

In the United States, people are not organ donors unless they have explicitly indicated otherwise (on their driver's license or in a state registry, for example). This is also referred to as the "opt-in" system, or "explicit consent."

However, there is an acute shortage of organ donors. According to the study authors, more than 45,000 Americans have died since 1995 while waiting for the appropriate organ. Another recent study found less than half of brain-dead potential organ donors actually provide organs to transplant patients. This is despite the fact that 85 percent of Americans have been found to approve of organ donations.

To shed more light on whether different default positions made a difference in organ donations, two researchers at Columbia University in New York City did an analysis of existing data.

The first study was an online experiment, which asked 161 participants whether they would be donors based on three different scenarios. In the first scenario, respondents were told they had just moved to a new state where the default was not to be an organ donor (opt-in). The second scenario was the same, except this time the default position was to be an organ donor (opt-out). The third scenario required the person to choose whether or not to be an organ donor. Choices were made with the click of a mouse.

When the default was to be an organ donor, people opted to donate twice as often as when the default was not to donate. In the third scenario, participants chose to donate at the higher level.

"When forced to make choices, most people do become donors," says Eric J. Johnson, a professor of business and co-director of the Center for Decision Sciences at Columbia University in New York City. "It also suggests that forcing people to make choices makes a difference."

Next, Johnson and his colleagues looked at the number of people who had opted in and opted out in different European counties with different policies.

While some European countries follow the U.S. model, others have the opposite default policy. These "presumed consent" nations assume people are organ donors unless they have registered not to be.

The four opt-in countries had lower rates than the six opt-out countries. One reason, say the authors, may be the higher cost of changing from the default in terms of filling out forms, making phone calls and sending mail.

But the real issue was not what people chose but how many donations actually occurred, a vastly more complicated problem.

An analysis of actual organ donations from cadavers in several European countries between 1991 and 2001 found that when donation was the default, there was a 16.3 percent increase in donations (from 14.1 per million to 16.4 per million). An analysis of donations in 1999 for a larger set of European countries revealed a 56.5 percent increase in the rate, from 10.8 per million to 16.9 per million.

Even after controlling for such variables as religious beliefs and education, different defaults were associated with different rates of donation. "We think part of that is that many people find making the decision costly emotionally and costly in terms of time," Johnson explains. "Default saves some people the effort of making difficult decisions."

"We're not saying that one default is necessarily the best, but we want to point out the cost," Johnson says. "The current default is costing lives. With the other way, there may be some people who aren't sure who become donors, but any default has a trade-off. You have to look at this trade-off."

Changing the default position is one of several ideas that has been bandied around in recent years in an attempt to increase the number of organs available for donation.

"The idea has been brought up again and again," says Anne Paschke, a spokeswoman for the United Network for Organ Sharing. "A couple of years ago, Texas introduced the idea of presumed consent, but it didn't go anywhere."

Other ideas include having markets for organ donations, paying families or even making organs the property of the government once a person dies.

Some states are grappling with the issue of "first-person consent," which means that even if you've made a decision to donate and indicate it on a driver's license or a state registry, additional permission is still required from the family.

Tommy Thompson, Secretary of the U.S. Department of Health and Human Services (HHS) seemed to gingerly embrace the idea of the opt-out default, through a spokesman.

"Given Secretary Thompson's strong support of organ donation as a means of saving lives, this is certainly an interesting concept, one that deserves further study," says Kevin Ropp, a spokesman for the Health Resources and Services Administration, a part of HHS. "HHS is committed to creating a donation-friendly America by focusing on known barriers to donation and taking action to substantially increase donations and transplantations."

More information

For more on organ donation, visit Secretary Thompson's Gift of Live Donation Initiative or the United Network for Organ Sharing.

SOURCES: Eric J. Johnson, Ph.D., professor, business and co-director, Center for Decision Sciences, Columbia University, New York City; Anne Paschke, spokeswoman, United Network for Organ Sharing, Richmond, Va.; Kevin L. Ropp, spokesman, Health Resources and Services Administration, U.S. Department of Health and Human Services, Rockville, Md.; Nov. 21, 2003, Science
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