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Opt-out organ donation register ‘unlikely to increase donations’

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Plans to move to an opt-out organ donation register are unlikely to spark an increase in the number of donations, according to a new study by researchers at Queen Mary University of London.

They said donors should actively choose to be on the register to ensure they genuinely wanted to donate their organs and to limit families from refusing the donation of their relatives’ organs.

“They may veto the organ donation if they can’t tell for sure what your underlying wishes were”

Magda Osman

They noted that most organ donation legislative systems around the world, whether opt-in or out, include a clause that allows the final decision to donate to be made by family members.

NHS Blood and Transplant said in 2016 that more than 500 families had vetoed organ donations since April 2010, despite being told their relative was on the opt-in NHS Organ Donation Register.

This translated into an estimated 1,200 people missing out on potential life-saving transplants, the researchers highlighted.

Plans to introduce an opt-out system in England by 2020 have recently been announced by the government, but the researchers warned this would create ambiguity and not reduce veto rates.

In their study, which involved three experiments, US and European participants from countries that have either a default opt-in or default opt-out system were presented with a fictional scenario.

It asked them to take on the role of a third party to judge the likelihood that an individual’s “true wish” was to actually donate their organs, given that they were registered to donate.

Overall, regardless of which country they came from, the participants perceived the donor’s underlying preference to donate as stronger under the opt-in systems than the opt-out systems. The researcher’s findings have been published in Journal of Experimental Psychology: Applied.

“All it will do is increase the number of people on the organ donation register”

Yiling Lin

Study author Dr Magda Osman said: “We show it’s harder to judge the underlying wishes of the deceased if they were on an opt-out and mandatory donation register.

“Making a free choice indicates what your preference is,” she said. “If you don’t actively choose and you are listed as a donor on the register, then it isn’t clear if you really wanted to donate your organs.

“This matters because if in the event of death your relatives have to decide what to do, they may veto the organ donation if they can’t tell for sure what your underlying wishes were,” she said.

Fellow study author Dr Yiling Lin added: “There are plans to launch an opt-out organ donation system in England, but what we show is that this system is unlikely to increase actual rates of organ donation or reduce veto rates, all it will do is increase the number of people on the organ donation register.”

In 2017-18, there were 6,044 people in the UK waiting for a transplant, while 411 patients died while waiting on this list.

Behavioural interventions, such as nudges, have previously been used to provide practical solutions that are based on psychological and behavioural economic research.

An example of a nudge is an automatic default – the rationale being that it can bridge the gap between a good intention and the effort needed to implement that intention into practice.

“To help increase actual rates of organ donation, we need more transplant co-ordinators”

Magda Osman

Dr Osman said: “Our findings are important because they challenge the efforts of many nudge enthusiasts to promote the use of opt-out defaults in organ donation.”

She added: “To help increase actual rates of organ donation, we need more transplant co-ordinators working with families to help them understand the issues before being faced with a monumental and distressing decision.

“We also need to offer people a way to indicate explicitly what they wish to do,” she said. “This should involve an expressed statement of intention if their wish is to donate, or an expressed statement of intention if there is an objection to donate.

“This reduces the ambiguity in trying to infer what one wanted to do when it comes to donating their organs,” she added.

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