Impact of opt-in versus opt-out organ donation legislation on donation rates: A systematic review

Abstract

Purpose:

This systematic review analyses existing studies on organ donation rates from various countries to provide insights that may inform policy decisions and improve organ donation rates globally.

Design/methodology/approach:

A systematic search was initially conducted on 3 October 2024 and updated on 20 October 2024 across electronic databases including PubMed, Scopus, Cochrane, and Science Direct. Following an initial pilot screening, all unique references were screened by title and abstract, then full text, by at least two independent reviewers against predefined inclusion criteria. Disagreements between reviewers were resolved by double-checking at each step. Extracted data were compiled and summarised.

Finding:

Fifteen studies on organ donation policies were identified, with 13 high-quality studies included after rigorous screening. Based on these studies, opt-out consent systems show mixed outcomes across countries. Policy effectiveness varies significantly between nations. The COVID-19 pandemic substantially disrupted organ donation rates. Factors beyond legislation, such as public awareness, cultural attitudes, media campaigns, and health care infrastructure, also influence donation success.

Practical impact:

While presumed consent may increase deceased donor rates, it is not a universal solution. Effective organ donation strategies require a holistic approach involving public education, trust-building, and nuanced policy implementation tailored to specific national contexts.