The Collegian
Thursday, May 23, 2024

OPINION: The United States needs to rethink its organ donation system

<p>Graphic by Annie Scalet/The Collegian</p>

Graphic by Annie Scalet/The Collegian

At this moment, 113,000 people are waiting for a lifesaving organ transplant in the U.S., and 22 people die each day waiting for a donation.

Every organ donor has the potential to save up to eight lives, according to nonprofit organization Donate Life America. At the same time, thousands of would-be recipients have to endure excruciating suffering as they wait and hope for a transplant. Our consent system for organ donation is flawed and needlessly limits the number of donations available. 

The U.S. should save lives by switching from its current opt-in organ donation system to an opt-out system. 

Having an opt-in system means that a person can become an organ donor only by explicitly consenting to being one. In contrast, a "presumed consent" system means that motorists could select an option if they would not like to become organ donors at the Department of Motor Vehicles. If they do not check that box, they are presumed to be organ donors. 

Such a change may appear insignificant, but would actually have an enormous impact. Economists Alberto Abadie and Sebastien Gay conducted a statistical analysis for 22 countries over a 10-year period. Their findings showed that presumed consent legislation increased organ donation rates between 25% to 30%. 

To emphasize the distinction between the opt-in and opt-out systems, Nobel laureate Richard H. Thaler and legal professor Cass R. Sunstein compared donation models in Germany and Austria in their book, "Nudge." They found that Germany, which uses an opt-in system, had an organ donation rate of 12%. The organ donation rate in Austria, which has a presumed consent system, was 99%.

What could be behind such a dramatic difference in organ donation? One answer is that humans have biases toward default settings and tend to prefer the default rather than making a decision to alter it. This helps explain why statistics from Donate Life America show that 95% of Americans are in favor of being an organ donor but only 58% are actually registered. 

The influence of default settings has also been scientifically supported. 

Two experts in cognitive decision-making, Eric Johnson and Daniel Goldstein, created an experiment in which participants chose whether to be an organ donor under two separate conditions. 

Participants with the first condition had to opt out of being an organ donor, and participants with the second condition had to opt in. A control group made participants choose with no prior default. The experiment found that only 42% of participants with the second condition chose to be a donor, compared with 82% of participants with the first condition.  

Johnson and Goldstein's experiment shows that default systems are influencing people to choose not to be organ donors. Changing the default system would logically prompt additional donations.

The proposed system would cost little and is a simple way of saving lives without large spending increases. The DMV would only have to make a minor change on its organ donation form and in what it communicates to new drivers. When drivers get their license for the first time, they would be presented with a slip of paper. If a person does not wish to be an organ donor, they would have the option to easily opt out. They would also be able to notify the DMV and change their organ donation preferences at any time.

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There are people who will certainly object to the proposal that I have outlined. You may be uncomfortable with a presumed consent system because it seems to imply that the government would have an improper ownership over people's bodies. 

I am sympathetic to this concern, but I do not think that this objection applies to this circumstance.

It is important to note that I am not advocating for mandatory organ donation upon death. Such a system would violate the rights people have to determine what happens to their bodies when they die. Instead, I want to change the default system that people encounter. 

It would be remarkably easy for people to indicate that they do not want their organs donated. All they would have to do is notify the DMV. There are no major costs to opting out, so requiring someone to opt out would not negatively impact individual freedom. If people still have the ability to refuse consent for organ donation, the government is not exercising an improper ownership over people’s bodies.

Such a change is also justified because it most accurately reflects what a default actually is. Defaults exist to reflect a standard option when someone makes a decision. As previously noted, 95% of Americans are in favor of becoming organ donors. It seems strange to have the default choice retain a presumption against consent when reflecting the opinion of the majority would save lives.

In summary, default settings exert a heavy influence on human psychology. My proposal is to align human psychology with human welfare without compromising freedom. Switching to the presumed consent system will save lives without a large spending increase or excessively infringing on freedom. In an era of polarized politics, this is a policy proposal that offers an easy way to improve human welfare.

Contact opinions writer Alec Greven at

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