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Organ Donation: To Opt In Or Opt Out

Organ shortage is a serious problem in the United States. About 20,000 organ transplants occur every year in the U.S., and 116,689 Americans are currently on a waiting list for an organ, with kidneys being the most needed. The obesity epidemic is contributing to the shortage; a quarter of prospective donors are too obese to donate their kidneys. People typically wait 3-5 years for an organ, and thousands die every year (an average of 18 people per day) because they do not get the organs they need.

Research is being done using embryonic stem cells and engineered scaffolds to try to regrow organs, but the complexity of these organs and the number of different cells and tissues comprising each organ indicates that this is not a possibility in the near future. However, there is something that can be done right now. I argue that the U.S. should switch from an opt-in (alias informed consent) system to an opt-out (alias presumed consent) system for organ donation.

Consider Germany and Austria, which are very similar countries. Germany has an opt-in system and a 12% donor rate (the percent of people registered to donate), while Austria has an opt-out system and a 99% donor rate! To compare, the donor rate in the U.S. is about 40%. Here’s another comparison: Spain, with an opt-out system, currently leads the world with 34.4 deceased donors per million people, while the U.S., with an opt-in system, has 21.9. (This number reflects people that actually donate. Some who are registered do not end up donating because their families do not give consent).

A study by Abadie and Gay showed that countries with opt-out systems have 25-30% higher donation rates than countries with opt-in systems. Similarly, Johnson and Goldstein analyzed 17 European countries and observed that there is a 16.3% increase in donation when donation is the default. They also performed an online experiment where they told participants to assume that they were moving to a country with an opt-in system, an opt-out system, or no default. Those moving to an opt-out country had nearly twice the rate of consenting to be donors.

Clearly the default matters in this situation. In opt-out programs where the default is being an organ donor, there are higher donor rates. The government is taking a stance and telling people what it recommends, and this greatly affects how people respond.

One of the major criticisms of the opt-out program is that freedom and liberty are being compromised. However, this is not the case because you still give each person the opportunity to opt out. Ultimately, it is each person’s responsibility to make this choice.

Another potential problem is that an opt-out program may not actually increase organ donation rates, as Johns Hopkins researchers suggest. They say that physicians always approach the family members of the deceased and ask whether they would still like to donate their loved one’s organs. The family gets to make the final decision, regardless of the deceased’s intentions. I can see where they are coming from; physicians want to be respectful of the grieving family. However, people do not always think the most clearly when they are emotional and grieving. Further, this limits the autonomy of the deceased, as they may have wished to have their organs donated. If the wishes of registered donors were followed more strictly, perhaps we would have more organs donated, especially if we switched to an opt-out program. Thus, switching from an opt-in to an opt-out system in the U.S. has the potential to save many more lives.

Ryan Denu Ryan Denu (7 Posts)

Contributing Writer

University of Wisconsin School of Medicine and Public Health

Ryan is a Class of 2019 MD/PhD student at the University of Wisconsin School of Medicine and Public Health. He graduated in May 2012 from the University of Wisconsin-Madison with a BS in molecular biology. He enjoys thinking and writing about health care policy and bioethics, and is also an avid tennis player, instructor, coach, umpire, and fan.