The Walking Dead

Why we should opt-in to opt-out

Posted by Julia Chang on September 25, 2015

In the US, 18 people die every day while waiting for available organs. The organ transplant waitlist is over 100,000. We are facing a medical crisis in this country.

It’s easier than ever to sign up to become an organ donor: many states only require an additional signature while processing your new or renewed driver’s license. Two check boxes pop up on the screen; you get to choose one. Could it get any easier?

However, a recent survey found that most Americans are willing to donate their organs after death but only 38% of registered drivers are registered to do so. What drives this disparity? Research suggests that misconceptions about the donation and registration processes are two of the primary factors that create this difference. Some people fear they are not healthy enough or are too old to donate viable organs. Others believe doctors will not work as hard to save their lives if they are organ donors. Some even fear having their organs sold on a black market after donation.

Even I suffer from these misconceptions. I’m open to the idea of organ donation—who wouldn’t want to save a life if it’s within his or her power? Yet, I’m not a registered organ donor and don’t go out of my way to register. Whenever I’m renewing my driver’s license, I usually breeze through the organ donation screen with a quick check in the “NO” box. Why? This is usually after over an hour of wait time; I don’t know if there are additional screens after the first organ donation one if I check “YES.” All I know is that I want to get out of the MVA as fast as possible—and I do not feel strongly about organ donation so any extra time spent on the process creates negative utility for me.

This is why the US should have an opt-out organ donation policy. An opt-out policy will have great gains in donation rates amongst currently unregistered people who are either willing to donate or are indifferent about organ donation. Changing the program from opt-in to opt-out eliminates some structural and bureaucratic inefficiencies, thereby increasing the availability of organs anywhere from an estimated 16% to 50%. When organ donation is the default assumption, it will take extra effort to remove oneself from the program and only those who are strongly against organ donation will take the time to do so.

Furthermore, the current US organ donation policy is inconsistent with its other property destruction policies: the US has historically denied individuals the right to destroy. Courts are concerned with the waste of resources available to society as a whole; they generally try and prevent the negative externalities that would result from the destruction of one’s physical or financial property. A physical house might be worth $1,000,000. Yet, the average estimate of the value of a statistical life for a middle aged worker is $7,000,000. Why should someone be stopped from destroying his or her house but be not only allowed, but systemically encouraged by government policy, in destroying his or her kidney that could save someone’s life?

US policy regarding organ donation boils down to the societal norms. Our society treats the human body as sacred and is not educated on the realities of organ donation. Mass media and hippie yoga teachers hand us whey kale shakes and whisper seductively in our ears: “Our bodies are sacred. Let us worship at their shrines.” It would be different to become an organ donor—it’s not the norm. Consequently, there is not a widespread push to change the current policy and policymakers are reluctant to even approach the subject. Yet, can a dead person’s kidney really be more sacred than a living human’s life?

The US would not be the first country to adopt an opt-out organ donation policy; France, Spain, Australia, Belgium, and Portugal all have varying forms of presumed consent policies, along with significantly higher organ donation rates. If the US follows their progressive lead, we can fight our medical crisis and save more lives, one kidney at a time.