Opt-out Organ Donation

Full disclosure up-front, I’ve recently been given some test results which suggest that a kidney transplant in the next five years isn’t beyond the realm of possibility. So I do have something of a personal stake in this.

According to various websites, the demand for donor organs simply dwarfs the supply. This probably isn’t news to anyone. It also probably isn’t news to anyone that only a minority of people are organ donors, or that the main reason for this is simple apathy. Most non-donors have no ideological objection to organ donation - indeed, when asked they think organ donation is a fine idea - but they simply can’t be bothered to spend five minutes filling out the registration form. They think “Meh, I’ll do it another day”, and they never do.

Given all this, wouldn’t it make so much more sense to put the onus on opting out rather than in. It will save lives, help ease the worry of people on the donor waiting list, and if you don’t like it you can just opt out.

I can honestly see no reason not to do this.

This isn’t exactly a reason NOT to move to opt-out, but I question if an opt-out system would net sufficient donor organs to meet demand. There are, after all, requirements from medical history to manner of death to yield a usable organ and many who have opted-in still aren’t able to donate for one reason or another.

It would, however, almost certainly yield more donor organs than an opt-in system.

When my daughter taught behavioral economics, (and we used this slide when we taught behavioral engineering economics) she showed organ donation rates in Europe and challenged the class to explain the vast differences between countries. The answer was opt-in vs opt-out. There is an immense difference - I don’t have the slide handy but it is something like 15% vs 85%.
It is certainly true that not every organ is going to work and not every potential donor will die in a way that makes donation possible - but there is a big difference.
It is one of the classic examples of default behavior, like signing up for a 401K.

We’ve had this discussion before. I’m with you all the way, but some people just freak out at the possibility that they or a loved one would give an organ without opting in. There is also some degree of fear that Big Medicine will let people die to take their organs faster.
It appears that some people care deeply about this - just not deeply enough to bother to opt out.

Form? In California, at least, all you have to do is put the little “DONOR” sticker on your driver’s license (or state ID).

I agree with the OP. People who feel strongly enough can opt out when they become legal adults, their parents can opt out when they’re minors. Otherwise the default should be donor.

My dad had a kidney transplant in November 2014. He only waited 6 months and got a 100% cadaver match, just 4 days before the surgery was scheduled for my stepsister to donate hers. It’s unheard of, and he damn well knows how stinking lucky he is.

not even a sticker in most states- you just check a yes box when applying for your license and it automatically registers you forevermore. It would be pretty easy to reverse it and require objectors to check a no box while everyone else gets automatically flagged as yes.

Asserts facts not in evidence.

If it’s just a sticker, how do they know if they don’t have your physical ID card?

Full disclosure, so as to preempt any possible accusations of hypocrisy: I’m personally a registered organ and tissue donor (regardless of familial consent, i.e my organs/tissues will be donated if possible whether my parents/partner/children object or not) in an opt-in system, as well as a registered O-neg blood, bone marrow, and platelet donor.

It deeply bothers me that opt-out systems are not more common. I know with certainty that a large part of my peers (i.e, young people in their early-mid 20s) have absolutely no objection to organ donation, and yet as far as I’m aware I’m the only registered donor in my relatively wide circle of friends which includes more than a fair few medical students.

At the very least for an opt-in system to work, I think it’s strictly necessary that one’s general practitioner have license to bring up the question of organ donation at annual physicals. Requiring people to go out of their way to hunt down an obscure pamphlet of their own accord, fill out forms, etc results in an abject waste of perfectly good organs that would otherwise be willingly donated - to the point where I consider not switching to an opt-out system little better than participating in involuntary manslaughter on a societal scale.

I really, truly have yet to hear a rationally grounded objection to an opt-out system.

Again - where do you live that “hunting down an obscure pamphlet” is part of the process? I’ve never lived anywhere where it wasn’t a yes-or-no question on a driver’s license form. If you live in such a place, perhaps fixing that should be your priority rather than going after the organs of those who have given no indication that they wish to donate them.

The decision of what to do with one’s body after death is a deeply personal one that should be decided by that person and only that person. If they want to donate their organs, there’s nothing stopping them from making that preference known.

It should not be assumed that the state has power of eminent domain over our bodies and that harvesting us for parts should be the default.

An opt-out system leaves every bit as much room for the individual to decide that they do not wish to donate their organs as an opt-in system does. The issue is purely one of which attitude towards organ donation is considered default.

Now, this may not be the case where you are, but where I live, opponents of organ donation are by far the minority, and yet we still do not employ an opt-out system. Because organ donation is only facilitated by filling out a so-called “Organ Donor Card” which preferably has to be carried on your person at all times, this means a large part of the population dies, and while they do not actually object to the idea of donating their organs, they never bothered to fill out an ODC and as such their organs go to waste.

I’m every bit as much a proponent of bodily autonomy as you, Smapti, but the fact of that matter is that opt-in systems lead to large-scale waste of organs that would otherwise have been willingly donated. The way I see it, in this case, the onus must be on the minority to opt out. Even if it can be interpreted as to some extent an infringement on their rights to have to do so, it is by a wide margin the lesser evil.

On a tangentially related note I also think opting out of organ donation should by law dictate that one is also disallowed from receiving organ donations. I do not see how not wanting to donate organs but being willing to receive them is a coherent position.

I can agree to that sentiment. However the problem here is that most people are very reluctant to deal with the eventuality of their own demise. Thus instead of opting out or in most simply do nothing. I believe the state should find a viable way of forcing the issue, i.e. obtain a clear statement from each citizen on whether they are willing to be donors or not. Asking the question when issuing a drivers license seems a reasonable thing (but it is definitely not done everywhere). However of course that only works for those of us who do have a driver’s license.

In every state I’ve lived in they ask the same question of people getting an official state ID card, which is pretty much identical to a driver’s license (the de facto identity card in the US) except for now granting driving privileges.

And really, that is a decent solution - instead of requiring a separate donor card simply make it part of the official ID used for any other official business.

I live in Germany. The system here is based on an organ donor card (“Organspendeausweis”). A small document that you are encouraged to fill out, sign and carry around in your wallet. If medical staff find such a card on your person, they know to what extent you have agreed to organ donation. The card is easy to obtain. Pharmacies, doctors and hospitals have it. Your health insurance company will send it to you. Or you can download it from the internet and print it. Whatever you do, your decision is not centrally registered. It is considered a private matter and as long as you do not die nobody needs to know.

The system has the usual drawback: People need to *do *something before they can become donors, and many who say they have no objection to becoming donors still do not have the card. (If you happen to live in Germany, get the card here. Today. Takes less than 5 minutes of your time.)

I am a registered organ donor & a blood donor but I am not in favour of an opt out system

However I can get completely behind this sentiment

And while we’re at it, if you’ve never donated blood, the paramedics should let you bleed out.

And if you don’t make enough to pay income taxes, you shouldn’t be eligible for food stamps.

And if you’ve never been a first responder, they shouldn’t prioritize saving your life in the event of a disaster.

No. I can understand where this is coming from, and I am critical of people who are unwilling to donate. But not to the extent that I would refuse to save someone’s life over it.

These are strawmen, and you know it. There is a significant difference between simply not having done something (i.e not having opted in) and having outright and actively refused participation in something. If there were as critical a shortage of donated blood and opting out rather than opting into blood donation was a reality, I would hold the exact some position on this as I do on organ donation.

Say, hypothetically, that a person lay bleeding out, and you were asked to donate your blood. If you were to actively refuse to do so on no solid grounds (e.g it would kill you because you have a severe bleeding disorder), I do not see how you could object without hypocrisy to similarly being allowed to exsanguinate, or how someone that refused blankly to pay income taxes (if this were legally possible, anyway) could object without hypocrisy to being denied food stamps.

Now, perhaps I can agree with Hiker that in the hypothetical situation where there was an actual surplus of organs (i.e there were no waiting lists at all for organ donation), I would not deny an organ even to someone that had opted out of donating themselves - but in practice this is not the case, there is not a surplus of organs, and someone that opts out of donating their own organs should at the very least be placed at the absolute back of the line. I am not familiar enough with existing opt-out systems to say whether this is already general practice, but if it is not, I cannot consider that anything other than a gross injustice.

I know no such thing.

I have no obligation to provide my blood to anyone. That is in no way inconsistent with being willing to accept blood that is given out of the donor’s free will. There’s a difference between choosing to donate and being strongarmed into it under threat of death.

Deciding whether an innocent person deserves to live or die based on their willingness to make a “donation” is a gross injustice. I wouldn’t want to live in your dystopia where the medical professional I’m paying to help me has to tell me “Sorry, the state doesn’t approve of your moral choices, so I’m obligated to do nothing and watch you die.”