In terms of opt-out, I only know the data in the U.S. but basically while it might be a good idea, it’s unlikely to yield significant increases: it seems like such an attractive decision architecture/nudge type intervention, but when you dig in, it’s a much closer call (which is why Sunstein and Thaler don’t recommend it, for example).
The current American system is more of a hybrid than clear opt-in. Right now, about 75% of those who could become deceased donors ultimately consent to do so (about 40-50% are registered as organ donors and of the remainder, the family consents about 40-50% of the time). Thus even if an opt-out system worked as intended, the marginal upside isn’t so high (and the downside to it failing or being counterproductive would be quite severe). Spain, the country with the highest deceased donation rates in the world, ostensibly has an opt-out system, but the families are very empowered to say no to donation, and the actual difference between Spain and the U.S. is that in Spain a lot of their deceased donors are over 70 and here very few are.
There’d also be some risks of going to an opt-out system. So imagine what happens when someone is actually eligible to become a deceased donor—they’re brain dead, so their death is often sudden and unexpected to their family. Let’s say the donor didn’t choose to opt out. What do you tell the family who’s in the room with a brain-dead patient whose heart is still beating—“she’s dead. Now you have to leave the room so we can harvest her organs”? If they have no control over what happens to their loved ones body, you can imagine a lot of people becoming pretty upset, even people who might have been persuaded to say yes to donation. The deceased organ donation relies on the public’s support and good graces, so if you have repeated instances of grieving families publicly decrying the opt-out system, that creates a significant risk that the change will be counterproductive.
I haven’t studied organ donation, but I was under the impression that the current state of the (admittedly non-experimental) evidence suggested that switching to opt-out would likely yield significant (though not huge) increases in organ donation, e.g. see here and here.
Is it easy for you to explain, or link me to, the reasons for your skepticism?
The U.S. is third in the world for deceased donation per million persons. The difference between us and the #1 (Spain, which has a suite of good deceased donation policies, one of which is a version of presumed consent) can be explained by our generally not accepting deceased donors over 70 and Spain doing so. http://onlinelibrary.wiley.com/doi/10.1002/lt.23684/full
Also, the kidney shortfall is 20K/yr. Total deceased donor kidneys are about 12K per year. Opinions differ as to what percent of those eligible to be deceased donors donate, but the official government estimate is 75% (I think a range of 50-75% is probably credible), so even if all eligible deceased donors donated, there would still be an enormous shortfall in kidney transplants each year.
In terms of opt-out, I only know the data in the U.S. but basically while it might be a good idea, it’s unlikely to yield significant increases: it seems like such an attractive decision architecture/nudge type intervention, but when you dig in, it’s a much closer call (which is why Sunstein and Thaler don’t recommend it, for example).
The current American system is more of a hybrid than clear opt-in. Right now, about 75% of those who could become deceased donors ultimately consent to do so (about 40-50% are registered as organ donors and of the remainder, the family consents about 40-50% of the time). Thus even if an opt-out system worked as intended, the marginal upside isn’t so high (and the downside to it failing or being counterproductive would be quite severe). Spain, the country with the highest deceased donation rates in the world, ostensibly has an opt-out system, but the families are very empowered to say no to donation, and the actual difference between Spain and the U.S. is that in Spain a lot of their deceased donors are over 70 and here very few are.
There’d also be some risks of going to an opt-out system. So imagine what happens when someone is actually eligible to become a deceased donor—they’re brain dead, so their death is often sudden and unexpected to their family. Let’s say the donor didn’t choose to opt out. What do you tell the family who’s in the room with a brain-dead patient whose heart is still beating—“she’s dead. Now you have to leave the room so we can harvest her organs”? If they have no control over what happens to their loved ones body, you can imagine a lot of people becoming pretty upset, even people who might have been persuaded to say yes to donation. The deceased organ donation relies on the public’s support and good graces, so if you have repeated instances of grieving families publicly decrying the opt-out system, that creates a significant risk that the change will be counterproductive.
I haven’t studied organ donation, but I was under the impression that the current state of the (admittedly non-experimental) evidence suggested that switching to opt-out would likely yield significant (though not huge) increases in organ donation, e.g. see here and here.
Is it easy for you to explain, or link me to, the reasons for your skepticism?
The U.S. is third in the world for deceased donation per million persons. The difference between us and the #1 (Spain, which has a suite of good deceased donation policies, one of which is a version of presumed consent) can be explained by our generally not accepting deceased donors over 70 and Spain doing so. http://onlinelibrary.wiley.com/doi/10.1002/lt.23684/full
Also, the kidney shortfall is 20K/yr. Total deceased donor kidneys are about 12K per year. Opinions differ as to what percent of those eligible to be deceased donors donate, but the official government estimate is 75% (I think a range of 50-75% is probably credible), so even if all eligible deceased donors donated, there would still be an enormous shortfall in kidney transplants each year.