Steffel, Williams, and Tannenbaum (2019) on Presumed Consent for Organ Donations

Mary Steffel, Elanor F. Williams, and David Tannenbaum, “Does Changing Defaults Save Lives? Effects of Presumed Consent Organ Donation Policies.” Behavioral Science and Policy 5(1): 69–88, 2019 [pdf here].

• The chief source of kidneys for transplants come from deceased (cadaveric) donors – approximately one-quarter of kidney transplants involve a living donor. (A cadaveric donor, of course, is often able to donate two kidneys.) 

• There is a kidney shortage. More than 90,000 Americans are on the waiting list for kidney transplants, and thousands of them die from conditions that a timely transplant would have averted.

• Many people who survive the wait list nevertheless wait for years (often more than five years) for their new kidney. During their wait, they are maintained (to some extent) by dialysis. 

• Most Americans, it seems, favor a presumed consent system – an opt-out system – for cadaveric organ donations. [FWIW, I do not, nor do nudgers Thaler and Sunstein.]

• No US state uses a presumed consent system; rather, opt-in (explicit consent) or active choice mechanisms are employed.

• Presumed consent does, at least, “make it easy” for (what is apparently) the majority of the population that wants to be on the organ donor list. Nonetheless, presumed consent can seem, well, presumptuous.

• With presumed consent, family members (next of kin) of potential donors might be unsure of their deceased relative’s wishes, given that there is likely not to be an explicit indicator of those wishes.

• Donor lists tend to grow (markedly) when presumed consent becomes the rule – although many of the new additions to the donor roster did not get there through an active choice.

• The procurement of organs for transplant, and the number of transplants, also seem to be enhanced (though not so markedly) by a presumed consent system.

• Active choice is where people are encouraged to explicitly say yes or no (or perhaps yes or later) to a query about whether they would like to be an organ donor.

• Mandated choice is where the encouragement to answer is somewhat more forceful.

• An active choice system where the choice easily can be postponed or avoided does not seem to enhance donor lists.

• Surviving family members generally get to make the call on donations, even when the deceased opted into the donor list. It might be sensible to nudge family members, if the goal is more donations.