Opting-out: The Real Reason Behind the Lack of Organ Donors

If you were asked to predict whether or not someone was a registered organ donor, what factors would you consider first? Perhaps religion? Cultural influences? Their family’s values? What if someone told you that these factors were all irrelevant, and that the main deciding factor was really whether or not someone had to check a box? For such a significant decision, this explanation is not very satisfying, but it may very well be true.

In a 2003 study, Eric Johnson and Daniel Goldstein studied rates of organ donation in European countries. The rate in Austria was close to 100% and in Sweden it was almost 86%, but in Germany and Denmark the rates were 12% and 4% respectively.  Despite the cultural and physical proximity, there were huge gaps between the rates. The main difference between these countries was that the ones with high percentages of organ donors had an “opt-out” system, whereas the countries with low percentages had “opt-in” systems. Essentially, people did not become organ donors in the “opt-in” countries because of the extra effort required to check a box. As Daniel Kahneman succinctly stated in Thinking, Fast and Slow, “The best single predictor of whether or not people will donate their organs is the designation of the default option that will be adopted without having to check a box.”

Kahneman defines this phenomenon as the “framing effect.” He views it as a threat to the economically rational view of human decision-making since people can clearly be manipulated into making (or not making) important decisions based on how a situation is presented.

The United States has an opt-in system with about 45% people registered as organ donors. While 45% is a better figure than some of the other opt-in countries, it is still not enough to prevent the number of deaths that occur due to a lack of organ donations. The logical next step is for Congress to pass a bill changing America’s opt-in system to an opt-out system. Unfortunately, passing a bill through Congress requires even more effort than checking a box.