The United Kingdom has just completed a review of its organ donation system. The British, like others, have a long waiting list of people who need organ transplants. It is estimated that 1000 people a year there die while waiting for an operation. (In the US the number is above 7000 per year.) The Guardian newspaper took an interest in this issue and ran editorials on the problems with the current system. A central focus of the debate was the contrast between the current ‘opt in’ system of donation and an ‘opt out’ (or presumed consent) system. An ‘opt in’ system requires people interested in donating organs to explicitly choose to do so. An ‘opt out’ system presumes that people are willing to donate, but gives them the right to refuse to do so. The Guardian had argued that an opt out system produces more organs, without compromising the autonomy of donors who wish not to donate. See this editorial, for example.
http://www.guardian.co.uk/commentisfree/2008/nov/16/health-organ-donation
But, it turns out, the commission charged with formulating new proposals for organ donation rejected this idea. I take it that Parliament can accept or reject the recommendations.
http://www.guardian.co.uk/society/2008/nov/17/health-organ-donation
Part of the debate concerns whether an ‘opt out’ system will create worry for seriously ill patients and lead them to mistrust doctors and nurses, thereby actually reducing the number of organs donated.
I found an interesting blog post on this issue written by a retired British civil servant, James Wimberley, who discusses the experience of Spain. Apparently Spain is held up as a success story because of its high rate of donation. Wimberley argues that Spain’s success is not due to its opt out system, though that is what the Guardian and others had claimed.
http://www.thesamefacts.com/archives/health_care_/2008/11/buggins_good_turn.php
Wimberley estimates that if the US achieved Spain’s rate of donation, 5000 lives would be saved every year.
The virtues and vices of ‘opt in’ and ‘opt out’ systems have relevance in many other areas. For example, it is said that many more workers contribute to their own retirement accounts if they have to opt out of a contribution program rather than opt in.
Here is a case where good social science can save lives (and help people get into the habit of saving, among other things). If we can gather evidence that a small change in the way that a choice is structured for people makes them more willing to donate organs—and is otherwise acceptable—there’s a good reason to see that we do it.
Steve Sverdlik