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'Opt Out' Policies Increase Organ Donation

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An organ donor


According to the American Transplant Foundation, 18 people die every day in the United States for want of an organ transplant, and some 122,344 people are waiting for a donated organ.


Changing U.S. policies so that people’s organs are automatically donated when they die—rather than requiring people to “opt in” to donating their organs while they are still alive—may lead to more organ donations and more lives saved.


In countries such as Austria, laws make organ donation the default option at the time of death, and so people must explicitly “opt out” of organ donation. In these so-called opt-out countries, more than 90% of people register to donate their organs. Yet in countries such as U.S. and Germany, people must explicitly “opt in” if they want to donate their organs when they die. In these opt-in countries,fewer than 15% of people register.

Social psychologists Shai Davidai, Tom Gilovich, and Lee Ross set out to understand the psychology behind these different organ donation rates. The researchers first asked Americans to consider what it means to donate one’s organs in opt-in countries versus opt-out countries. The researchers discovered that Americans view organ donation in opt-in countries as extraordinary altruism—more like leaving 50% of your estate to charity than leaving 5%. Yet in opt-out countries, what’s extraordinary is not donating your organs—more like skipping your child’s graduation than skipping your child’s baseball game. Americans also liken organ donation in opt-in countries to costly acts like going on a hunger strike, but see organ donation in opt-out countries as less consequential—more like letting someone go ahead in line.

The researchers then probed the beliefs of participants who live in countries with opt-in or opt-out policies. In Germany, an opt-in country, participants consider organ donation an ethically meaningful and costly action. But in Austria, an opt-out country, participants consider organ donation an ethically trivial and inconsequential action.

Based on these findings, the researchers conclude that changing policies so that the United States became an opt-out country, rather than an opt-in country, would change organ donation from a meaningful and costly action to a trivial and inconsequential one. This change in meaning, in turn, would lead to an increase in organ donations. 

Why This Works

This study targets people’s perceptions of what is the normal and usual thing to do—the status quo. People tend to conform to the status quo. In an opt-out country, the status quo is to donate organs upon death. A simple adjustment to the phrasing of the default option in the United States has the potential to lead more people towards organ donation and, consequently, saving thousands of lives.

When This Works Best

Countries or states that currently have an opt-in policy and no religious or cultural beliefs that discourage organ donation would benefit most from changing their default policies. 

The Original Study

Davidai, S., Gilovich, T., & Ross, L. (2012). The meaning of default options for potential organ donors. Proceedings of the National Academy of Sciences, 15201-15205.

In the Press

The New York Times

Related Topics

Civil Society Health


Text by Francesca Scheiber

Image: Organ Donor via photopin (CC BY-NC-SA 2.0)