The problem with automatic organ donation

BBC News: Gordon Brown says he wants a national debate on whether to change the system of organ donation. He believes thousands of lives would be saved if everyone was automatically placed on the donor register.

I see the use of default options becoming an increasingly common trend in coming years – it has already been suggested as a remedy for pensions problems, and may well end up being the way we fund our political parties.

It is undeniably effective. But I can’t help wondering if it is really the best way to go about things.

The behavioural economist David Laibson has shown how important defaults are in determining our “choices” (here and here – pdfs both). When employees are automatically enrolled in their 401k plan [American employer-sponsored retirement scheme], for example, only a tiny fraction opt out, producing nearly 100% participation. When employees are not automatically enrolled, less than half join in on their own during their first year of employment.

Playing on inertia may well create better choices. Employees benefit from having a 401k plan. But it also gives enormous power to the authority in charge of setting the defaults. Even the best-intentioned opt outs can end up costing people money (as the FSA showed in 2005 in its report on second state pensions). And who’s to say we’re bound to get well-intentioned advice?

This isn’t a real issue with organ donation, a simple yes or no decision with few technical difficulties. But that doesn’t mean that there aren’t problems with Brown’s plan. Using inertia has other costs: most notably, in public awareness and ability to act.

The idea behind default choices is to exploit the combination (found widely) of general willingness for ideas like organ donation, but general unwillingness to act on them. But the idea that government can make all social duties opt out is a ludicrous one. Putting everyone on the organ donor list might solve that problem, but it won’t solve the related (and equally pressing) one of blood donation. Opt outs only serve to increase apathy. What we need is creative action.

There is, of course, an alternative solution to the problem of organ donation: force people to choose. Make it mandatory for everyone in the country to see their GP when they turn 18: at this appointment, present them with the options, make it clear to them what they are deciding, then don’t let them go until they’ve said one way or another.

It hardly sounds pleasant, but it may be the only answer. I have written before that, if current trends continues, we may end up having to choose between two evils: extreme paternalism or extreme libertarianism. On one hand, all our defaults are set by (hopefully) benign dictators; on the other, we are forced, painfully, to be free.

There are ways out of this dilemma, but none spring to mind right now. If you think of any, do let me know.