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.

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3 Responses to The problem with automatic organ donation

  1. David Laibson says:

    Forcing people to choose is an intriguing proposal for organ donation. My coauthors and I have shown that it has worked well in one retirement savings plan. For details, read this paper.

    http://www.som.yale.edu/faculty/jjc83/AD.pdf

  2. Personally I don’t think that Mr. Handsome has received enough accolades for his humanitarian efforts. In my opinion a lot of celebrity do-gooders are totally phony and engage in so called good deeds merely for positive publicity. I have to say that I don’t think that George is one of the phonies out there in the world of celbrity do-gooders. I admire what he is doing for the Haitian people. I wish more celebrities were as real as he is when it comes to helping out those less fortunate in the world. So kudos to George and his desire to make this world a better place.

  3. William Smith says:

    Hello,
    Since I’m an American, my perspective is a little off, but here goes. In many states, the choice to become an organ donor can be made at the time you get or renew a driver’s license. While I think that defaulting in/opting out is a good idea, I think that there would have to be very stringent checks on whether a person has opted out or not. For the people who opt out, for religious or personal reasons, this is VERY important, and with the time constraints of organ donation, how can those people’s wishes be maintained? Today’s system assumes that you can’t harvest organs without getting a positve, documented, release. When the assumption is reversed, will people be 100% diligent for the reverse. I think this question would have to be addressed comprehensively, completely, and respectively for the majority of the people to accept this change.
    Thanks

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