Richard Thaler on organ donation

Richard Thaler writes about opt-in vs. opt-out vs. mandated choice organ donation policies in this week’s Economic View column. Illinois follows a mandated choice policy.

Here is how it works: When you go to renew your driver’s license and update your photograph, you are required to answer this question: “Do you wish to be an organ donor?” The state now has a 60 percent donor signup rate, according to Donate Life Illinois, a coalition of agencies. That is much higher than the national rate of 38 percent reported by Donate Life America

The Illinois system has another advantage. There can be legal conflicts over whether registering intent is enough to qualify you as an organ donor or whether a doctor must still ask your family’s permission. In France, for example, although there is technically a presumed-consent law, in practice doctors still seek relatives’ approval. In Illinois, the First-Person Consent Law, which created this system, makes one’s wishes to be a donor legally binding. Thus, mandated choice may achieve a higher rate of donations than presumed consent, and avoid upsetting those who object to presumed consent for whatever reasons. This is a winning combination.


5 Responses to “Richard Thaler on organ donation”

  1. dju316 Says:

    So, only 60% of Illinois drivers agree to donate their organs when they die. I bet every single one of the other 40% would accept an organ transplant if they needed one to live.

    Half of the organs transplanted in America go to people who haven’t agreed to donate their own organs. As long as we let non-donors jump to the front of the waiting list when they need transplants we’ll always have an organ shortage.

    There is a simple way to put a big dent in the organ shortage — allocate donated organs first to people who have agreed to donate their own organs.

    Anyone who wants to donate their organs to others who have agreed to donate theirs can join LifeSharers, a non-profit network of organ donors who agree to offer their organs first to other organ donors when they die. Membership is free at or by calling 1-888-ORGAN88.

    Giving organs first to organ donors will convince more people to register as organ donors. It will also make the organ allocation system fairer. People who aren’t willing to share the gift of life should go to the back of the waiting list as long as there is a shortage of organs.

  2. Barbara P Says:

    Most people who are not organ donors are simply unaware of what it’s really about. They have some idea of course, but they may think that doctors will remove them from life support sooner, etc (which isn’t true). Ultimately, they let their fear of the unknown rule their decision-making. Arguably, they are mildly selfish in the sense that they don’t apparently care to learn more.

    The problem with dju316’s idea is that the crime of being mildly selfish hardly deserves the harsh punishment of being put on the bottom of a waiting list for organ donation.

    That said, perhaps if the question were phrased as “consent to donate organs AND to receive them if necessary” that would nudge them into checking “yes”?

    • dju316 Says:

      Barbara P says “Most people who are not organ donors are simply unaware of what it’s really about.” But public opinion polls say that 90% of Americans are in favor of organ donation. So the problem is not lack of awareness, it’s lack of action – the action of signing up to donate.

      What better way to get people to sign up than to link willingness to give with ability to receive. Barbara’s suggested nudge is excellent.

  3. Stewart Brock Says:

    For jurisdictions that don’t want to go for an opt-out system, then it is better to ask people first on their drivers licence application if they would like to receive donated organs should the need arise, such as after a road accident. Then ask people if they would like to be a donor. The rate will be much higher because it is much harder to refuse to be a donor if you have indicated you do wany to be an organ recipient.

  4. Marlene Record Says:

    Are you aware of an email going around, supposedly from WorldNetDaily, by Aaron Klein that reports Obama’s newly appointed regulatory czar defends the possiblity of removing organs from terminally ill patients without their consent? OMG.

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