If We Want More People in the U.S. To Donate Organs, We Might Have to Change How We Ask

Why take it with you?. file404/Shutterstock

More than 114,000 people are on the waiting list in the U.S. for transplants of hearts, lungs, livers, kidneys and other organs, with an estimated 20 people dying each day waiting for a transplant. Although 95 percent of American adults support organ donation, only 54 percent are signed up as donors.

Some governments are looking for a change in legislation to solve this dilemma by starting from the opposite end of the spectrum: considering everyone an organ donor. Then, the "opt-out" organ donation law would push an individual to either embrace that idea or to remove himself from the organ donation list.

Versions of opt-out organ donation laws exist in more than two dozen European countries, including Spain, Belgium and France.

Lawmakers in the Netherlands approved a similar new law in 2017. Every person over 18 who isn't already registered as a donor will receive a letter asking if they want to donate their organs after they die. They can indicate yes, no or that a specific person will decide. If they don't respond to the letter or to a second one sent six weeks later, they will be considered organ donors, according to ABC News.

The Dutch Kidney Foundation's director, Tom Oostrom, said the new law means "hundreds of patients will get back their lives and freedom."

Starting in 2020, a new law is set to take effect in England where organ donation consent will be presumed unless people opt out. There's a similar law already in place in Wales, according to New Scientist, with a comparable proposal on the table in Scotland. The English legislation is named Max and Keira's Law after a 9-year-old boy who received a heart transplant and the 9-year-old girl who donated it.

Change the meaning and you change the outcome

When something is expected of you, it changes the meaning you attach to it. That's what Stanford and Cornell university psychologists found when they looked at how organ donation is viewed in countries like the U.S. that choose the opt-in route versus countries where opt-out is the norm.

The researchers discovered that Americans (where organ donation is a choice) view it as an extreme act of altruism. They liken it to leaving 50 percent of your estate to charity instead of 5 percent or to taking part in a political campaign instead of simply casting a vote for mayor. Americans put organ donation on par with an act like going on a hunger strike.

But people in opt-out countries tend to see it as something less consequential, like letting someone go ahead of you in line. Not agreeing to be a donor, though, is seen as similar to skipping your child’s graduation compared to skipping your child’s baseball game.

Their study, which was published in the Proceedings of the National Academy of Sciences, concluded that people tend to conform to the status quo. In an opt-out country, the norm is to donate organs, so that's what they tend to do. In opt-in countries, changing the default option and making organ donation less of an "ethically meaningful and costly action" would likely make more people to do it, the researchers said.

Basically, making it no big deal would actually make organ donation a more common deal. And save a lot of lives.