Does changing defaults save lives? Effects of presumed consent organ donation policies

Abstract

In this review, we examine whether presumed consent organ donation policies save lives. We compare presumed consent defaults (where people are considered organ donors by default but can opt out of donation) with explicit consent defaults (where people are considered nondonors by default but can opt in to be considered donors). Experimental, cross-sectional, and longitudinal evidence indicates that rates of consent, donation, and transplantation are higher under presumed consent policies than under explicit consent policies. The evidence also suggests, however, that presumed consent is one factor among many that determine the number of organs donated and lives saved; policymakers must balance a number of other considerations to ensure that shifting to a presumed consent system will boost donation and transplantation rates. We underscore the importance of investing in health care infrastructure to support organ procurement and transplantation and offer empirically informed recommendations to enable consent policies to save the most lives.