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In the United States, over 100,000 people are currently in need of a lifesaving organ transplant. Unfortunately, 17 people die every day in the United States waiting for an organ. The United States currently has a patchwork of laws on organ donation, though there is a model legislation called the Uniform Anatomical Gift Act that has been adopted by many states. Under this model, the “opt-in” system is used, wherein individuals can choose during their lives to become organ donors after death, or the next-of-kin of deceased individuals may choose to have the deceased individuals’ organs donated. While about 54% of the population are registered organ donors, only a small percentage of people who die will die under circumstances that allow for organ donation, approximately just 3 in every 1,000 deaths. In 2021, for example, only about 14,000 deceased individuals donated organs.

Under the “Spanish Model” of organ donation, organs may be harvested from deceased individuals unless they affirmatively indicated during their lives that they did not wish to be organ donors after passing away. Even though in practice organs in Spain are usually not donated without family permission, studies show Spaniards’ confidence in the organ donation system is high, and thus, it seems having an “opt-out” policy does not necessarily hurt the population’s confidence in the organ donation system. While the “Spanish Model” includes more features like public awareness campaigns, dedicated institutions for transplants, and detailed reimbursement schemes for medical costs, I believe that even if the United States adopted just the “opt-out” system, the current regime would be improved upon.

Under my proposal, individuals and their families would still retain complete autonomy. Nobody who chooses to forgo organ donation would have their organs harvested against their wishes. However, many people may be indifferent about organ donation, or they might not recognize its importance, and so they might not go out of their way to sign up as organ donors. Many states have previously used “opt-out” type models, and they worked well. For example, Georgia adopted such a statute for corneas in 1978, and cornea transplants jumped from 25 in 1977 to 1,000 in 1984; Alabama’s similar law led to having more available corneas than were even needed.

In 1988, Iran adopted a novel program that provided compensation for living organ donors who donated organs to non-family members. Less than 20 years later, Iran completely eliminated its waiting list for those in need of kidneys. If the United States adopted Iran’s model, I would be concerned about impoverished individuals needing to resort to selling their organs, essentially. However, I would be in support of payments to next-of-kin for organ donations made after death. I believe this would work well in conjunction with an “opt-out” system, but I would still support it as an addition to our current system if an “opt-out” system is not implemented. According to one study, just a 5% increase in kidney donation rates by paying $10,000 per kidney would save about $340 per donation, thanks to savings on costs like dialysis treatment. Additionally, this would result, on average, in a .11 quality-adjusted life year (a measure of how medical treatments can improve health outcomes) increase for organ recipients.

Therefore, I propose that states adopt “opt-out” organ donation legislation. Given the overwhelming need for organs, and the tremendous medical costs society is burdened with by caring for those in need of organs, I believe our country would be greatly improved by adopting this policy. Furthermore, I would support at least considering compensating next-of-kin for organ donations, as I think this would induce more donations from those who no longer have a need for their organs.

 

Suggested Citation: Jared Feltman, Let’s Change the “Opt-In” Policy and Save Lives, Cornell J.L. & Pub. Pol’y, The Issue Spotter (Feb. 25, 2024), http://jlpp.org/blogzine/lets-change-the-opt-in-policy-and-save-lives/.