The shortage of organs for transplantation is a thorny problem. Nearly 118,000 people in the U.S. are on waiting lists for transplants of kidneys, hearts, livers, and other organs; an estimated 8,000 of them will not live to receive a transplant.

The desperate situation has spurred various searches for solutions. Scientists are working on ways to preserve donated organs longer and are developing algorithms that factor in a patient’s proximity to a transplant center along with their health characteristics. Others have suggested ways to increase the organ supply, maybe through financial compensation for donors, or via relaxed standards for donated organs.

But one of the most effective means might be a simple policy switch — from requiring donors to specifically sign up, to assuming everyone is a donor unless stated otherwise.


It’s called opt-out organ donation or “presumed consent” and it means that basically every resident is an organ donor unless they remove themselves from that list. Some version of opt-out organ donation already exists in 25 European countries including Spain, Belgium, and, as of January, France. The U.K. is currently considering opt-out policies.

And those policies have been on the whole incredibly effective. A 2012 study found that organ donation rates are “typically exceeding 90 percent in opt-out countries and failing to reach even 15 percent in opt-in countries.”

But so far those policies have gotten little traction in the U.S., despite scattered efforts by states to introduce opt-out legislation. And so it remains an open question whether the policy change could solve America’s organ shortage — or whether, as some fear, it might actually make it worse.

States’ initiatives

While Americans overwhelmingly support organ donation, only about half of them are actually registered, according to the Department of Health and Human Services. And of those registered, only a few have usable organs after they die.

“In order to be an organ donor, you have to die in a way that keeps oxygenated blood flowing through the organ,” explained United Network for Organ Sharing spokesperson Anne Paschke. “But only 2 percent of people die that way.”

Bills introduced this year in Connecticut and Texas would have created opt-out organ donation policies in those states — but the former died in committee and the latter hasn’t moved much further. Colorado and Pennsylvania considered similar bills in 2011 and 2014, respectively.

Connecticut state Senator Ted Kennedy Jr., a health care attorney and cancer survivor, said he was inspired to draft the bill after Connecticut Senate President Martin Looney received a kidney transplant the previous month.

“My goal was to get the conversation started,” he said. “To get people to acknowledge that this is an issue. I was surprised to learn that 1,500 people are on the waiting list in Connecticut.”

But backlash in the state was strong. Letters to the editor ran in the local papers, and Republicans emailed their constituents to encourage them to oppose it, Kennedy said.

For instance, Chris Kelly, who lives in Kennedy’s district, wrote in a letter to the New Haven Register that the bill “insinuates that after our death, our bodies are by default the property of the state unless we have previously ‘opted out.’”

“I knew it would be controversial,” said Kennedy. “But nobody asked anyone who was on the transplant waiting list what they thought,” he added.

Texas Republican state Rep. Jason Villalba proposed a similar bill in that state in March. Currently, the bill sits in committee while the Texas Legislature is in recess.

Would it work?

Even if these policies gained traction in the U.S., it’s an open question whether they’d solve the organ shortage.

New England Donor Services President Alexandra Glazier said that an opt-out system would not necessarily increase donations, and that it could cause the number of organ donations to drop.

“Although it’s well-intentioned, we think it could backfire,” Glazier said. “People might be put off and would opt out, not because they’re against donation but because they’re against government control of their bodies. There’s the potential for large numbers of people to opt out.”

And those concerns have some basis. Brazil and Sweden are among countries that have faced a backlash against opt-out organ donation policies.

And cultural differences may mean that such policies can’t be directly replicated, even if successful elsewhere.

“Our attitudes here are very different,” said Paschke. “Individual rights are very important in this country more so than in other countries. Opt-out hasn’t been very popular because of the way that people here view government making decisions for them.”

Still, Kennedy believes the time is right for a discussion to challenge some of those beliefs.

“I’m not holding out much hope for this happening soon,” Kennedy said. “But I’m going to continue to raise the issue. I would love to see will happen next year.”

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  • I am a resident of the United Kingdom. England will be changing to opt out in the spring of 2020. I am of the opinion that this may well back fire especially after the Alder-Hay scandal of 1988-1995.
    As a result of this new legislation being introduced in England next year I have, along with most members of my family have opted out completely, where as before most of us were happily opted in. We have taken this stance as a demonstration against the British Governments attitude that seems to give us the impression that the state owns our bodies when in fact they don’t.

  • Opt out is great in countries that have universal care; Spain is a good example of an excellent health and transplant system. The USA is a For-Profit system and of course it has horrendous financial barriers to transplant. Until the US system changes, I don’t think opt out is at all appropriate.

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