New System Might Increase Organ Donations

Bill Greisling waited three years for someone to help him breathe.

Finally, this past May, hospital workers called the 62-year-old father of six and grandfather of 15, to let him know that help had arrived. A high school student had died in a car crash on his 16th birthday and Greisling would receive his left lung.

"I can't tell you how grateful I am," said Greisling, who, before the surgery couldn't even walk to his mailbox without running out of breath due to idiopathic pulmonary fibrosis, a progressive disease of the lung. "You start looking at life very differently — all you want to do is help others."

According to a Gallup poll, 83 percent of Americans understand the benefits of organ donation and approve of the practice but only 28 percent have granted written consent to release their organs if they die. Since 1995, more than 45,000 people have died waiting for an organ donor.

Avoiding the Question

Some say the problem lies in a reluctance to make what can be a very uncomfortable decision. They say a new opt-out system, which would assume people are donors unless they specify otherwise, could dramatically increase the number of donors and save lives. A similar example lies in the do-not-call telemarketing system, where it is assumed telemarketers may call people at home unless they add their names to a do-not-call list.

But because releasing your organs to medicine after death can be such a profound decision, critics say adopting a similar opt-out system for organ donation would also introduce all kinds of ethical land mines.

"It's a really emotionally hard decision to make — you have to think about your own demise," said Eric Johnson, a social scientist at Columbia University. "It's easier to not think about it at all."

Numbers from some European countries show that forcing people to confront the decision can make a big difference.

In several countries, including Austria, Belgium, France, Hungary, Poland, Portugal and Sweden, authorities assume everyone is willing to be a donor — with the approval of family after death — unless they say otherwise in written form. In those countries, 85 percent to 99 percent of people are on paper as willing donors and actual donations are higher by about 56 percent.

In Germany, Denmark, the Netherlands and the United Kingdom, where it is assumed people are not willing donors unless they sign up to be, the consent rates range from just over 4 percent in Denmark to 27 percent in the Netherlands.

Surveys by Johnson and his colleague Daniel Goldstein suggest a change in how people sign up could make a difference in this country as well.

Rephrase the Question?

The pair interviewed three groups of people. Members of the first group were told they had just moved to a new state where it was assumed they would be an organ donor. They were given the choice to confirm or change that status. Another group was told the same except it was assumed they were not donors unless they specified they wanted to be. The third group was told to simply choose whether or not to become organ donors — with no prior default.

Among those who had to opt out from being a donor, 82 percent volunteered to be donors. For those who had to change their default to opt in and become a donor, only 42 percent signed up. And 79 percent of those who made the choice without any prior default said they would be donors.

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