Designing Organ Donation Programs

recycleRichard Thaler, co-author of Nudge, writes an interesting piece about the behavioral economics of organ donation for The New York Times. Research has long shown that opt-in donor registration programs result in low rates of sign-up, while opt-out programs result in high rates of sign-up. But many object to the opt-out programs, believing organ donation should require explicit consent.

Fortunately, there is another possibility, called “mandated choice,” under which people must indicate their preference. In Illinois, where I live, this system has been in use since 2006 and doesn’t seem to have ruffled many feathers.

Here is how it works: When you go to renew your driver’s license and update your photograph, you are required to answer this question: “Do you wish to be an organ donor?” The state now has a 60 percent donor signup rate, according to Donate Life Illinois, a coalition of agencies. That is much higher than the national rate of 38 percent reported by Donate Life America.

What does this mean? It indicates a large degree of latent support for organ donation. That is, these results are consistent with the idea that many people want to register for organ donation but don’t because of the hassle required to do so.

This is exactly what we saw with Select Home Delivery: roughly half of people getting their maintenance medication in retail moved to Home Delivery when required to make an explicit choice (and offered assistance with the move).

(Note: this entry originally appeared at

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