Abstract

Thousands of people die each year waiting for a life-saving organ transplantation. Cadaveric organ donations from the deceased provide the majority of transplanted organs in the U.S. and many other countries. In the U.S., a potential donor has to “opt in” to become a donor under the principle of informed consent. Many countries around the world have shifted cadaveric organ procurement to a presumed consent system where a deceased person is classified as a potential donor in the absence of explicitly “opting out” of donation before death. Using an event studies design and newly constructed cross-country panel data, we offer new causal evidence on the impact of presumed consent laws on donation rates. We offer theoretical predictions on when opt in yields more organs than opt out, and when the opposite is true. We study in the laboratory an experimental game modeled on the decision to register as an organ donor and the decision to donate someone’s organ on their behalf as a decision proxy to investigate how changes in the default consent regime might impact donations. We find that an “opt in” regime results in more donations than an “opt out” regime except in situations where a population’s donation propensity is moderate and where families have little power to overturn presumed consent.

Joint with Ayush Gupta and Yetong Xu

Paper available here.