Solving Economists' Favourite Problem

If you are ignorant about economists, you probably think that their favourite topic is something like unemployment or interest rates. If you read the same blogs I do, you'll come to the conclusion that their favourite topic is organ donation.

The background of this is that around the world, there is a shortage of after-death organ donations. Economists come up with the kind of solution to this you would expect from them: Let people sell the right to harvest their bodies after their death (e.g., here).

The problem with this otherwise fine solution is that many people find it repugnant. In other words, it is not politically feasible.

In light of this, many people advocate to replace the typical opt-in solution (a person actively declares her consent to be harvested) with an opt-out solution (a person is presumed to be o.k. with her being harvested unless she declares otherwise).

The problem with this otherwise fine solution is that many people find it repugnant also: How dare the state assume my consent (e.g., here)?

There is a simple solution to this mess. Borrowing a term from psychometrics, I'll call it "forced choice". Here's how it works. When you get your first driver's license/ID/whatever, you have to make a choice on whether you want to donate your organs in the case of your death. Otherwise, no driver's license/ID/whatever. You can change your mind later on.

Problem solved.


pj said...

I seem to recall having the option when I got my license to choose to go on the organ donor register (which I did).

The problem though is that even if you've gone on the register, even if you have an organ donor card, your family still get to trump your wishes because, fundamentally, you're dead and they're not, so they have rights and you don't.

And most families, when asked, refuse. That's the essential dilemma, which is what opt-out consent is partly trying to achieve - it is not just saying that everyone is presumed to consent to rgan donation unless they've specified otherwise, it is also trying to shift the presumption such that the family can't trump the wishes of the deceased (whether that be conscious opt-in, or presumed) because they won't be asked.

LemmusLemmus said...


that's weird. I am under the impression that here in Germany one's decision is actually binding, but I'm not sure. Come to think of it, in the brochure that came with my card it said one should inform family members of one's decision. I assumed at the time that this was intended for cases in which a person dies but is not carrying her card, but I might have been wrong.

If the family can trump a deceased person's decision, the only functions of the decision would seem to be a) being valid in cases in which there is no family, or they have no opinion, or b) to signal one's will to the family. (In fact, trumping the deceased's will on this question seems like a pretty rude thing to me.)

Anyway, if the problem is as you describe it, it seems to me that the solution is not opt-out, but rather have a rule which says that the deceased's decision cannot be trumped by the family.

P.S.: I enjoyed your destruction of the "sexy walk" study. Great laugh!