In 2004 my father was diagnosed with acute renal failure caused by hypertension. He was advised to start dialysis and the kidney transplantation process by getting on the National Transplant Wait List. His transplant coordinator said it could be several years before he received a kidney. At that point, I made a personal decision to see if I was a match to become a living donor… I was.
April is Donate Life Month and the deteriorating health of our nation may imply that some of us will experience or know someone who will experience the need for a transplant. Health issues like diabetes, obesity and hypertension increase the risks for organ failure. According to the U.S. Department of Health and Human Services, more than 113,000 people need an organ transplant and 18 people will die each day waiting for an organ.
The majority of Americans, nearly 90 percent according to Donate Life, support organ donation, however only 40 percent of all U.S. residents age 18 and older are enrolled in state donor registries. Given the shortage of donors, the gap between approval and action is a matter of life and death.
In addition to supporting activities that encourage a healthy lifestyle, donor registration has to increase to fill this need. Legislation has been proposed Illinois, Pennsylvania and Texas for an opt-out policy for organ donation.
Speculations on why the proposed bills have not left the committees stem from ethical and practical issues involved with changing from an opt-in to an opt-out policy. A Donate Life survey provides insights into a belief that some American’s feel physicians may not work as hard to save a patient if that patient is a registered donor. This goes against professionalism and ethics of medicine and clearly shows barriers, misconceptions and the lack of comfort most people have with discussing death and organ donation.
The opt-out policy for organ donation is not a new concept. A study conducted by researchers at Columbia University show that an opt-out policy for organ donation proved effective in countries including Austria, France, Belgium, Hungry and Poland with registration rates averaging 98 percent of their population.
If preferences for becoming an organ donor are given, the defaults can influence participants in the following ways:
- Defaults suggest a recommended action
- Making a decision takes effort-accepting the default is effortless
- Many would rather avoid making an active decision about donation, an unpleasant and somewhat stressful topic
More people will register for organ donation with an opt-out policy.
Behavioral economics as a strategy for social marketing is a growing practice in public health and other industries. Specifically, defaults—what you get if you don’t actively make a choice—work by instilling a perception of ownership before an action takes place. Because the pleasure we perceive from gains is less intense than the pain from equivalent losses, “unchecking the box” to not become an organ donor would have more of an emotional impact than opting in as an organ donor, our current standard.
An opt-out policy for organ donor registration may not be in our immediate future. Until this option is seriously considered in legislation, increasing organ donation registration is the best we can do. One organ donor can save up to eight lives. Health and Human Services’ web site provides resources for those interested in learning more about ways to support organ donation, state registration and provides great information for starting the conversation with family. Visit http://www.organdonor.gov/index.html.
My father and I had our surgeries seven years ago and we are both in excellent health and enjoying life. We personally understand how the nation’s need for organ donation could have impacted our family.