Tuesday, 7 October 2014

Opt-in or opt-out on organ donation: the right thing to do should be the default thing to do

For a while now, I've been wanting to begin a series of posts I'm calling Magic Society, on the subject of magical thinking with regard to social issues (the politically correct term is non-evidence-based thinking). The name Magic Society is derived from the UK Conservative government's Big Society, a scheme to bring about adequate government of a large and complex system by 'integrating the free market with a theory of social solidarity based on hierarchy and voluntarism.'

My kick-off post is just what it says, a little reflection on how to optimize a tiny part of our society, saving lives in the process. 

Since organ donation has become so successful, we are all aware of the difficulties of long waiting lists for transplants. I just signed a Change.org petition to ask the UK to switch to an opt-out system, which means people would be considered willing donors unless they've specifically indicated they don't want to be. There are ongoing campaigns to bring about opt-out systems in the US and Australia as well.

Since it seems kind of obvious that organ donation is the right thing to do, I thought I would like it to be the default. The problem is that nobody wants to mistakenly take the organs of someone who would have opted out, but somehow failed to make their choice known (just as so many of us fail to make our preference for being donors known). It might seem we could address this with an extensive public information campaign, special liaisons with religious groups likely to opt out, and so on, but I think there would inevitably be accidents and oversights.

It seems to me that the real 'right thing to do' is to make sure everybody has a declared preference and that their choice is accessible to medical professionals at points where it will be needed. That would mean a single organization (probably the NHS) actively soliciting that choice from everyone in the country, double-checking it from time to time, and making sure it appears on identity documents most people are likely to have (or make it accessible by other means).

It's a system that would be easier to arrange in some countries than others. Unlike some state health systems, the NHS has rather given up on prevention and prefers to see most of us as little as possible, making it hard for them to collect information from us. Since the British are very resistant to carrying identification cards, we can't push for the relatively easy and inexpensive solution of getting this information displayed on them. We certainly don't want to rely on multiple organizations to hold this information: a driving license authority here, a medical insurance there, because of the risk of people giving different choices. The right default involves a single authority soliciting everyone's decision and allowing them to change it at will. This could be one of those situations where a lack of existing social infrastructure forces Britain to hover between two non-optimal solutions - meanwhile, people die who didn't need to ...

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