Let’s Make Everyone Become an Organ Donor

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Why you should care

Around 20 people die every day in the U.S. awaiting transplants. So should we require Americans be their neighbor’s keeper?

This week: Should everyone be required to be organ donors? Let us know by email or in the comments below.

What is the worst place in America for health disparity? If you’re talking about obesity, hypertension, sleep apnea, diabetes or a number of other maladies, you’re almost assuredly talking about the South. But for patients waiting on a kidney or liver? The worst place is the Empire State, where around 8,500 residents are awaiting organ transplants despite having access to world-class hospitals and scientists, as The New York Times reported in July.

Nationwide, more than 115,000 people are awaiting organs, and 21 people on average die each day, according to David Fleming, CEO of Donate Life America. Yet their deaths could (largely) be avoided — if we as a society are willing to save them. What if, instead of redistributing wealth, we redistributed entrails? Rather than asking you to tick a box at the DMV, maybe it’s high time we all be made legal organ donors. What do you think, should the United States institute mandatory organ donation?

 The benefits to public health are self-evident in the case of organ donation.

To our knowledge, no nation has been willing to go that far. But until we can manufacture organs, they have to come from somewhere. And the idea isn’t so outlandish when you consider that many countries are already practicing a slightly less invasive method: Rather than asking permission, these nations automatically assume you want to be an organ donor, and if anyone objects, they have to actively opt out.

The process of “presumed consent” has worked wonders in places like Spain and Belgium, which top the global list for high donor rates. Last year, Spain’s 2,183 deceased donors paved the way for 5,260 transplant surgeries, including 360 lung and 300 heart transplants, according to a news report by Mosaic. In the past year, Iceland, Wales and Scotland adopted similar presumed consent models, creating living policy laboratories for researchers to study going forward.


A survey conducted by Astellas Pharma US and Donate Life America in February showed that nearly 72 percent of Americans say they want to donate their organs after death. But only 38 percent of licensed U.S. drivers actually are registered to do so. Because of this inconsistency, Art Caplan, an NYU School of Medicine bioethicist, argues that adopting a presumed consent model — what he calls “default donation” — would actually better reflect American society’s views.

Still, some experts, including Fleming, believe that opt-out programs won’t work. He points out that 12 of America’s 58 regional organ recovery systems actually performed better than Spain’s, emphasizing the importance of expanding best practices to lagging groups. He notes that the American legal system, built on the idea of organs being considered “gifts,” makes an opt-out system very difficult. “You can’t give a gift by doing nothing,” he says. His organization and others are working with businesses like Apple’s health app to give people more options to sign up for organ donation than just at the DMV.

Then there are the religious objections. Some believe they must keep their bodies (and organs) intact to enter the afterlife. Bob Marley, for example, reportedly refused to have his toe amputated (to stop his spreading cancer) owing to his Rastafarian beliefs. Another less common but intriguing objection comes from poor people who might refuse to become organ donors as a form of class protest. “There is a backlash among poorer people who think the organs just go to the rich,” Caplan says. “And they are partly right.” 

But pettiness shouldn’t dictate medical practice, no matter how warranted their frustration is at a health insurance system that leaves many uncovered. And as far as belief goes, the U.S. government already prohibits parents from refusing their children medical care due to religious reasons. And the benefits to public health are self-evident in the case of organ donation. 

As of now, the U.S. is sixth in donors per million, according to the International Registry in Organ Donation and Transplantation. This isn’t bad, but it leaves a lot on the cutting-room floor. And because organ transplants are mostly handled at the state level, a patient in New York might face a much bleaker reality than, say, someone in the Midwest, where donor rates are highest.

In New York, it has gotten so bad that federal regulators are threatening to let the certification lapse for New York’s organ procurement operation, LiveOnNY. This would be the first time in history such drastic measures have been taken. The rest of the nation is watching, and for those who are sick or desperately need help, time is of the essence.

What do you think? Should the U.S. require that residents donate their organs? Is a default donation system the way to go, or should Uncle Sam keep his hands off your kidneys? Let us know via email or in the comments below.

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