Status quo bias and presumed consent for organ donation

Yesterday the UK organ donation taskforce released its report on a
presumed consent (opt-out) system for organ donation. To the
consternation of the chief medical officer and the Prime Minister the
taskforce advised against the introduction into the UK of such a system.

In an editorial in today’s Guardian, it was observed that both the low
rates of consent in the UK – and the taskforce’s response to the
question of presumed consent may represent an irrational preference for
the default position. They may both be examples of the status quo bias.

The status quo bias represents a serious and widespread cognitive bias in decision-making. It may be relevant to a range of different ethical and public policy issues (see here, and here for example). One reason for thinking that it may apply to organ donation consent is that a quarter to a third of people opt in to donate their organs when the default position is not to donate. And a similar proportion opt out of donating when the default position is to donate.

The taskforce raised questions about whether presumed consent on its own could improve donation rates, and had concerns that the introduction of presumed consent might lead to a paradoxical fall in the overall supply of organs – due to public mistrust in doctors.

But (drawing on Nick Bostrom and Toby Ord’s Reversal Test), now let us imagine that the UK already had in place an opt-out system for organ donation consent. Is it likely that moving to an opt-in system would increase donation rates?

It is possible that a presumed consent system would lead to a fall in organ supply. The taskforce cites the example of Brazil, where a presumed consent law was introduced in 1997 but repealed in 1998 due to widespread public anxiety and mistrust. On the other hand presumed consent has been introduced into many other countries including Spain, France, Italy, the Netherlands, Denmark, Israel. Before and after studies show an increase in donation of up to 25%. The taskforce rightly points out that other measures were introduced simultaneously, so it is not clear that this increase was due to presumed consent – at least not on its own. But there is more evidence that donation rates increase with the introduction of opt-out organ donation than evidence that they would fall.

Presumed consent on its own would not be the answer to the organ shortfall. But it is by no means clear that changes to transplantation infrastructure (the taskforce’s recommendation) are either. If we are to meet the needs of the 1000 UK patients who died on waiting lists for organs each year (and the many more who remain ill on waiting lists for a prolonged period) we will have to reject our preference for the status quo and consider novel, even radical solutions.

Links
The potential impact of an opt out system for organ donation in the UK: an independent report from the Organ Donation Taskforce

Chief Medical officer condemns organ donation decision Observer 16/11/08

Organ donation: Brown says presumed consent still an option Guardian 17/11/08

A lethal shortfall Guardian 18/11/08

Status quo bias in practical ethics
Animal experimentation 17/11/08
Unpopular policies and public rationality 07/08

The Status Quo Bias and the reversal Test – Bostrom and Ord