An Evaluation on The Role of Legislative and Non-legislative Factors in Opt-Out Organ Donation in the United States

Presumed consent, also referred to as opt-out, organ donation systems became prominent across European countries in the late 1900s. In this system, citizens are born as organ donors; if desired, they may opt-out of donation. Existing research shows that successful implementation, one that increases organ donation rates, is dependent on legislation in combination with a complex variety of societal, cultural, and structural factors—including family authorization, public education and understanding, public trust, and medical infrastructure—which this paper refers to as non-legislative factors. This paper considers how such an opt-out policy would function in the United States and the extent to which it could improve living and deceased donor rates. This paper also highlights challenges unique to the U.S. from Europe, including a decentralized healthcare system and regional differences by state, further considering different subdivisions of opt-out systems. This paper includes international donation data, behavioral science studies, and cross-country comparisons to determine the ultimate impact of presumed consent systems in practice and what patterns emerge across countries. This paper aims to evaluate if an opt-out organ donation system would be effective if implemented into the U.S. Being able to understand how an opt-out system would impact the U.S. could significantly advance the field of transplant medicine by changing policies that could vastly improve or save lives.